We ended 2012 on a positive note! Our quality and patient satisfaction scores continue to improve and we were able to break even financially for the first time in two years. I am most proud of our staff and their work to improve quality scores because the care we give to our community is the most important activity for all of us. Ridgecrest Regional Hospital (RRH) continues to meet and exceed national patient safety standards in many areas. Our medical staff and 570 employees deserve congratulations!
After completing ground work in 2012 to bring RRH to a financially stable position, our focus in 2013 is building a stronger and trusting relationship with the people we serve. This Community Update is the first step, and each month a manager within a division at RRH will provide an update covering changes and major developments, as well as key issues & challenges. We also encourage two-way communication between you and our hospital to discuss any questions or concerns. Our goal is to let you know what’s going on so that you may make choices based on facts.
Critical Access Hospital Status, Why?
When the new $72,000,000 patient care tower was constructed in 2010 RRH incurred expenses (depreciation and interest) of over $7,000,000 per year. The mortgage on the new tower is $68,000,000 paid over the next 25 years. In order to fulfill mortgage payments, we were compelled to introduce new programs and make changes to our reimbursement plans. One of those positive changes was gaining Critical Access Hospital (CAH) status, allowing increases in Medicare reimbursements of $5,500,000 per year. Without this contribution RRH would not have been able to make mortgage payments on the tower, which would have led to cutting services and jobs. CAH status has protected RRH from many of the negative effects of the financial impact of healthcare reform. In addition to gaining CAH status, RRH also is in the process of gaining Trauma Level IV designation for our Emergency Department.
Because of the way the CAH regulations are written, we must not exceed 25 inpatient beds; but that doesn’t mean we are limited to 25 patients in total. To allow us to serve more than 25 patients at a time, RRH added 10 “observation beds” and introduced a skilled rehabilitation unit with another 26 beds. I want to stress that this scenario is not specific to RRH. Nationally, hospital inpatient census continues to fall as Medicare and insurance companies are restricting services and procedures qualified as “inpatient services.” Under healthcare reform we expect inpatient census to continue to drop another 10 to 20%.
ER Transfers. When & Why?
The other trend occurring with declining hospital admissions is the need for increased emergency room transfers. In many cases, this is required by county emergency medical services (EMS) protocols. If transfer is imminent, we do everything in our power to diagnose and stabilize the patient’s condition first, then get them to the most appropriate hospital for advanced services. With this process there has been much improvement in stroke and cardiac care. Keeping patient’s safety and interest in mind, RRH may choose not to perform high level procedures that are best performed in a larger hospital with more resources. RRH expects its medical staff to only perform procedures best suited to the patient’s health and well-being rather than finances. In order to provide the most appropriate care for the patients and avoid conflict of interest, RRH employs an outside physician group that works closely with our local physicians to determine which level of care is most appropriate for our patients.
The graph below shows reasons why we transfer patients:
Since the 1970’s, this community has seen a decline in the number of local physicians. Several remaining physicians can no longer accept Medicare, Medi-cal and some low-paying insurances. We also have an aging physician population that we must plan for to ensure that our community always has the physicians and the care it needs. Losing our local physicians prompted specialists from the Lancaster Palmdale region to tap into our community, remain available only 1 – 2 days a week, and then require patients to travel to Lancaster Palmdale for their procedures including pre and post ongoing care.
Responding to the lack of specialist care in our community and considering that we were losing $2,000,000-$3,000,000 annually to surrounding regions rather than investing in our local economy, RRH implemented a physician recruitment program to bring specialists in these needed areas to our community who operate independently AND perform procedures in our community.
RRH uses an external, unbiased firm to determine how many physicians our community needs, and we recruit to that plan taking into account which physicians accept all patients.
During the last couple of years, RRH has recruited specialists in the following areas:
• Gastroenterology (GI)
RRH expanded services and care for the women in our community by introducing Women’s Health Specialists division, comprised of OB/GYN’s, certified nurses and registered counselors. RRH also offers child birth classes, breast feeding classes as well as lactation counseling. In 2012, 481 babies including 8 set of twins were delivered at RRH. Our breastfeeding rates went up to 87%, and we are now #1 in Kern county and 14th in the state of California in terms of breastfeeding rates.
In 2013, RRH will add 2 more OB/GYN’s to this team due to overwhelming response.
Future of Healthcare:
This decade will be one of incredible changes in the healthcare system as we move from a treating only the sick model to one of helping people prevent as well as treat disease/injury. I am pleased with the steps we have taken to be able to adapt to this new model. All hospitals in California are going through these growing pains and it is critical that we do the same to remain locally controlled and be able to focus our resources on improving the healthcare in our community. The financial pressures will not be minimized in the foreseeable future, but RRH is taking steps to ensure our presence in the community continues and thrives.
We welcome your support by choosing us for your health care needs. From surgery, lab and rehab to imaging, specialist care, to in/out-patient surgery, RRH offers a full range of advanced services and technology supported by a dedicated team of physicians and highly experienced clinical staff. We want your experience with Ridgecrest Regional Hospital to be a positive one.
I welcome the opportunity to meet with anyone that has questions on the information I have provided. Please contact me at 760-499-3901.
Ridgecrest Regional Hospital