Virginia Gay Looks to Value-Based Future with Enthusiasm and Anticipation

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Virginia-Gay-thumbMike Riege, Chief Executive Officer, Virginia Gay Hospital

by Pete Fernbaugh

Mike Riege, chief executive officer of Virginia Gay Hospital in Vinton, Iowa, has been with the organization for 24 years, originally being hired as chief financial officer, then being promoted to CEO in 1992.

Riege has presided over impressive growth during his tenure. In 1992, Virginia Gay had an annual budget of $4 million and 50 to 60 employees. In fact, Riege said he was able to manage each capital transaction personally because of the size of business at the time.

Now, Virginia Gay employs 300 and has an annual budget of $35 million. It has also added four hospital-based rural health clinics, a home health agency, and a retirement housing development to its nursing home and hospital. Last year, it was recognized by iVantage Health Analytics with the HealthStrong Award for its quality outcomes, safety, and patient satisfaction. In 2013, its nursing home was named one of the best in the country by U.S. News and World Report.

Furthermore, Virginia Gay was the first hospital in Iowa to join the National Rural ACO.

Unlike many rural executives who are faced with the increased possibility of being acquired or shut down, Riege is optimistic about Virginia Gay’s sustainability into the future and is enthusiastic about the direction of healthcare in the United States, especially as value-based care takes root.

“I think it’s a neat time to be in healthcare,” Riege said. “I would equivocate this to very similar to 1965 when Medicare came into existence. It was something brand new, but at the same time it was something that was exciting. I look at healthcare reform as an exciting challenge and not a burden.”

Making EHR usable for everyone

Riege said Virginia Gay is currently planning the strategy by which it will become involved with an ACO. He and his staff are also preparing for ICD-10 and Meaningful Use Stage 2, which will be implemented in the medical clinics during the first quarter of the new fiscal year.

However, the major challenge occupying the organization right now is streamlining its EHR and making it work on an individual basis for all of its providers.

“Each user has different expectations of them and we’re trying to plan out the various problems that our users have with the systems, and we’re trying to make it work for everyone and trying to teach everyone how to use the thing, trying to integrate things like voice recognition, trying to make it a more efficient means of using electronic health records,” Riege said.

Right now, the EHR has lengthened the time it takes to process patient visits in Virginia Gay’s clinics, which is frustrating for the doctors and midlevel staff.

“It’s all growing pains in using this new technology, but we think that after a year or two of using it, people will consider electronic transcription as being the more efficient way of doing things as opposed to the old paper-based transcription,” Riege said.

Realizing the various learning curves of the staff, Riege and the Virginia Gay leadership identified super-users of the EHR who would be able to help colleagues struggling with mastering the platform to navigate rough spots and develop shortcuts that work for them.

“I’ve been lucky,” he said. “I haven’t had a group of nurses or a group of providers threaten to walk out because of the medical records we use. They understand these things are expensive, and we’ve allowed both the provider staff and the nursing staff to select the system that they want to use. So, we have some buy-in from them from that perspective. And they understand they have to make it work. We don’t have an endless supply of money to just get rid of the system because it has some quirks. Plus, all the systems out there have quirks. It’s just something you work through.”

Taking a strategic approach to joining an ACO

As part of its preparation for ACO, Virginia Gay has been participating in a managed-care service that reimburses the organization for quality and patient satisfaction. Riege feels this has helped his staff take the baby steps needed before the organization fully shifts to an accountable-care organizational structure.

“We know come fiscal year 2017–Oct. 1, 2016—Medicare is going to be transitioning over to accountable care organizations as a means of reimbursement,” Riege said.

The Iowa Medicaid system will be transitioning to ACO as well.

“We have approximately a three-year window to learn how to operate in this system,” he continued. “So, my role as a leader is to try to understand how these systems work, which organizations would be the best for us to partner with, and making the commitment to go forward and trying to convince my board and my staff members and my medical staff that this is what we’re invested in and this is what we have to make work.”

With 20 percent of rural hospitals under the threat of closure as value-based purchasing is implemented, Riege believes only the ones who know how to function in the new environment will maintain their independence.

“It’s really up to us to understand how this whole thing’s going to work and making the time investment, along with everything else we have to do, to do our due diligence to try to figure out this whole system and be on the leading edge of it rather than the trailing edge of it. It’s like three-dimensional chess. You try to put all of these things together to make everything work with your staff, with the government, with the private insurers, and with your patients.

“There’s no blueprint for any of this,” he concluded. “The best thing we can do is keep the patient at the center of all of this. If we do that, we’ll be fine. It’s up to us as leaders to make healthcare reform work.”

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