The Times - Serving Waitsburg, Dayton and the Touchet Valley

DAYTON – Directors of the Columbia County Health System are wrestling with a tough decision: What will the community need from its hospital in the next five to 10 years?

"With legislative changes to Medicare and Medicaid reimbursements and the rapid technology changes going on, this is hard to figure out," CCHS Chief Operations Officer Shane McGuire said. "There is so much going on in healthcare right now, I feel bad for the board coming in once a month and trying to keep up with everything going on so they can make decisions."

One year ago this spring, faced with the loss of depreciation reimbursements and nearly $375,000 annually toward operation of Booker Rest Home, the board successfully secured a $5.5 million bond levy to improve Dayton General Hospital with the approval of district voters.

But how best to achieve this "improvement" is now the question before the board of directors. At their April meeting, they agreed that a decision must be made soon. The firm hired to evaluate the hospital's needs and provide recommendations – Stroudwater Associates – has provided the board with a facilities plan. And the board is planning a workshop in the coming weeks, prior to their next meeting on Thursday, May 28.

"I'd really like to see us go out to bid on the project in August or September," board chairman Ted Paterson said.

But the board has not yet received profit and loss statements from each hospital department, Paterson said on Friday. Directors requested the statements at their last meeting so they could better understand which services at DGH are most used and produce most revenue for the district.

But these numbers are hard to pin down, Paterson said, because of insurance reimbursement rates. In addition, several different digital tracking and coding systems are used in various departments – and they don't have the ability to produce comprehensive reports across software platforms.

Recognizing that the community is interested in what Stroudwater Associates have recommended, however, the board released that report to the press on Friday, explaining that the firm relied heavily on historical data related to healthcare in the region as well as more recent district demographics, trends, and service volume numbers together with changes in the makeup of rural, critical-access hospitals across the nation.

"The proposed redesign is very sound in terms of taking this 1965 structure and ensuring that it meets the needs of the community in the near future," Paterson said. Stroudwater's facilities plan does not propose any changes to the footprint of the hospital campus and stays within the $5.5 million budget approved by voters in November, Paterson said.

The redesign does recommend some big changes to the layout of the hospital, Paterson said. The idea is to centralize the hospital's core services: emergency, ancillaries (imaging, lab, pharmacy), outpatient (rehabilitation services such as physical and respiratory therapy), and acute and swing beds.

From the Stroudwater Report:

Courtesy Image

Stroudwater Associates have recommended that CCHS directors remodel the inside of Dayton General Hospital to better serve rural patient care needs.

Improving staff efficiency through a central location of core services (emergency, diagnostics, outpatient, acute care, swing beds) is very important to future sustainability of the hospital and overrides any interest in maintaining the emergency department where is it currently located, regardless of the recent investment in it improvement. The department is both undersized and located in the middle of the facility, away from the emergency entrance.

The recommended facility plan:

Uses existing resources to their highest and best use. New construction is limited to the pool.

Uses the Booker annex for some rehabilitation services with a significant expansion to the physical therapy gym and additional treatment spaces.

Creates new kitchen with improved adjacency to long-term care without blocking the residents' view from the dining room.

Creates new dining room that doubles as a conference center with outside patio seating.

Moves administration into the main facility, improving staff accessibility.