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Hospital pulls plug on cardiac rehabilitation

Lack of physicians to monitor patients leads to closure

— Citing physicians’ scheduling conflicts, Three Rivers Hospital commissioners have decided to shut down the cardiopulmonary rehabilitation program effective May 22.

“The physicians have come to the conclusion they do not have enough time to supervise the program because of their own practices,” board Chairwoman Vicki Orford said. “This program needs to be stable, sustainable, and in the best interest of the patient and it is not at this time.”

The fate of the cardiac rehab program has been in question since September. During budget discussions, hospital officials said the program operated at a loss of about $86,000 last year.

The primary impetus behind the closure, however, is a new federal mandate requiring such programs in critical access hospitals to be constantly supervised by a physician. Without anyone to supervise, the hospital would be out of compliance with the law.

In December, commissioners decided to keep cardiac rehab open two days per week when hospital employees objected to closing it and some physicians offered to supervise in order to keep the program running.

But with a dwindling number of physicians left in the area, finding someone to supervise cardiac rehab patients has been getting increasingly difficult over the past several months, Executive Director of Patient Care Gretchen Aguilar said at Monday’s board meeting.

“It’s the inconsistency,” she said, noting the hospital has also changed hours to accommodate providers. “We’ve had to juggle patients around and they’re not really happy.”

She noted that Dr. Gordon Tagge has been the primary supervisor recently, but has been struggling to find the time.

“As of May 1, I’m back to searching all over again … I don’t have anybody,” she said.

Currently, classes take place for a few hours on Wednesdays and Fridays at the hospital, 507 Hospital Way. Aguilar said nine people were on the program’s wait list, but that number has also been declining.

“It appears to me … that we can’t make this a sustainable program at this time,”

Commissioner Cherryl Thomas said. “At this point, it just doesn’t make sense to keep it going, in my opinion.”

Commissioner Jerry Tretwold, who argued in favor of the program last year as well, was the lone vote against closing it.

“I think that we’re going through some real struggles here and we just had a huge fight with the community about (obstetrics),” he said. “Let’s see if there’s a way to save this. I don’t think it would be right to make a decision now to just close it.”

“We don’t have enough physicians or enough patients right now to either supervise what patients we have or make cardiac rehab profitable,” outgoing CEO O.E. “Bud” Hufnagel said.

J. Scott Graham, the hospital’s transition adviser who is expected to take over as CEO this month, said he also doesn’t think the program is currently sustainable.

“I oversaw a cardiac rehab service line for many years when I worked at St. Luke’s” Rehabilitation Institute in Spokane, he said. “You need a significant patient count, and physicians within the proximity to meet Medicare laws.

“I just don’t think the configurations we have here and the constraints we have here” would allow the program to meet its own cost, he said. “It’s just a reality the cardiac rehab programs don’t make money anywhere. Hospitals that are well-off financially offer it because they can cover the losses.”

With the hospital still indebted to Okanogan County for about $2 million in warrants, Graham suggested focusing on services that do generate revenue.

“I think we all realize that it’s not going to be a big moneymaker,” Commissioner Michael Pruett said after moving to close the program. “We need to be able to step up to the plate and shelve the program at this time.”

The decision may not mean a permanent end to cardiac rehab services in Brewster.

“We’ve been kicking it around for a while, trying to figure out a way to save it,” Orford said. “I personally feel our reputation’s on the line at this point, that we’re not offering quality service that’s best for the patient. I would go to close it and open it again when we get some more physicians available to start the program again. I think it’s well-received, but we just can’t do it.”

Meanwhile, Orford said she’s been working with Dr. James Wallace on suggestions to boost obstetrics services. Despite labor and delivery being one of the hospital’s busiest departments, it also doesn’t generate enough revenue to meet costs, in large part due to low Medicaid reimbursements.

Orford said the overall focus of obstetrics will be on women’s health, not just delivering babies.

“Swedish and Deaconess (hospitals) both see us as an outstanding rural hospital for maternity care, and at the same time our community needs more,” she said of the Seattle and Spokane facilities, respectively.

Some of Wallace’s recommendations include routine well-baby weight checks, breast-feeding support, a doula program, childbirth classes, postpartum home visits, collaborating with Room One in Twisp for Methow patients, and mental health services.

“He also believes that midwives play an important role and could be very helpful in promoting women’s health,” Orford said. Three Rivers already has a working relationship with one Twisp-based midwife, Blue Bradley of Methow Midwifery and Women’s Health.

The board decided to table the discussion until its next meeting, scheduled for 4 p.m. May 12 at the Hillcrest Administration Building, 415 Hospital Way.

In other business, hospital commissioners hired Merritt Hawkins and Associates to help recruit new physicians.

Hufnagel recommended Three Rivers begin with trying to recruit two or three general practice physicians with experience in obstetrics.

“We know it’s going to be inordinately difficult to recruit family practice with OB, but I think we need to get into it first to figure out what’s in the market and what’s available,” he said.

If that effort fails, he said the hospital should focus on hiring two family medicine providers and one obstetrician-gynecologist.

The cost to recruit new physicians can fall between $25,000 and $30,000, Hufnagel said, but the quicker the firm finds new hires, the less expensive it will be.

“The amount of revenue that’s ultimately associated with each one of those physicians is substantially more than that,” he said.

Tretwold expressed concern that it would give the firm incentive to drag its feet. Hufnagel said that in his previous experience with the recruiters, they didn’t drag their feet but the search itself wasn’t successful.

Chief Financial Officer Jennifer Munson reported a net income of nearly $220,000 in March, which Hufnagel said has contributed to “an $879,000 turnaround over the past year.”

“Year to date, this was the best first quarter we’ve had for five years,” he said.

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