Uvalde Memorial Hospital Strategizes SRHT Implementation

June 2018
National Rural Health Resource Center (The Center)

Uvalde Memorial Hospital (UMH) is a 25-bed county-owned not-for-profit Critical Access Hospital (CAH), providing acute care, emergency medicine, swing bed, rehabilitation therapies, imaging, lab, surgical services, wound care, hospice and primary and specialty care to the residents of Uvalde, Texas and surrounding communities. With a vision “To be the provider of choice to the people [they] serve with the best staff, the best care and the healthiest community,” the hospital serves a population draw of nearly 50,000 residents.

Matt Mendez and Lindsay Corcoran, consultants with Stroudwater Associates, worked with UMH in 2017 through the Small Rural Hospital Transition (SRHT) project on a Financial and Operational Assessment (FOA). Center staff spoke with Thomas J. Nordwick, CEO, at six and twelve-months post project to discuss the implementation and outcomes of the consultant recommendations.

Q: Tell us about the implementation of this project and what kinds of things you found to be successful.

A: First, our team incorporated the ten action items recommended in our 2017 strategic plan. Next, we adapted these into a Studer management tool and created a pillar called ‘Stroudwater.’ Each action item was then assigned to various team members and 90-day action plan items were created. The teams modified time frame goals to coincide with the strategic plan to stay focused on the implementation of the plans.

For example, one goal was to increase swing bed usage. The utilization review team reviewed all criteria for swing beds and implemented screening tools. They developed marketing materials for doctors’ offices and will be working on education of providers about keeping nursing home patients in the hospital rather than discharging them immediately. While it has been a challenge to change provider mindset, the team continues to address this as they recognize an opportunity to market to San Antonio providers to send referred patients back to swing beds.

A second focus was to evaluate the addition of a cardiac rehabilitation program. I met with a cardiology group to assess the need and whether the group would refer to a local program. Everything is now in place to initiate the program and we are building out new space, which could accommodate the needs for this new service.

UMH is committed to maintaining our hospice program and is finding ways to impact the viability. The team has revamped staffing, mileage, square footage of the building, and other overhead for the program. One consideration is making hospice a 501c (3) for further benefits, and we fully believe it to be an essential service to the community.

To impact population health, UMH is beginning by utilizing available claims data to establish strategies for improving the health of the insured employed population. The hospital continues to focus on wellness programs and setting goals within the employee population and target improvements based on the data. We incentivize staff to join the in-house wellness program through benefits like decreasing the employee’s insurance premium. We are considering specifically addressing either diabetes or COPD in the future.

UMH came in under budget for contract nursing by optimizing staff efficiency. The team achieved this by implementing a staffing tool and utilizing students from the local college to supplement.

Q: What are the ways this project has impacted your hospital culture?

A: The non-measurable outcomes include:

  • Looking “outside of the box for solutions”
  • Analytics confirmed things hospital leadership knew and reinforced findings to the board
  • Helped better define outcomes that could be used in the strategic plan

Q: What progress did UMH make on measurable outcomes?

A: UMH met or made progress on the goals set!

  • Days cash on hand increased by more than 10 days
  • HCAHPS score for “rate the hospital” increased from 77.2% to 83.6%
  • Net patient revenue increased by 3%
  • Operating margin increased by 2.6%