Wayne County Hospital: Daren L. Relph, PS/CCP, Chief Executive Officer

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Rural hospitals across the country are working to become more efficient, meet their financial obligations, and evaluate service lines to ensure they are providing the most necessary care to their patients.

Uncertainty about the effects of reform still looms, as details of changes to critical-access status or other reimbursement issues are not yet clear. But most rural hospitals are fighting to stay open and reminding Washington that, although small, they are vital members of the communities they serve.

Caring for friends and neighbors

In one of the most sparsely populated counties in Iowa sits Wayne County Hospital. The 25-bed critical-access hospital serves a county of about 6,600 people with a total catchment area of approximately 18,000. It is the largest employer in the county, and as a result, Wayne County has a close connection to the residents.

“In a community of our size, our staff always has some connection with our patients,” said Chief Executive Officer Daren L. Relph, PS-CCP. “We see them in the grocery store, at ball games. Our staff is constantly aware of the people we are serving and our commitment to providing healthcare for our populace.”

In addition, employees of the hospital are closely tied to the community, actively participating in PTAs, city council, school boards, and other civic or service organizations. This spirit “draws tight connections between our facility and other entities in the community,” Relph said.

Providing the best care needed to patients

As with any small hospital, Wayne County is constantly evaluating the services it provides to ensure they are the most useful to the community. The hospital operates four family-practice clinics that are spread throughout each corner of the county. These clinics are extremely successful for the hospital, with the largest one receiving more visits per month than there are residents in the town.

In addition, the hospital provides obstetrics for a five-county area and has a strong orthopedic program, performing hip and knee replacements. Wayne County leverages technology to provide quality care to patients as well. The hospital recently upgraded its electronic medical record and added a patient portal for the clinic system that allows patients to schedule appointments, pre-register for appointments, and pay bills online.

In partnership with Saint Luke’s Hospital in Kansas City, Mo., Wayne County Hospital provides eICU care for critically ill patients. The service has remote-monitoring capability for patients requiring a higher level of care than a normal acute admission.

“The eICU program allows us to keep higher-acuity patients near their families and give them the care they need,” Relph said. “It also gives our medical staff and nurses the back-up they need to feel comfortable with that level of care. We were one of the first critical-access hospitals in the state to have an eICU.”

Wayne County continues to look for services to add as it strives to determine what is most needed for the community.

“We regularly vet proposals for service lines to see what is most productive financially and what will meet the needs of the community,” Relph said. “We would like to expand services and create job opportunities to increase our economic impact as well.”

Dedicated to quality and patient satisfaction

When providing care to family, friends, and neighbors, patient satisfaction is extremely important to Relph and the hospital staff. Wayne County has received two awards from Press Ganey for consistently achieving high patient-satisfaction scores.

“We remain focused on the importance of our patients’ perception of care and continue to carefully monitor the results,” Relph said. “We currently survey our Ambulatory Surgery Department, Emergency Department, Inpatient Service, and Outpatient Service areas, and beginning January 2013, we will survey our Medical Practice Clinics, as well.”

He added, “I think our rural setting and friendliness of staff lends itself to higher quality and patient-satisfaction scores.”

The hospital has a robust quality program and has a partnership with the Studer Group. Relph said the hospital has been able to identify areas for quality improvement, but now has a better ability to mine data and track progress and has developed a process for submitting areas of improvement to drive change.

Preparing for financial changes

Wayne County Hospital has a management agreement with Mercy Medical Center of Des Moines and is part of the center’s statewide collaborative, Network of Healthcare Services. But with changes to the critical-access program, the hospital is unsure of what reimbursement will look like in the coming year.

The hospital sees a large number of elderly patients and has a payer mix of about 60 percent Medicare and Medicaid. Relph said the focus now is on efficiency and process improvement. To receive a more favorable reimbursement, the hospital and clinic system obtained official Rural Health Clinic designation for all locations.

As with everyone in healthcare, Wayne County is looking for ways to do more with fewer dollars and shelter itself against legislative uncertainty where possible.

“I think that the pressure is on the C-suite in every organization to be as innovative as possible,” Relph said. “As the healthcare dollars from reimbursement get smaller and smaller, we will have to be smarter about how we operate.”

-by Patricia Chaney

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