Critical Access Hospitals


Kristen Fischer, DOTmed News | July 28, 2011
From the July 2011 issue of HealthCare Business News magazine

Additional services may not be huge money-makers, but they help to ensure that residents choose RiverView for their medical care and don’t have to travel far for critical services. Once the public gets involved and sees the hospital as an integral part of the community, it’s more likely to pitch in and advocate for the facility. The community may not be able to do much about what’s going on in Washington, but the donor dollars can offset reimbursement cuts and make a difference.

At Rankin County Hospital in western Texas, the clinic has been integral to bringing in more people and providing much-needed services. The facility does not get a lot of admissions annually, so having outpatient services offered via an on-site keeps residents coming to the clinic for minor care and using hospital resources. While Rankin does not rely on donors as much as RiverView, the clinic has proved an effective financial model to boost income and better counterbalance cuts, enabling more cash flow into the system.

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Getting creative with staffing
Rankin County Hospital has gotten resourceful with staffing to accommodate its patient flow while still being able to provide sufficient care. Wayne Ogburn, the hospital’s administrator and CEO, says reorganizing the personnel has helped keep costs manageable, since salaries make up a huge chunk of hospital expenses.

“We are doing something that I’ve never seen done before,” he says.

Part of the solution includes paying employees the IRS rate to commute to and from work within a 65-mile radius. Many staff members also work longer shifts so they do not need to commute as often. Employees with only short breaks between their scheduled shifts can also sleep in converted dorm rooms at the hospital to cut down on commuting costs, but must provide their own food.

“We’ve done some creative things like that,” says Ogburn, explaining that the facility does not pay above market rate.

The 15-bed hospital is small but needs to have vital services, for example, two people run both the laboratory and X-ray department. There are two physicians on staff that also service the adjoining clinic and are paid hourly with on-call responsibilities. Flexible staffing has been imperative to ensure that the hospital has coverage for patients, as sporadic as their visits may be.

Ogburn says the next challenge for his hospital is trying to obtain accreditation as a swing bed facility, which means the hospital could use its beds to provide either acute or skilled nursing care. Medicare Part A would cover the post-hospital extended care services provided in this type of designated facility. In addition, Rankin County Hospital is trying to establish a telepsychiatry service in the clinic so local patients can get medical care with mental health professionals across the country using video technology, Ogburn adds.

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