NRMC board receives diagnostic imaging update

Nevada Daily Mail

On Tuesday, diagnostic imaging director Todd Fine updated the Nevada Regional Medical Center board on projects under development and completed by his department over the past 18 months including new mammography technology.

Fine said, "Huge projects [have been completed] in the last 18 months" and, "now we can finally breath."

Mammography services have been upgraded to include three-dimensional tomosynthesis technology. This new technology takes 25 pictures in one sweep and only requires a single and gentler compression of the breast. The system has received FDA approval and is online. In 2015, NRMC performed 1,257 mammograms using the old system.

A new computerized tomography, or CT scanner, has been placed into service. The old system was eight years old and at the end of its useful life. The new system was installed in February and is capable of capturing 64 images or slices at once leading to higher resolution images. The highest volume user of the CT scanner is the emergency department.

As previously reported, the nuclear medicine contractor dissolved and NRMC decided to move the operation in-house. Hospital based operations fall under different regulations than contracted providers even though the equipment and service remained the same. After three months of nuclear medicine being unavailable, service resumed in March. The equipment purchased from the previous contractor had not received maintenance over the past eight years. According to Fine, the new maintenance contractor has done a good job and there has been a 20 percent increase in utilization.

Fine explained that the pictures archiving and communication system, or PACS, is in service after suffering a catastrophic failure in 2015 with only one component of the new system left to be installed, real time dosage tracking.

Board member Brad Copeland asked Fine what caused the PACS to crash. Fine said that NRMC did not know about the controller failure (crash) in the primary virtual machine until contacted by Agfa Healthcare, or AGFA. AGFA brought in Hewlett-Packard service techs to change the controller. After the primary virtual machine controller was changed, AGFA asked HP to update the firmware. Something with the update caused the new controller to fail, and subsequently the secondary controller to fail rendering the system unusable. The system crashed around 10 p.m. on a Thursday and the new system was operational by the next Monday. All data was lost between the April 15, 2015, launch of the PACS system and the system failure in December.

Fine asked AGFA and HP to bring up the old system and try to recover the data. All of the exams, images, and reports were recovered with the exception of two weeks of images taken in September. NRMC is only paying the cost of the old system until the new real-time dosage tracking ability comes online.

In explaining the differences between an x-ray and magnetic resonance imaging, or MRI, Fine said, "If x-ray is a science teacher, MRI is an astrophysicist."

NRMC has not previously offered MRI services at night or on the weekend. However, MRIs will soon be available during a four-hour period on Saturday and Sunday per request of the Freeman hospitalists.

The previous hospitalist, Dr. Crymes, has accepted a position elsewhere, so NRMC has been working with Freeman to fill hospitalist shifts and will have to use temps until late July when one of the new doctors starts full-time.

According to long-term care director Steve Branstetter, LTC was approved by the Centers for Medicare and Medicaid Services for a rate increase in May, which is retroactive to January.

LTC census was low through March until the middle of April, however admissions from the Kansas City metro area have increased. Branstetter said, "Census is back where it needs to be."

Work is still being done on the lab and x-ray computer interface with LTC.

LTC is sending three people to a monthly University of Missouri leadership group this fall. Their focus is to reduce employee turnover.

Repairs to the Moore-Few roof should be completed with the next few weeks and the plumbing projects have been completed. NRMC chief executive officer Kevin Leeper said that trusses for the clinic roof in Rich Hill are due to be delivered next week.

Moore-Few did not meet budget expectations for March and is currently at a $49,000 loss for the year. There were 13 open beds that LTC had budgeted to be full. This contributed to the income short fall.

In opening the NRMC board meeting, Leeper said their, "environment is improving every quarter."

The board discussed the growing need for mental healthcare. Board chair Steve Russ noted that prescription drug abuse is the fastest growing trend in the U.S. Holly Bush, quality control officer, stated that Missouri is the only state without prescription tracking.

"We're getting better scores in patient surveys," Leeper said during his administrators report. He also noted that while the patients are pleased with the service they receive, they are still not recommending NRMC to others.

Bob Beaver said, "We don't have the public image we need."

Holly Bush noted that the, "door to physician average [time] is 23-24 minutes -- that's extremely fast."

Leeper discussed moving behavorial health unit outpatient services off site. He further explained it's a benefit to the community but said, "in-house service hasn't evolved because we don't have the [doctors]."

In discussing NRMC's financial standing, Chief Financial Officer Mike Harbor asked, "how long has it been since we have been able to say we have a year to date profit? We do now."

In early April, NRMC received a net $1.1 million dollar Medicaid Disproportionate Share Hospital payment for FY13. This moves NRMC's budget from a deficit to a profit of $164,000 dollars for the year despite the third quarter's low patient volume and provider [doctor] issues.

Board member Larry Bledsoe said that, "if our volumes were normal, we would be good"

Harbor noted that BHU in-patient admissions are down 50 percent from this time last year but clinic visits are at record levels.

The board voted to approve continuation of the bio-med service contract. The May and Junes meetings were moved up by one week.