Published by the National Rural Health Resource Center (The Center), July 2019
Roosevelt General Hospital (RGH) is a 24-bed, not-for-profit, Short Term Acute Care (STAC) hospital, providing acute care, emergency medicine, surgery, interventional pain management, imaging, rehabilitation, laboratory, and related outpatient ancillary services to the residents of Portales, New Mexico and surrounding communities. RGH also provides primary and specialty care services through the following owned and operated Hospital-Based Rural Health Clinics (PB-RHC): RGH Portales Clinic, and newly opened RGH Clovis Clinic.
In 2018, Matt Mendez and Lindsay Corcoran, consultants with Stroudwater Associates, worked with RGH through the Small Rural Hospital Transition (SRHT) project on a Financial and Operational Assessment (FOA).
RGH was spotlighted in January 2019 for their impressive six-month post-project progress. In April 2019, we spoke with CEO Kaye Green and the leadership team. They had such amazing outcomes that we created a Video Spotlight on them!
“We have been able to now be in the black, and we expect to have nearly a million dollars of positive revenue this year, whereas, we have no history of being in the black before for this facility, so that’s very exciting for us.”
– Brad Roberts, Chief of Clinic Operations
In one year, Roosevelt General Hospital was able to:
- Reduce bad debt by 25% ($1 million in less than a year)
- Increase point of service collections by 22% (clinic) & 15% (hospital)
- Increase collections by $2.25 million
- Reduce past time refiling by over 52%
- Reduce no prior authorization denials by 77%
- Reduce registration errors by 60%
- Reduce days in accounts receivable from 77 to 50
- Reduce non-acute patient visits in the ED by 25% in just three months
Q: The financial improvement in such a short time is astounding! How did you do that?
“The onsite consultation by the SRHT team really helped us focus. I think we thought things were just not within our reach before, and through the consultation process, we found out they absolutely are.”
– Kaye Green, Chief Executive Officer
Collections were up to $1.4 million just six months after they received the consultant recommendation to update and review their charge master. Now, three months later, collections are up to $2.4 million! Last year, RGH had $3 million in deficits and lost $1.5 million from their bottom line. This year, in nine months, they’re up $535k from operations and $1.6 million with Gross Receipt Tax (GRT).
They have added two new positions: a billing lead and assistant business office director (first assistant director in the hospital) and are working with an outside entity to take over patient payment plans to reduce bad debt. Business office staff attended a billing bootcamp and learned a lot about inpatient and observation billing and will be improving their documentation. RGH is now using a productivity tool which helps with staffing and has reduced overtime.
RGH implemented an ED redirect program in September and saw a 25% reduction of non-acute patients that have been redirected to the clinic. They are also receiving very positive feedback on patient experience surveys. Recently, RGH partnered with an outside entity to assist in managing their chronic care patients. The entity contacts these specific patients monthly by phone, which has helped to decrease readmissions even more and bring in revenue for the phone-visits.
In July 2019, the RGH Clovis Clinic was opened to expand their service area. The new clinic location is starting with primary care, including a physician and mid-level provider. Both are known to provide exceptional patient experiences. They hope to offer Saturday services and will evaluate the addition of services such as pain management, endocrine, and behavioral health.
The physical therapy (PT) department is working to grow their service line and has found three new services to provide, including wound care. Therapists have received training for the new and advanced services. RGH is contracting occupational therapy and will evaluate the advantages.
RGH is working to increase their surgical services as well. Since adding ophthalmology, they are now seeing about 15 cases a week. In the future, they would like to add orthopedic surgery and are talking to an interested provider. They hope to hire a second general surgeon. RGH plans to work directly with Certified Registered Nurse Anesthetists which should save up to $120k annually because they will only be working when the surgeon is there.
The application for swing bed has been submitted to CMS and they should be able to admit their first patient very soon. The plan is to admit slowly to ensure success. Not only will they be able to keep more patients local, but they hope swing bed will help to stabilize the workforce on med-surg.
“I want everyone to know the value of the program. This opportunity, the SRHT Project, has been life-changing. We felt like we had support. We felt like we had a plan.”
– Mercedes Lopez, Chief Nursing Officer
- Shifted our thinking from “how do we reduce costs and act like a small rural hospital” to “how do we go after it and make things better.”
- During a March survey, surveyors stated “It doesn’t feel like you are a small rural hospital…every director had a plan for where they want to go”
- Department heads see their service lines as a business and look for new ways to do things
- Culture is now a culture of reward where leaders can embrace opportunities and are recognized for what they do instead of what they do wrong
- Respect among leaders has increased
- Quarterly retreats planned to encourage planning and discuss change management