Susan McDaniel Havre Daily News smcdaniel@havredailynews.com
Many changes are taking place at the Liberty County Hospital & Nursing Home, and Ron Gleason, the new CEO, has been giving a series of PowerPoint presentations in public meetings to explain the changes and what they will mean for the future of healthcare in Chester and along the Hi-Line. “I have been talking with all the various civic groups,” Gleason said. “I’ve been down to Rudyard a couple of times, I’ve talked with the Chamber here in Chester, the Senior Citizens Center and the Rotary group. I have been trying to get the information out there as much as I can to the community and everybody has been very positive.” A public meeting was held Tuesday night at the Lutheran Church Fellowship Hall in Chester where Gleason explained that the main change that is taking place at the hospital is a conversion of the facility to a 25-bed Critical Access Hospital. Gleason explained to the audience that the financial reserves of the hospital were almost gone and that they were losing over $50,000 each month before tax revenue. He also explained that the nursing home is only half full, has been running that way for quite some time and that the hospital has an average of less than one inpatient each day. The outpatient services is still in good shape because over the years many of the procedures that used to require a hospital stay are now handled on an outpatient basis. “So we need to do something,” Gleason said. “The reason we are doing this is because under the Critical Access Hospital status we can continue to provide nursing home services, long term care services and continue to provide acute care services all under the Critical Access Hospital.” Gleason explained that the hospital was certified as a Critical Access Hospital in 2003. It is a federal designation that indicates how a hospital gets paid by the federal government. As a Critical Access Hospital they can provide what is called swing beds, a bed that can be used either for acute care services or for long-term care services. “And since we have a very low need on the acute care side we can have patients in those beds for the most part that are long-term care patients,” Gleason said. By making the conversion the federal government reimburses the hospital in a different manner than before. Gleason explained that before they became critical access they were getting paid much less than what it cost them to provide the care. Now as a critical access, Medicare participates at cost for all inpatients, outpatients and swing bed services. But on the nursing home side, they don’t get paid cost. The hospital is only reimbursed a flat rate regardless of what its costs are. The overhead costs are where they are losing a lot of money because Medicare takes the pool of overhead costs and breaks them down between all of the revenue producing departments. “We are talking laundry, dietary, housekeeping, maintenance, administration, plant costs and depreciation,” Gleason said. “Everything but the departments that produce revenues are considered overhead.
“The goal is to bring the entire facility together under one Critical Access Hospital license so that all those overhead costs stay within the Critical Access Hospital and then Medicare can participate in all the overhead costs not just a portion.” Gleason explained that the impact that this has is about a half a million dollars each year. The federal government will pay them more money once the conversion is made because they also participate in those overhead costs. Becoming a Critical Access Hospital also allows them to do some things to save money as well. The main difference will be that they will no longer pay the nursing home bed tax, which costs them about $80,000 a year. “We won’t be a nursing home’ any more,” Gleason said. “We will now be providing nursing home care in our Critical Access Hospital. So we won’t have to pay that bed tax of $80,000 a year.” Another cost cutting measure enabled by the change is that there will be only one nurse’s station for the entire facility. Currently there is an acute care nurse’s station and a nursing home nurse’s station because the acute care area is completely separate from the nursing home. “Even when we have nobody in the hospital we are still required to have staff in the hospital,” Gleason said. “So once we combine all of this we will have staff there even if we have no hospital patients, because they will be here taking care of the rest of the people in the facility.” Other changes that will save money will come from better utilization of the existing staff members and a renegotiation of the CNRA (anesthesiologists) contract. They are hoping to also cut down on hiring agency nurses from outside the community because they cost about three times more than an employee. Gleason then explained to the audience of approximately 20 people the physical changes that have begun taking place and will be finished by June 30 or shortly after, beginning with the consolidation of the nursing home and hospital. “We need to get this done by June 30 so that on July 1 we can start with our new operation,” Gleason said. “We will discharge everybody from the nursing home on June 30 at midnight and July 1 will re-admit them into a swing bed. “We are required to provide exactly the same care to a swing bed patient as we are to a nursing home patient. Exactly the same care, we have to provide all the activities and the social services, all of those things will stay exactly the same, so the people who are in the nursing home right now won’t even notice a change. It is going to be exactly the same as it was before.” Gleason explained the one of the main costs of the project was to get oxygen and suction into the new acute care rooms. They will be spending $25,000 to get medical gases into the rooms. A new, larger emergency room will be located at the end of the southwest wing of the nursing home with the rooms in that wing holding acute care patients. Two-day rooms will be added to the wings that house the long-term care patients that will provide a more home-like atmosphere for the patients.
The south wing that now houses the hospital will hold ancillary services, including radiology, lab, physical therapy, surgery, anesthesiology and CT. They will be moving the pharmacy to a little bit bigger area in the same wing and installing a tele-pharmacy service. The sleep study room will be located in the old wing on the east side of the building. The medical records department will be moving into the space now occupied by the sleep study room. The hospital/clinic billing offices will be moved into the space now used for physical therapy and a larger waiting room will be located across from the activities/ dining area. This will allow for more privacy in the emergency room area. The main entrance to the hospital will be on the north side of the building with new signs posted to more clearly mark the entrance. “We have to do this without spending much money,” Gleason said. “We are trying to do this mostly with in-house help. We are going to need some electrical and plumbing work done, but we are going to do as much as we can in-house.” Gleason then displayed a floor plan of the hospital and showed the audience where the physical changes were taking place. The new location for the emergency room provides more privacy for patients and a large concrete pad outside the door allows the ambulance to pull in off of the street. A floor plan of the new emergency room shows a larger space holding two beds with a barrier separating them, each holding a desk for the nursing staff to fill out paperwork and a rest room. “Getting more space in the emergency room is going to be a huge plus for us,” Gleason said. Gleason explained to the audience what the economic impact for the community would be if the facility were no longer in operation. “The community needs this facility,” Gleason said. “As far as the economy of the county, we had an economic development report done and 23 percent of the non-farm jobs in Liberty County are at the hospital. The county will be in serious trouble if we can’t keep this place open. If the facility closes then the school’s population goes down because people have to move out, you just have this spiral. It’s a problem.” A question and answer period followed where audience members asked questions regarding the new facility. In response to the question of what happens if you are the 26th person who needs to be admitted, Gleason answered this way: “The only response that I can give is that we have to make it to the future. If we aren’t able to stay in operation, then it really doesn’t matter if we need more beds in the future, because then we won’t be here anyway. We have to live with the rules that are in place right now. Five years from now, the whole system is going to be different, the healthcare system is changing so rapidly, five years from now the rules are all going to be different. So what we have to do is keep up with the rules, we have to make the changes that keep us alive under whatever set of rules are in place at that point in time.”
