Hospitalist program at NRMC through partnership with Freeman

Nevada Daily Mail

A contract to implement a hospitalist program at Nevada Regional Medical Center will be up for approval at the NRMC Board of Directors meeting on Tuesday.

At NRMC, hospitalists (generally, primary care physicians) will admit patients to the hospital when necessary, especially people who are in the ER who don't have a primary care physician. For patients with regular doctors, the primary physician and hospitalist will work together until patients are admitted. After admission, the hospitalist takes over patient care.

The contract, approved by the NRMC Financial Strength Committee on Tuesday, would provide 24/7 hospitalist coverage with roughly two NRMC physicians and two Freeman Hospital physicians for $841,282 beginning in the fall or winter this year.

The hospitalist fees from services rendered, would be retained by NRMC, which Interim CEO Dave Hample said brings the cost of the program down by $300,000.

"I fully support this proposal and think it will work," board member Brad Copeland said, "but obviously, the degree of success is going to hinge on the individual. I like the fact our local doctors will be involved. We will have some people from out of town. I guess we are at the mercy of Freeman on who they provide, to some degree?"

Hample said if issues arise with any given physician, the hospital would be able to discuss the issues with Freeman and change the situation.

"Both St. Luke's and Freeman are interested in developing long-term relationships with us," Hample said. "I think, moving forward, we need to get rid of the notion we can be an island. Not just with places like Freeman and St. Luke's, but also with Cedar and Bates County hospitals. How can we work together to be more efficient? This does not mean they are going to come in and buy us. That's not the point. The point is, there are ways to do things more efficiently, when you do things together."

Board member Bill Denman asked if the program would involve capitation -- payment of fees determined by the number of patients.

Hample said the program is primarily salary driven. "It's providing one local fee to provide care for the community you're responsible for," he said.

David Yackell, QHR representative, stressed the importance of monitoring the number of inpatients as the program progresses.

"Implementation has been lacking in several programs, over the last few years," Denman said. "This is one thing I don't think we can afford to drop the ball on."

Hample added the contract is flexible enough to end after 90 days, if the program completely fails.

"You have to dig a deep hole to build a tall building," he said. "There's got to be a foundation for good things to happen. I think the hospitalist program will be a good foundation going forward."

Board member Larry Bledsoe said whatever happens, the negotiations have made the doctors more aware than ever of the need to enter patients in the hospital.

In other business, the committee discussed potentially hiring a psychiatrist from North Carolina, to begin in December, an OB/GYN specializing in Cesarian deliveries to begin next August and a radiologist.

In the financial report, chief financial officer Greg Shaw said while the hospital has done well with lowering expenses, Patient Financial Services needs to continue to improve.

"Average daily expenses are down 7 percent, or $7,000 a day, for the last three months," Shaw said. "Expenses, overall, from February to April 2014 are down $800,000 from February to April 2013."

He said the hospital experienced good volume numbers in April, making the month's loss of $185,000 the lowest this year.

The net accounts receivable days, the average number of days it takes to collect the payments due, reached 97.3, however.

"It's due to issues in PFS," Shaw said. "Cerner is helping staff learn the system. For the first time since I've been here, I've heard the PFS manager say we're making progress. Hopefully, we'll see no more increase in AR days in May and improve it in June, July and August. We can be as busy as we are in April, but if we don't collect the cash, it doesn't mean a thing."

He said one problem in the department is 80 to 90 percent of the day is spent getting claims out the door, which leaves no time to do follow-ups on unpaid bills.

"It's just a disaster up there," he said. "It's taken awhile to put the pieces back together. The staff is energized and willing to turn the situation around. They just didn't have the tools to get it done. Cerner's training has been pretty helpful so far. I would expect, by the end, we will be a lot better off than we are right now."

Denman asked when the board would be able to review service lines, breakdowns of individual departments detailing their cost and profitability.

Hample said he didn't trust the data on service lines enough to present them to the board.

"Are there departments out there that are probably getting close to raising an eyebrow?" he said. "I'm sure there are. We need to be careful as we start to evaluate that the data is good data."

In other business, the committee approved bringing a $63,900 contract for a Clinical Bone Densitometer before the board for approval.

"The DEXA bone density unit was taken out of service back in March," Shaw said. "It was 15 years old. Even though this is a little more expensive, there's a warranty and it has less radiation exposure than other models."

The committee also approved a $6,000 contract to Heather Russell as Barone Alzheimer's Care Center medical director, effective July 1.

In the long term care report, administrative officer Steve Branstetter said Barone and Moore-Few made a net profit of $14,979 in April.

"Year-to-date we've made $75,847 compared to last year's $410,140 loss," he said. "Our average census is 104 for both. Accounts receivable days did increase to 56.18, an increase of 1.93 days compared to March."