Hospital board reviews efforts to bring more services close to home
North Big Horn Hospital board trustees continued to discuss making more services available through the district at its regular board meeting held on Tuesday, Sept. 17, and at a special meeting held on September 24.
To that end, the board approved the purchase of a $62,000 DEXA scanner that will be purchased, in part, with proceeds from a $41,800 donation to the district from the Caryl Turner Memorial through the North Big Horn Hospital Foundation. The hospital district will pay the balance.
A DEXA scan (bone density test) is a method of checking bone health. It’s like a regular X-ray but measures the strength and mineral content of bones instead of just taking images of them. Providers use DEXA scans to screen for osteoporosis, osteopenia and other conditions that can silently weaken bones.
The scanner can also be used for body fat composition testing and is often more accurate than other methods. Kathy Walker, in her capacity as the new service line development coordinator, relayed a story where a patient who worked out extensively in the gym continued to show a high body fat ratio when tested using other methods. When tested using the DEXA equipment, it was discovered that his body fat was quite low.
Currently, the hospital does not offer this service, which requires patients to travel outside the district for testing. A recent pro forma study conducted by the hospital revealed that it is feasible to offer this service at the hospital from a financial standpoint and would make the testing convenient for patients.
The board also discussed a scheduled first visit of the mobile MRI unit. CEO Eric Connell commented that many rural hospitals are taking advantage of this opportunity to provide these services through a mobile unit, which is a very cost-effective alternative to purchasing the equipment, since the equipment is quite expensive to purchase and maintain. The unit did visit the hospital later in the week and will offer mobile based services every two weeks.
Women’s health
Expanding women’s health services was once again a topic of discussion. On Sept. 17, Connell presented some preliminary information regarding the feasibility of adding additional services specific to women’s health care needs. He noted that the hospital will not be delivering babies on site, as there would not be enough demand due to limited population size to support the staffing required (three or more specialized providers on call 24/7). However, a preliminary look at the feasibility of adding prenatal and gynecological services did look hopeful, and having those services available to women in the community would be a tremendous convenience for patients, Connell said.
Preliminary numbers based on a population of around 6,000 patients from Lovell and adjacent communities showed promise regarding the feasibility to provide both inpatient and outpatient services.
Regarding outpatient procedures, the potential exists for as many as 66 to 100 procedures per year to be performed on site, Connell said. An estimated 76 to114 inpatient procedures could realistically be performed on site per year, as well.
CFO Darcy Robertson presented the results of an extensive pro forma study at a special board meeting held on Tuesday night, Sept. 24, confirming the feasibility of providing these specialized services from a financial standpoint. The board voted at that meeting to authorize Connell to recruit a women’s health care provider to expand women’s health care services in the near future.
Connell is already in discussions with an OB/GYN provider who is very interested in joining the staff. The provider is currently providing these services in another state and is very experienced in performing all procedures and services that are under consideration.
An offer to enter a special management arrangement with Peaks Healthcare, a company that operates three nursing facilities in Wyoming, was also discussed at the special meeting. The proposal is for NBHH to enter an UPL (upper payment limit) agreement with Peaks Healthcare like an arrangement the district has had with Rocky Mountain Healthcare in Evanston since 2018.
Attorney Blain Benard explained how the UPL program shores up a “gap” between lower payments made by Medicaid and higher payments made by Medicare to nursing homes, allowing the nursing homes to receive the higher amount of payment.
Connell noted that, through its participation, NBHH not only helps the other facility become more sustainable but also receives a financial incentive for its help. The trustees authorized Connell, with the help of attorney Bernard, to negotiate and authorize the agreement with Peaks Healthcare. He noted that “the spirit of the agreement” is to help all of the facilities participating in the special state approved program.
In other matters, the clinic saw 1,262 patient visits in August, exceeding its target of 1,100 visits per month. A total of 42 patients are now enrolled in chronic care management. Visiting nurses performed 298 visits during the month, which is about 70 visits more than they typically see in an average month.
According to a hospital census report for the month of August submitted to the board by Director of Nursing Michael Henley, the hospital admitted 14 patients for observation, 20 inpatients and four swing bed patients. Two of the swing bed patients were referrals from Billings Clinic. The hospital saw one COVID-positive admission during the month.
Connell noted in his CEO report that staff surgeon Dr. Michael Hill performed two appendectomies during the week that were the result of emergency room visits. He said the operating room has completed 61 robotic assisted surgeries (an average of 7.6 cases per month) in its first eight months of offering the surgeries. He said that is 16 more surgeries than the previous full year, prior to the robotics program.
“We are currently on pace to complete around 91 cases in the first full year, close to the ‘best case’ projection of 93 cases,” Connell said.
The hospital foundation reported raising $7,000 at the Friends of the Foundation Golf Tournament. The funds will be used to update the hospice and patient rooms in the hospital.