Wing Memorial Hospital: Dr. Charles E. Cavagnaro III, President and CEO

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Wing Memorial Hospital and Medical Centers in Palmer, MA, is a small community hospital that has been serving the Quaboag Hills and Pioneer Valley regions of western Massachusetts since 1913. In 1999, they became a member of the second largest health system in the state, UMASS Memorial Health Care. Wing Memorial operates an acute care hospital with 74 beds and a network of five community medical centers in towns surrounding Palmer. The Wing system also includes an outpatient mental health center and the area’s only geriatric psychiatry unit.

“We have extensive outpatient services and a small community hospital all in the same system,” says Charles E. Cavagnaro III, MD, President and CEO of Wing Memorial Hospital. “What is unique about Wing is that the doctors are, for the most part, hospital employees. This makes all our outpatient services hospital–based, bringing the rules of the hospital to all our clinics. Thus, our patients get seen regardless of their ability to pay, and this has always had a positive effect on the communities we serve.”

This staffing model was developed by Wing Memorial in the 1960s. Physicians are employed directly by the hospital just the same as nurses, technicians, and receptionists.

Growing through an Era Known for Downsizing

Wing Memorial Hospital has grown from 42 to 74 beds in the ten years since the merger with UMASS Memorial. “It is nice to have that kind of growth in these times,” says Cavagnaro. “This is more than a 75% increase in the number of beds in a time when many organizations are downsizing.

One way Wing has assured its growth is by developing niche services. The hospital recently renovated its former ICU and medical/surgical units and turned it into the 15-bed Center for Geriatric Psychiatry. They’ve added beds to the emergency room which has seen a 75% increase in traffic since 1999. “We have put more than $50 million in capital improvements into the hospital in the last decade, including the largest expenditure, the Country Bank Pavilion, which is a virtual hospital replacement,” says Cavagnaro.

In November, Wing completed a million dollar renovation of their laboratory. “We also just purchased a new 64-slice CT scanner,” he says. “For a small community hospital, it is great technology and will serve our needs very well.” The hospital also has mobile MRI scanning capabilities.

Along with the whole UMASS Memorial Health Care system, they have a three-year plan in place to move the hospital to an electronic medical records system.

Meeting Challenges

“Everybody asks me, ‘Exactly what is it that keeps you up at night?’ Every night it is different. There is not one thing,” says Cavagnaro. “The most immediate concerns for a community hospital in this environment are the finances. Do you have the volume to support your operation? Is the volume that you have able to produce the revenue that you need to keep the organization going? Where are the problems in terms of efficiencies of your operation and in terms of the revenue cycle?

Cavagnaro also worries about the long-term issue of work force. “It is all about recruiting and retaining the professionals you need. We face a lot of challenges, but as physicians’ lifestyles change, we start to have more of a divide between physicians who work in hospitals and physicians who work in offices. You basically need more doctors today to do what fewer used to do.”

In addition, the expectations of doctors are changing. Fewer are willing to work the long hours, including rounds before seeing patients in their offices and rounds again after. “You have to pay premiums to get doctors to work in hospitals overnight,” says Cavagnaro. “And then there is the whole issue of sub-specialty care. Specialists do not want to cover five hospitals; they want to go to one. They want to go to a big hospital or a regional center and have their office right next door. Many surgeons will now go to ambulatory surgery centers, offering procedures that are more routine. In many cases, they are also part owners of these centers.”

“This hurts the community hospital,” he says. “We basically have to run an operating room and an emergency room 24/7. If you are trying to run those and pay for them only on emergency cases, it’s very difficult. You are steadily losing the cataract surgeries, the office urologic surgeries, the minor ENT surgeries—a lot of this can be done in a surgery center.” This trend pulls these surgeries out of the hospitals’ operating rooms and therefore, the funds out of the hospital.

Cavagnaro says being part of a larger system is crucial for surviving current trends in healthcare. Wing Memorial has added hospitalists to its staff in recent years to help ease the burden for physicians. “We have added a lot of different providers for a different style of health care delivery in the past few years,” he says. “Now we have to concentrate on making sure that the care we deliver is the best you can get in this type of a setting.”

“We are dedicated not only to being here, but we are dedicated to making sure that our community gets the care that they deserve in a way that centers on their needs and is sustainable over the long run.”

-by T.M. Simmons

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