TONASKET — Three Rivers Hospital (TRH) board chairman Mike Pruitt attended Thursday’s meeting of North Valley Hospital (NVH) Board of Commissioners, describing the collaboration between the two hospitals as an “innovative idea.”

“It’s where communities of rural health are destined to be,” said Pruitt. “I applaud us for taking the first step and giving it the college try. We’ve laid out a good foundation and I think communities will appreciate what we are doing in taking this step.”

“Collaboration is an innovative new concept. We did an assessment with both hospitals asking is it working? Should we continue on?” said NVH and TRH CEO Scott Graham, adding they would discuss it further in executive session, as it involved assessment of the CEO. “We’ve sprouted a sprout and done something really important, but we are in the beginning stages.”

Collaboration goals

Graham said the collaboration needs to lead somewhere, and he was working towards consolidation and moving towards integration. Graham laid out the following timeline for goals he hoped to see:

2019 creating pathways to share staff

2020 10 percent shared resources

2021 One EMR/IT across regions in hospitals

2022 centralize revenue cycle

2023 50 percent shared resources

2024 create new corporation

2025 centralize all operational functions

2026 complete interoperability

“This is us taking the leadership role to decrease inefficiencies and increase quality,” said Graham. “We are doing it in rural America, and if it is successful, it could be a role model for others.”

Graham said the idea of collaboration as opposed to competition was “kind of unique to this area. In urban areas they are more competitive, but rural areas seem to understand the need for cooperation.”

Obstetrics discussed

Graham reported meeting with Dr. Peter Rutherford to discuss NVH providing an obstetrics doctor for the call pool.

“If Dr. (Paul)Lacey and Dr. (Elizabeth) Stuhmiller would accept that, obstetrics/gynecology would also be able to do surgical procedures,” said Graham. “Dr. Rutherford was skeptical the numbers don’t bear out. I explained there’s an expectation from the community of us to try this, and he said he would talk to Stuhmiller and Lacey.”

Graham said Dr. Stuart Freed, chief medical officer from Confluence Health, called back on Rutherford’s behalf and met with the commissioners.

“Dr Freed did a nice job listening to our perspective that the community expects this of us. What I heard him say is, we just don’t have enough births in this area to have a practitioner to keep their skills and keep them safe. They have to do at least six c-sections a year.”

Graham said Freed suggested a full-time obstetrician could be brought in “if we were willing to pay for them to go to Confluence several times a year for two-week stays.”

“He didn’t think it was a money issue, just that new residents coming out of general  need higher numbers to keep their skills up,” said Graham. “With some prodding, he offered they will try to bring specialists back into this community to show they are not closing us down. If we have births going to Mid Valley, he suggested bringing other specialists up here. He said they were fat on certain specialties and could stand to give some up.”

“But he would have to convince them to come up here,” said board chairwoman Jean Pfeiffer. “Also, suggest with primary care they could do more referrals to us than Mid Valley.”

“The dilemma is, if we recruit and Stuhmiller and Lacey aren’t willing to accept the OB provider we bring on, could we afford and recruit three OB providers at a cost of about three-quarters of a million dollars per year, per provider.”

Graham said standards have changed for delivering babies, and doctors now have to be board certified.

“They have to be c-section certified to do one, maybe 15 c-sections here per year. So they can’t keep their newly minted skills up,” said Graham. If we could find a way to give them that, but we can’t shoulder the burden of hiring three OBs”

“Omak is just a few years away from being in the same boat,” said Commissioner Adam Tibbs. “Their birth numbers are down, and they have aging ob/gyns there getting ready to retire.”

In other business, commissioners:

Learned Graham met with legislators in Olympia, where he advocated for more flexibility in overtime and on-call legislation.

“I also advocated for more dollars to be directed to behavioral health. We have a crisis here in Okanogan County and across the state,” said Graham. “There is a four-billion deficit in the budget, and we asked that they not take it out of healthcare or behavioral health.”

Learned a general surgeon candidate toured the hospital facilities.

“We extended an offer to her,” COO John McReynolds said. “We are hopeful she will select NVH and TRH, but she has several more interviews.”

McReynolds said NVH has been working with Veterans Service Officer Eric Fritts to implement a better process for billing the VA for veteran ED visits.

“It is often confusing for patients and hospital employees what the VA will pay for, and the form Eric developed will allow more clarity and a timelier notification to the VSO,” reported McReynolds.

Heard a financial update from CFO Alan Ulrich.

Ulrich reported working with Health Information Management Manager Payge Fries to initiate a consulting program for regional hospitals.

Ulrich said he was working with the state auditor to complete the review of fiscal 2016 and 2017 activity, with a closing conference on Feb. 27. Ulrich said he expected a presentation by Dingus, Zarecor & Associates PLLC (DZA) to the board in April on cost reports done on the Long Term Care facility and the hospital.

Ulrich said DZA assisted him in contesting the state’s new Medicaid reimbursement rates, and was able to get higher rates effective as of Jan. 1, 2019. 

Ulrich said private pay patients doubled in 2018, contributing “tremendously to Long Term Care loss.”

“Since July into February, we have seen an increase in swing bed admittance, so that has increased revenue and helps mitigate losses from the summer,” said Ulrich.

Rhonda Piner reported swing bed patient and inpatient average census 33 percent above target for the month of February. Piner reported January had a 58 percent variance above budgeted census days.

Heard commissioner reports.

Commissioner Adam Tibbs said the new building committee had their first meeting and worked on identifying concerns.

“The laboratory needing more room, the sewer pit and the boiler were the three main topics we talked about,” said Tibbs.

Commissioner Jerry Bradley said the long-range focus committee was in the beginning stages of possibly creating a community advisory board from committee members.

Commissioner Herb Wandler reported Dr. Douglas Wilson will be leaving at the end of August for a new assignment in Wenatchee.

Commissioner Dick Larson said he was sorry to see Dr. Wilson go.

Board chairwoman Jean Pfeifer said the finance committee met with Ulrich, who “walked us through the financial picture.” Pfeiffer said they were pleased they could now review monthly bills on one page rather than go through a stack of bills individually.

Pfeifer also reported being proud of hospital staff after hearing of a situation in the ER a couple weeks ago where a team of nurses worked together in assessing a cardiology patient and getting them transferred within 90 minutes.

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