Overseeing day-to-day operations for three rural Kentucky hospitals, plus eight rural health clinics, many of which have or will be undergoing major construction projects, equals success for Westlake Teamcare CEO Rex A. (Rusty) Tungate. For small, rural hospitals to survive, Tungate believes they need to work together to cut costs and deliver quality healthcare.
“I think we’ve achieved something here in south-central Kentucky that hasn’t really been done anywhere else,” he said. “We have three independent hospitals with separate boards of directors, managed by one CEO and one management team. This arrangement is very efficient for costs, spreading them across many counties instead of one. You can afford to have a better quality of leadership and management than any one hospital could have on its own.”
Tungate, a Kentucky native, is in his 28th year of service to Westlake. He credits much of Westlake’s success versus more urban healthcare providers to its ability to work through what he calls “county-line barriers” where a sense of autonomy can inhibit efforts to join forces and work together.
“You have to be able to respect that autonomy and maintain it, but work together,” he said.
With this collaborative management approach, Tungate believes Westlake could potentially grow to include one, even two more hospitals within the group.
“I think you can have a better quality of care rendered for less cost with the approach that we have,” he said.
What began as one rural hospital has evolved into a network of eight rural health clinics operating under three hospitals, in five counties, all with a total of 850 employees. The three hospitals are Westlake Regional Hospital in Columbia, Ky.; Casey County Hospital in Liberty, Ky.; and Jane Todd Crawford Hospital in Greensburg, Ky. Tungate, who manages all three hospitals, took over management of Casey County in 1996 and Jane Todd Crawford in 2005. Although the CEO directly manages all healthcare facilities within the system, the three hospitals are separately governed, and each has its own board of directors.
Construction and Improvement Projects
The construction of a new facility at Casey County, completed in just 14 months, and upcoming construction projects at Westlake Regional and Jane Todd Crawford are among Tungate’s proudest moments. Opened for patients on September 3, 2008, the new Casey County hospital replaces the original structure built in 1945. The new construction is “patient friendly,” he said, with all private rooms with private, handicapped-accessible bathrooms and other individual amenities. As the old hospital structure is being torn down, construction is underway on a parking lot and helipad.
“We’ve upgraded to bring that facility into the modern world,” he said. “The changes from 1945 to now are phenomenal.”
Major renovations and expansion totaling $19.8 million are about to begin at Westlake Regional Hospital, including the addition of a third floor, an administration building, MRI capabilities and nuclear medicine. Plans are also underway for a new replacement hospital at Jane Todd Crawford in Green County.
Tungate has been recognized with a national award from the Builders and Contractors Association for the work on the new facility in Casey County for its construction and design.
The healthcare system, with its network spread over five counties, is working on a decentralized data processing system that is handled via individual departments. Part of this effort involves an eventual transition to complete digital medical records.
“There will be very little paper to keep,” he said. “That is the future.”
Converting two facilities within the system to critical access operations has helped with revenue generation, Tungate said, but this isn’t the only answer to how he can keep all the hospitals operating, to keep them growing and to keep the doors open.
“Finances are a big thing for small hospitals,” he said. “We’re always trying to figure out how to make ends meet. It’s hard on the urban hospitals and even harder on the rural hospitals.”
Tungate calls on his previous experiences as a CFO, and his financial background, in dealing with financial issues. From his work with Humana in particular, he knows about the nuances of Medicare and Medicaid, particularly about how the hospital is paid for services under those programs.
The organization thrives in a family atmosphere, with Tungate referring to the entire operation as an extended family of highly trained physicians and management personnel.
“Just because we are rural doesn’t mean we take a backseat to the urban areas when it comes to hiring,” he said. “We have the very best of physicians and nurse practitioners in the fields that we offer.”
Tungate and his management team conduct community outreach programs and an annual health fair at each of the three hospitals, where they offer free services to citizens of the counties they serve.
Quality and Patient Safety
The organization has standing committees comprised of medical staff at each hospital that meet monthly to discuss quality improvements, credentialing, safety, pharmacy and therapeutics. Input on quality and patient safety come from all departments within a hospital. Certain criteria are monitored monthly “to make sure we are providing the absolute best care that we can.”
“Once we feel like we have achieved a goal then we’ll move on to a different monitor,” Tungate said. “It’s a continuous process to monitor and maintain quality.”
The organization plays a vital role in the communities in which the hospitals and clinics operate. It is the largest employer in Adair County and second-largest in both Casey County and Green County. Healthcare replaced the textile industry as the leading employer in south-central Kentucky in the 1990s. Healthcare stepped in, picked up the pieces and kept the economy of these counties going.
“We’re not only the healthcare provider but we’re the major economic force in these counties,” Tungate said.
Surviving as a rural healthcare provider in a questionable economy is not easy. However, this CEO has continued to see his network thrive due to combining efforts and joining the facilities together to provide unified, quality service. An effective management style also goes a long way toward the goal of operating success.