Riverwood Healthcare Center: Michael Delfs, Chief Operation Officer

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Rural health systems are getting hit hard in today’s healthcare market. Proactively looking at partnerships with larger facilities or institutions is key to the future success of these organizations. In north-central Minnesota, Riverwood Healthcare Center is finding ways to remain independent through strategic partnerships with local institutions.

The importance of partnerships

Riverwood Chief Operating Officer Michael Delfs said he is concerned that the political rhetoric related to healthcare reform is trending toward removing higher-level services such as orthopedics, surgery, and trauma from rural hospitals.

“Some elected officials seem to believe that small hospitals should not provide higher-level services, but our communities really need these services available locally,” he said. “Patients are not keen on driving hundreds of miles for knee or hip replacement or chemotherapy, and in some cases, it is simply not possible for these patients to commute for the services.”

However, these services are expensive and difficult for a small hospital to provide without the resources available when affiliated with a larger regional health system. Delfs said it’s important to Riverwood, as it is to most rural hospitals, to remain independent. And to do that, the healthcare center has developed strategic partnerships with Minnesota Oncology; the Virginia Piper Institute at Abbott Northwestern Hospital, Minneapolis; and even a competitor health system in the area.

Working with the Virginia Piper Cancer Institute and a neighboring hospital to drive numbers, Riverwood is able to provide oncology services, including genetic counseling and stereotactic biopsy, respectively. The health system is also working toward becoming a fully accredited community cancer center by the Commission on Cancer of the American College of Surgeons. In addition, the collaborative partnership allows the community’s lone oncologist to consult with more than 90 partners in the state.

“To remain independent as long as possible, it is vital for rural facilities to partner with other organizations,” Delfs said. “It is much better to do it now proactively, rather than later reactively.”

Delfs said one concern he has about rural facilities is the time spent reacting to regulatory standards that trickle down, but not having enough resources left to proactively prepare for what the future brings.

Preparing for a new compensation model

Generating $70 million a year in gross revenue, Riverwood Healthcare Center is a 25-bed critical-access hospital with three primary-care clinics. The facility includes a Level III Trauma Center, Level I heart-attack program protocol, and is a Comprehensive Advanced Life Support hospital.

The service area is populated by numerous lakes and attracts a large seasonal population. Aitkin County’s population is 16,200, but in the summer, the area’s population can reach 75,000 or even 125,000. As expected, the emergency room and urgent care see the most increase in volume.

To account for the seasonality, Delfs said the hospital uses flex staffing to adjust with volume. The staff is offered a day off during the slow times, and the hospital maintains a schedule to follow at times when there are no volunteers.

Looking toward a pay-for-performance fee schedule, Riverwood has already formed a group of physicians and administrative members to evaluate what a physician-compensation model looks like in that environment.

“We don’t want to jump the gun, but we do need to start working to align the way physicians see patients with how the system gets paid,” Delfs said. “Health systems, both large and small, will be in trouble if we continue a pay structure based solely on volume.”

Shifting the focus to quality

Quality reporting is becoming more and more important to all healthcare organizations and not just in relation to future payments. In addition to core measures and HCAHPS, Riverwood has implemented initiatives for hand hygiene and state-based measures.

Minnesota Community Measurement asks for quality reporting in areas such as diabetes care and congestive heart failure. Riverwood has applied those measures internally to begin evaluating processes and improving care for chronic conditions.

Other areas of focus include falls and medication safety. Committees regularly walk the halls to evaluate potential fall hazards and make recommendations on how to improve patient safety. Medication safety is reviewed through an evaluation of process, equipment, and workflows.

To help improve quality and patient care, Riverwood has implemented the Transforming Care at the Bedside program. The goal of the program is to engage front-line nursing staff who spend the most time with patients with implementing changes in how the organization cares for those patients.

“We are empowering our nurses to make changes to improve care,” Delfs said. “We introduced the program, but let the nurses run with it to ensure it is not an administrative-driven initiative.”

To help improve patient satisfaction, the facility is undergoing a $21-million building project to convert all hospital patient rooms to private. Delfs expects this to also make patient care and staff workflows more efficient. With the former configuration of single and semi-private rooms, the hospital was essentially at capacity with about 17 or 18 patients because of gender, infection control, and other issues.

The building project also added a new and larger infusion center with five patient bays and a private entrance so that immunocompromised patients do not have to enter the hospital with the risk of exposure to germs.

The birthing suites will now provide more features that new moms want in terms of the overall birthing environment, look of the room, and comfort for family members. The orthopedic care area will also follow a new model, where patients will be examined by orthopedic specialists in the rehab area where their pain and mobility issues can be closely monitored with physical therapists, nurses, and surgeons working together as a team.

“Our hospital thinks about innovation and partnerships and this is where our focus will be in the future,” Delfs said. “Although rural health may only represent a small total of the country’s population, 100 percent of the population served by these centers needs healthcare services delivered locally. For everyone who chooses to live in rural areas, these services are vitally important.”

-by Patricia Chaney

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