Cookeville Regional Medical Center: Dr. Menachem Langer, CEO

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At a time when medical facilities are merging or forming joint ventures and other partnerships, few regional hospitals still stand on their own. Cookeville Regional Medical Center in Cookeville, Tenn., is a 247-bed acute-care medical facility serving a 14-county area in the Upper Cumberland region. The hospital is situated in a primarily rural area about 90 minutes from the major metropolitan areas of Nashville and Knoxville.

Growth in uncertain times

A large percentage of Cookeville’s patients are on Medicare or TennCare, and the hospital has to contend with high amounts of bad debt. Dr. Menachem Langer, chief executive officer, said the average household income in most of the surrounding counties is $30,000. Add to that, the hospital is surrounded by private hospitals and urgent-care centers that do not accept Medicaid, sending most of those patients to Cookeville’s emergency department.

Despite these challenges, Cookeville has seen tremendous growth over the past few years and maintains a higher standard of care than many large, tertiary care centers. Cookeville has many services not commonly found in community hospitals, including cardiac surgery, neurosurgery, and a cancer center.

“We are one of few hospitals to have growth despite changes and to be experiencing increasing inpatient admissions,” Langer said. “We have the capital to reinvest back into the organization.”

Over the past three years, Cookeville has added an $80-million patient tower, a $20-million operating room expansion, a $5-million electrophysiology lab, and is currently working on an emergency-room expansion. The hospital is also rolling out an inpatient electronic medical records system and computerized physician order entry in the first part of 2012. It is already halfway through rolling out the EMR in outpatient and is on target to achieve meaningful use.

Award-winning quality care

With Langer at the helm, Cookevillle has been working on a culture change to keep pace with the expanding services the hospital offers.

“We have to bring the medical staff along with the changes happening,” Langer said. “In the past, the hospital has been somewhat of a slower-paced community hospital, but it now functions similar to a tertiary-care facility.”

Cookeville has made a push to develop a mission and vision and create five pillars that support the mission and vision with a focus on quality. Langer and other leadership have worked on ways to translate these pillars into measurable goals for staff and to help the medical staff see how each of their actions affects the organization.

“We work on how the mission and vision relates to the staff level,” Langer said. “When staff talks about core measures, we have created score cards to help nurses understand how their actions relate back to the organization. We relate everything back to quality.”

The hospital has greatly lowered door-to-balloon times, averaging 40 or 50 minutes, well below the best practice average of 90 minutes. This is an excellent achievement for a community hospital transporting patients from rural areas and calling in doctors. Ambulances have EKGs to transmit data to the hospital, and patients bypass the emergency department and head straight to the cath lab.

This focus on quality has served Cookeville well. In 2011, the hospital received numerous HealthGrades awards, including number one in Tennessee for coronary interventional procedures for the second consecutive year. The hospital was also ranked number one in Tennessee for overall cardiac care, vascular surgery, spine surgery, and orthopedic services. In addition, the hospital was ranked as one of America’s 100 Best Hospitals in coronary interventional procedures, orthopedic surgery, and spine surgery.  The hospital also has numerous five-star rated programs and many programs ranked in the top 10 percent in the nation.

Looking toward the next few years, Langer is realistic about Cookeville’s future with its payer mix and lowering reimbursements. He envisions the hospital moving toward acquisitions, mergers, or joint ventures.

“I recognize that we may not always be able to stand alone,” he said. “We are independent with no money from the city, and we will need to start evaluating other opportunities for growth and expansion. But we will continue the same quality of care. We are proud that our communities feel they can get quality care in town. Ten years ago, people felt they needed to travel to Vanderbilt to get care. We have worked hard to change that perception and create that confidence in the community.”

-by Patricia Chaney

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