Schneider Regional Medical Center: Angela Rennalls-Atkinson, Interim Chief Executive Officer and Chief Operating Officer

by HCE Exchange on October 21, 2013

(Editor’s Note: Since this interview was conducted, Schneider Regional Medical Center has hired a full-time chief executive officer, Bernard A. Wheatley, D.B.A., FACHE.)

Angela-Rennalls-Atkinson-thumbThe plight of rural healthcare in the United States is frequently and rightfully discussed. What’s often missing from the conversation, however, are hospitals that are classified as urban facilities, but are actually serving a patient population whose make-up is more rural.

A good case in point is Schneider Regional Medical Center, a three-facility system that provides healthcare to the residents of the U.S. Virgin Islands and the Caribbean.

Its facilities include the 169-bed Joint Commission-certified acute-care Roy Lester Schneider Hospital, the Charlotte Kimelman Cancer Institute in St. Thomas, and its ambulatory care facility, the Myrah Keating Smith Community Health Center, on St. John.

In discussing the difficulties Schneider has in keeping pace with the changing healthcare paradigm, Angela Rennalls-Atkinson, interim chief executive officer and chief operating officer, emphasized two characteristics of Schneider’s care team: its genuinely united teamwork and its focus on patient care.

A collaboration of care

Schneider Regional Medical Center works in close collaboration with the local Department of Health and Human Services and other government entities to ensure that the services the system is providing are as comprehensive as possible.

With its partners, Schneider takes into account the many patients in its service areas who cannot afford care. At the forefront of discussions is how to manage those patients.

Rennalls-Atkinson said Schneider is currently facing two challenges that directly affect these discussions: financial constraints and aging infrastructure.

“We really don’t have capital to meet all infrastructure upgrades and the regulatory requirements for affordable care,” she said. “We maintain equipment in excellent working condition to help decrease unnecessary capital expenditures.”

Fundraising, unfortunately, decreased in the last year, as the decline in the U.S. economy affected some of Schneider’s key supporters. This is a blow to the organization, since Schneider is faced with IT requirements to comply with Meaningful Use standards.

“Our medical records are not fully electronic throughout the center,” she said. “A portion of the medical record is in paper format, which is something we know we have to improve to meet CMS requirements.”

Schneider has started Meaningful Use Stage 1 and is rushing to complete it in order to avoid penalties, but without capital funds, the system must utilize its operating budget to deal with capital expenditures.

As a semi-autonomous government facility, Schneider receives a certain amount of funds from the local government, but it’s less than half of the system’s payroll. Its gross patient revenue is about $140 million, but expenses are, not surprisingly, quite high.

Since the hospital is on a TEFRA payment structure, Medicare reimbursement rates are stuck in the 1980s, when the hospital was built.

Simply put, additional funding is needed to meet expenses. The rub is, Schneider could get additional funding if it were considered a rural facility.

However, one of the criteria used to determine urban or rural status requires a population density of fewer than 1,000 residents per square mile. The density in St. Thomas per 2010 census data is 1,652 residents per square mile.

This high population density affects the categorization of a rural locale, limiting access to some of the available grant funding that is readily administered to other islands or territories.

In the absence of additional funding, Renalls-Atkinson said Schneider is forced to prioritize expenditures that will best help her team coordinate patient care.

“With expenses being so high we are really running a deficit, so it’s very difficult,” she said. “It’s prioritizing so that we can meet the urgent needs of our patients.”

Always focused on the patients

No matter what an organization’s challenges may be, in healthcare, Rennalls-Atkinson said, it’s always about the patients and creating solutions for those challenges that also ensure continued improvement.

“Yes, it’s difficult to run a facility that is unrealistically categorized,” she said, “however, we are meeting and exceeding in our composite scores for core quality measures.”

This is why Schneider continues to look to the future, investing in spite of the obstacles. Right now, the organization is planning on upgrading its gastroenterology and urology services, along with other offerings. New specialists are joining the care team, and the organization is utilizing evidence-based practices. All of these investments are centered on patient safety, which is Schneider’s highest priority.

Why?

Because it’s always about the patients.

“Regardless of our designation, urban or rural, we make attempts to remove obstacles that negatively impact patient care and continue to strive to decrease expenses and increase our revenue,” Renalls-Atkinson said.

Schneider is the only safety-net hospital that provides care to patients in the St. Thomas/St. John district. It has to exist for the community and for the area’s visitors.

“We’re here for our patients,” she said. “As healthcare providers we are focused on our mission to be able to provide that quality comprehensive care that the residents and visitors expect and need.

“Clinical excellence is not an option; it is a requirement.”

-by Pete Fernbaugh

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