Yuma District Hospital and Clinics: John Gardner, Chief Executive Officer

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Yuma District Hospital in Yuma, Colo., opened the doors of its new 15-licensed bed facility in June of 2007, offering acute inpatient and outpatient health services, as well as home health. It also has an integrated clinic, the Yuma Clinic that has a Rural Health Clinic designation from the Centers for Medicare & Medicaid Services as does its Akron Clinic, located 30 miles to the west. Both clinics specialize in rural healthcare.

“The facility has been great for us, because it’s new,” John Gardner, chief executive officer, said. “It’s got current technology, and we’ve been very successful in recruiting and retaining physicians, which is always a huge challenge for rural facilities.”

New to rural healthcare

Gardner himself is relatively new to the rural setting, but he has been surprised at the nursing manpower in the Yuma area.

“This community has done a great job of growing their own in terms of nurses with lots of women who start out as nursing assistants, got their LPNs at local junior college, and moved on to get their RNs,” he said.

As a result, Yuma has a very stable pool of nurses. This is fortunate, since the area is afflicted with many health challenges.

Yuma is a retirement area for farmers and ranchers, and thus, has a larger Medicare load than other rural communities. Physicians see a diversity of patients with a variety of chronic conditions.

“We have primarily family practitioners in our clinic,” Gardner said. “Sometimes they feel like they’re practicing internal medicine rather than family practice. The patient is bringing much more to the table in terms of medical challenges for them.”

And because it’s rural, Yuma has to look harder to find specialists who will trek into the rural setting to help take care of these patients. It’s even more difficult since the hospital is located two to three hours away from the nearest urban hospital.

Gardner said it’s very stressful for patients to drive two to three hours to see a specialist for 15 minutes, so one of his ongoing initiatives is to partner with the urban hospital to get specialists out in his service area once or twice a month.

Yuma also struggles with OB, Gardner said. There aren’t many births in the area, so the hospital doesn’t offer surgical OB or epidurals for women in labor. In actuality, most women leave the area to have babies, and this is a problem Gardner wants to address.

Two of Yuma’s physician providers have already agreed to be trained in surgical OB, but looking at the volume of births in the area, Gardner has to wonder if he’d be able to use their skills at a level that would assure patient safety.

“We are really wrestling with that,” he said. “What’s the best thing for the community in terms of OB?”

Then, there’s the issue of reimbursements. Right now, Yuma is enjoying the benefits of cost-based reimbursement.

“We need to start positioning ourselves for the eventuality that that will probably go away and we’ll have to live just like the PPS (prospective-payment system) hospitals in terms of reimbursements,” Gardner stated. “It’s trying to figure out how to better manage our resources so that we can live in that new environment.”

Out of the urban jungle

Gardner is in his fifth year as CEO and has been with Yuma since it opened. He came from larger urban systems with more of a planning background and had spent three to four years as a consultant and doing interim hospital management. He was brought to Yuma as an interim CEO and accepted the role on a permanent basis because he saw an interesting opportunity.

“I think compared to a lot of my rural peers, because I’ve had kind of the integrated-system experience, tertiary center, I just bring a much different perspective to rural hospital management than many folks have,” he observed.

He is moved by the number of people the hospital sees who struggle to find the resources to pay for care. He is hoping that these financial barriers will go away with healthcare reform’s implementation, even if accounts receivable drop.

“I see my role in the next five years as positioning the hospital for dramatic changes in how we get compensated for our services,” he said.

Resource management comes into play, of course, especially revenue-cycle management. Gardner is constantly asking himself if there are more efficient ways for Yuma to be doing things.

He said he’d be the first to admit whether or not Lean was a worthwhile process after seeing CQI and other “initiatives-of-the-month.” But he’s been impressed with how it works, because the process has been very inclusive.

“I’m impressed with how effective it’s been,” he said. “I’m very hopeful that it’s going to get us a long way.”

As it stands now, Yuma is financially secure, and Gardner senses that the community would like to remain independent of a larger system, even if establishing such a partnership is Gardner’s first inclination. He’s not sure that Yuma can go another 10 years without addressing that option, and he urges those around him to keep an open mind to alternatives.

“I think we all get so focused on the way we’ve always done stuff, and I think this is a great time for creativity,” he said. “I encourage people to avoid the textbook solutions and to look for creative solutions that will help the organization thrive.”

-by Pete Fernbaugh

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