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By Dian Ver Valen
The Times 

Hospital Moves Forward with Upgrade

CCHS executives will seek architect, plan to use Stroudwater Associate's concepts

 

Dian Ver Valen

Directors are considering making this, the main entrance to Dayton General Hospital, into the Emergency Room entrance and making the ER entrance the main, administrative entrance.

DAYTON – Directors of the Columbia County Health System are moving forward with upgrades to Dayton General Hospital. The board unanimously agreed on Thursday that hospital district executives should secure an architect to draw up plans for the project using the Stroudwater report submitted to the board by an independent consultant firm in April.

"It makes sense given the information we have," Director Lisa Naylor said, and other members of the board agreed.

Financial reports prepared for the board indicated, as expected but not previously documented, that the hospital's imaging, lab and physical therapy departments contributed most significantly to the district's profit in 2014, interim CEO Jon Smiley explained.

The facilities plan created by Stroudwater Associates emphasizes development of these departments. "Community needs for core services, particularly emergency, diagnostic and outpatient services are not forecasted to decline," according to the report.

The board contracted with Stroudwater earlier this year to help determine the community's hospital needs after voters approved a $5.5 million bond levy to improve Dayton General.

Physical Therapy

Board members agreed on the importance of concentrating on urgent care, swapping emergency room and administrative entrances, but insisted on constructing a physical therapy pool despite Stroudwater's recommendation to hold off on that project.

"I think we will have a huge public relations problem if we don't move to the top of the list both increased services for physical therapy and the therapy pool," Director Jim Kime said, explaining that in many of his public appeals for support on last year's successful hospital bond levy he – and other board members – promised these very services.

Smiley, with Chief Operations Officer Shane McGuire, told the board they think a two-person pool with a submerged treadmill, which offers the same physical therapy as a regular PT pool but in a much smaller space, could be constructed for no more than $200,000. This idea was well-received by the directors.

Plans to relocate food service close to Booker Rest Home, however, were criticized. The board agreed with both Smiley and Stroudwater Associates on their recommendation that this relocation, estimated to cost nearly $500,000, be put on the back burner at this time.

"What happens if we go ahead and move food service closer to Booker, and the state drops reimbursement to 16 percent, as they're looking at now, and we end up losing Booker," Director Ted Paterson said. "Then we've relocated food service to a part of the building where it's not needed."

Next Steps

The board has directed Smiley and McGuire to begin the process of finding an architect to turn the Stroudwater recommendations into a remodel design. These plans, once approved by the board, will still have to go through the Department of Health, McGuire said.

"And they don't say it will take 90 days; it takes as long as it takes," he said. He and Smiley predicted the entire planning process could take until mid-October or November.

All of the redesign work, except for the pool, is inside work, however, and shouldn't be hampered much by weather.

"The biggest challenge with this type of work is how to phase it so that services in the hospital can continue without interruption," Smiley said.

The board hopes to keep a tight rein on the project and participate in decisions made along the way as far as which phases of the project are completed when. "My biggest concern is sequencing," Kime said Thursday.

Information Technology

One particularly nasty fly in the ointment for this project, however, is information technology. The board, together with Smiley and McGuire – who also holds the title of IT Director for CCHS – discussed IT at length prior to the hospital redesign discussion.

"We have to get everyone on a universal system," Smiley said. "We need to consolidate all patient records into one common system."

One indication of the problem with software systems not communicating with each other was the length of time it took for staff to produce profit and loss statements for each hospital department so the board could decide on the best way to redesign the hospital.

Currently, between the hospital departments and the two clinics, four different computer systems are being used for tracking and storing patient records and all other types of documentation, McGuire said. The hospital spent thousands of dollars five years ago for a new records system, but that system is now outdated and doesn't produce the records needed or even required.

"Five years is a long time in terms of technology," McGuire said. And now the more robust patient software systems are becoming affordable.

He predicted that $300,000 - $450,000, plus monthly service fees, would cover the cost. The system installed five years ago cost $1.2 million and didn't meet everyone's needs, he said.

The IT problem isn't integral to the hospital redesign plan, and the board has not indicated any plan to address the problem or use levy money for this purpose, but board members agreed it would need to be looked at soon.

"If we're going to enhance the system with this remodel, does it make sense that the IT system has sent us back to a clipboard hospital?" Paterson questioned.

Other Concerns

During Thursday's board meeting, Interim CEO Smiley mentioned several other ways of improving not only performance at CCHS but also increasing revenue. One issue was billing.

"We're in a good position, with our size, to do billing here," he said.

He recommended that the board consider a phased return to local billing (CCHS billing was outsourced several years ago), which could save the district over $200,000 annually.

The first thing to bring back, he said, is Medicare and Medicaid billing. Secondly, the hospital district should do its own group and private insurance billing.

"We could then contract out the private pay," he suggested; stating that this would relieve local staff in billing from potentially having to contact someone they know in the community about overdue medical bills.

Another idea Smiley shared with the board is a renegotiation of contracts with insurance companies. "Most contracts are paying at 40 to 45 percent of what's billed," he said. "One future thought is to see if we can get a bigger percent on these."

 

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