Russell County Hospital Aligning for Future Success

February 2017
National Rural Health Resource Center (The Center)

Russell County Hospital (RCH), located in Russell Springs, Kentucky, stands by their mission “To provide quality compassionate healthcare consistent with the trust and support of the communities we serve.”  RCH is a 25-bed Critical Access Hospital (CAH) offering cardiac and pulmonary rehab, ICU, swing bed, diagnostic imaging, emergency services, surgical services, sleep lab and wound care.

Eric Shell, Director, and Matt Mendez, Consultant, with Stroudwater Associates, worked with RCH in 2016, through the Small Rural Hospital Transition (SRHT) project, on a Financial Operational Assessment (FOA).  RHI staff spoke with Bill Kindred, Chief Executive Officer (CEO) concerning their progress on this project.

Q: What are some of your hospital's successes regarding implementation of Eric and Matt’s recommendations?   

A: RCH has made significant progress with implementation. One priority is to expand the primary care base and current strategies are the recruitment of additional primary care providers and establishing an after-hours clinic. Operating hours for the after-hours clinic could eventually be expanded to include weekend hours with the potential for 24 hours/7 days a week. This will make it easier for the patient to access care and the hospital to assist patients to connect with primary care providers (PCPs). RCH is working diligently to more closely align with other local providers and to provide lab services at their location. 

Another focus for RCH is expanding the surgery program and this is going very well. The first knee surgery was successfully performed in January and there are plans to pick up more orthopedic cases. Urology cases will begin once that office is better staffed. Overall, volumes are strong-80 to 100 cases a month. RCH was focused on strategic marketing and surgeons have been meeting with PCPs and talk to them about services. There is increased marketing face to face and utilizing handbills and billboards both locally and in nearby towns with no surgery programs. The hospital is beginning to receive referrals from these providers. RCH will next explore the possibility of new procedures with ear/nose/throat and reflux/hernia and they are committed to bringing only procedures which will generate enough volume to ensure staff expertise. A second plan for the future is to build a new surgery center to increase capacity. 

As suggested by the consultants, RCH is promoting their quality scores. They consistently report good scores and are a 4-star hospital so now are focusing on making sure the community is aware of this. The media attends board meetings and quality reports are shared at that time. This is now shared monthly in the local newspaper. There are plans to post more on the website and Facebook. Mr. Kindred presents to chamber and leadership groups and shares generously with them about their scores. 

Concerning the growth of swing bed and inpatient services, there has been a 5% increase in appropriate emergency department (ED) to inpatient patient transfers. The ED is more cognizant that they are the gatekeepers to inpatient admission. The ED and their Rural Health Clinic are working together to start a program where they follow up with patients after an ED visit who don’t have PCP and attempt to initiate scheduling an appointment with them for a PCP. Inpatient admissions have increased from an average daily census (ADC) of 10 in 2016 to 12 in 2017 and hospitalists are taking on more patients with higher acuities. Swing bed has increased from five to seven ADC. RCH is successfully collaborating with larger hospitals to bring hip and knee patients back to their swing bed. The community continues to see RCH as a good place to receive care.

Related to growth of ancillary services, the cardiac care patients been traveling away from the community for diagnostic testing. To grow stress testing, there is now a nurse practitioner (NP) and another physician who can monitor those cases locally. They are currently doing 15 to 20 a month. Upon completion of the NP’s training, it is expected the numbers to increase to perhaps 30-40 month. In middle April, the hospital will begin offering Molecular Breast Imaging which is a very accurate modality to detect abnormalities in dense tissue. The cost for the test is about 25% of the cost of an MRI and used for follow-up to mammograms which are inconclusive. They are currently working to complete the state requirements for this. RCH is creating a women’s diagnostic center inside the hospital that will provide digital mammography, ultrasound, dexa, molecular breast imaging, and stereotactic breast biopsy.  Concerning lab, a phlebotomist is now obtaining specimens in the clinics and test are sent to the hospital to complete; this allows for billing as outpatient service. 

RCH is developing their strategic plan to position the hospital for the future and include the community in that by tying in the results from the community health needs assessment that is currently being completed. Concerning the improvement of revenue cycle management, they will be establishing key performance indicators (KPIs). Currently, gross accounts receivable (AR) days are around 55 and net AR is 46.9. They recognize there are still opportunities for this and will focus on it next. 

There are plans to optimize 340B Program and they recently started a new program on specialty drugs which has huge potential. They hope to increase the collaboration with local pharmacies as they continue to work with local practices. The 340B program is expected to grow as they expand their primary care base. In preparation for population health, they are exploring PCMH and value-based health plan designs and whether this will be the best strategy for them. They are online with MACRA.

Q: What are some of the outcomes from this project and ways it impacted your hospital and community?

A: Non-measurable outcomes include:

  • Perception of a Critical Assess Hospital as being “less than than an acute care hospital” is changing and the hospital is seen by the community as having a broad scope of services that are of high quality
  • Departments realize their efforts in the delivery of patient care are interrelated and interdependent.  This is the foundation to delivering care as a healthcare team. 
  • A contagious attitude of pride and success continues to grow

Q: How do you believe this project has helped you move forward in the newly emerging system of health care delivery and payment?

A: “While wanting to remain an independent hospital, the current healthcare environment demands that at some point we will need to be more closely aligned with other or larger health systems. We are now on track to be a better performer than in the past and this puts us in a better negotiating position, a more attractive partner. We are working from a position of strength. Secondly, we are growing our primary care base which is the key to future success. We are looking more at chronic disease management. Strong PCP base leads to value over volume.”