Adding partners

NBHH board votes to expand agreements with outside long-term care centers

Hospital CEO Eric Connell updated the North Big Horn Hospital District’s Board of Trustees about the district’s continuing efforts to expand UPL (upper payment limits) with other nursing homes in Wyoming, during the July 15 meeting.

Only hospitals with a specific license are paid the upper payment limit for long-term care services. NBHH has this license. It partners with outside care centers, allowing them to operate under the special license, which makes the facilities eligible to receive a higher payment from Medicaid. As part of the agreement, NBHH also helps the long-term facilities with the management of their care centers. In exchange for those services, NBHH receives part of the upper payment limit funds.

The program was implemented when former CEO Rick Schroeder worked for the hospital. Schroeder negotiated the first UPL agreement with Rocky Mountain Manor in Evanston. Since then, other agreements have been implemented and are under consideration for board approval, and the success of that relationship has prompted other organizations to seek similar partnerships with NBHH. Schroeder, who was present at the board meeting, has been helping manage the program for the past several months. He said he has enjoyed helping these facilities outside of the community and has seen how the extra dollars have been used by the facilities to improve their care centers under the program. He said he has personally seen some of the improvements firsthand when visiting the facilities and was impressed with how the funds were used to make improvements, mentioning patient rooms as an example.

Connell noted a recent agreement with Rocky Mountain Manor will partner with NBHH in the UPL program for their newly acquired facility in Douglas. He said, pending board approval, the district will initiate the agreement, effective Aug. 1. He added that discussions are underway for a short-term operating advance to cover Medicaid shortfalls during the transition.

Also in another UPL agreement pending board approval, Peak Healthcare Consulting would like NBHH to manage its Casper facility under the program. NBHH also manages Peak facilities in Sheridan and Cheyenne. Connell reported similar discussions in progress with an undisclosed provider for another UPL agreement for eight additional nursing homes. With so many programs being added to the roster, Connell said Schroeder is “ready to expand his role,” and the hospital will likely have to add management staff to support the monitoring aspects of the agreement.

“We project a minimum of $80,000 per facility annually, before expenses, boosting NBHHD’s mission and Wyoming’s nursing home care,” Connell said, noting the partnerships diversify income for NBHH while at the same time helping other nursing homes throughout the state. 

The trustees met with legal counsel after the meeting in executive session to discuss the legal implications of the UPL agreement further. Following the session, they resumed the public meeting, voting to approve a resolution authorizing expansion of NBHHD participation in the UPL program.

CEO agreement

Also, following the executive session, which is not open to the public, the trustees voted to hire Connell as CEO of North Big Horn Hospital District, pending review of his employment agreement by legal counsel. The district currently employs Connell through Billings Clinic. This change in status will make Connell an employee of the hospital district.

Grant proposals

Connell introduced the hospital’s new foundation, marketing and grants coordinator Payton Gambill to the trustees. Gambill said she is in the process of preparing applications for a SLIB (State Loan and Investment Board) grant and a TEA (Transportation Enterprise Account) grant. The SLIB grant is earmarked to pay for preparation of unfinished space located near the clinic to support future provider expansion and community health initiatives. It will also be used to replace worn, outdated flooring throughout the facility, which will have the added benefits of improving safety, cleanliness and aesthetics.

The TEA grant is geared toward transportation and, if granted, will be used to purchase a reliable vehicle for the visiting nurses program. Gambill noted that the new vehicle will expand home visit capacity and help reach more rural patients in the hospital’s service area. Connell explained that Gambill needed board approval for the SLIB application to qualify for the grant. The board granted permission for her to proceed with both grants and approved the expenses once the grants are secured.

Other reports, motions

In other matters, the trustees approved the purchase of computer equipment. The equipment had been previously included in the budget for up to $45,000. The purchase will upgrade computers and software used throughout the facility.

Clinic manager Amber James reported that 1,377 patient visits were completed in May. She reported 1,320 clinic visits in June. The target goal of 1,100 patient visits per month was exceeded in both months. She also reported that the visiting nurse program, designed to help vulnerable patients at home and away from elevated risk environments, made 358 visits in May and 347 visits in June. She noted 20 patients were seen for the “lumps and bumps” clinic held in May, and 47 patients are currently enrolled in the chronic care management program. 

James reported that the clinic’s new appointment reminder system has been implemented. The system, which sends automated appointment reminders in the form of a text message to a patient’s cell phone, is already saving scheduling staff about an hour of manual phone calls each day. Previously, staff called the patient to remind them of upcoming appointments.

Connell updated the board on recruiting efforts to bring in additional professional staff. He noted that an interview with a cardiology nurse practitioner has been scheduled. The nurse practitioner will assist cardiologist Kristin Scott-Tillery, whose visit demand is exceeding capacity. He said he is also talking to a board-certified urologist, trained in robotic-assisted surgery, who may be willing to provide operating room services a few days per month, despite having a full-time practice elsewhere.

In other recruiting efforts, Connell is talking to a dermatology provider with local ties who may be interested in returning to the community, as well as exploring an outreach clinic agreement with Dr. Thomas Reid of Cody Regional Health, who is board-certified in internal medicine, hematology and medical oncology.

Special award

It was also announced that the hospital received the American Heart Association’s (AHA) bronze award for its attention to AHA guidelines for rural coronary artery disease prevention and care. The AHA offers various awards related to quality improvement initiatives related to cardiovascular disease and stroke. These awards recognize institutions like NBHH for achieving high standards in patient care and prevention related specifically to heart disease.