Surgical program off to a great start at NBHH

Patti Carpenter

At the North Big Horn Hospital District’s March board meeting, administrative managers reported the hospital district, for the most part, continues to do well and even exceeds expectations in many areas.   
Amber James, Clinic Manager, reported 1,237 patients visited the clinic in February. As part of an effort to improve the clinic’s ability to offer same day appointments, 193 patients were scheduled last month on a same day basis. Though the clinic was unable to schedule five same day requests in the month of February, it was much better than the 15 same day visits that couldn’t be arranged the previous month.
A total of 215 eligible patients received visiting nurse services in the month of February.
“The program helps keep vulnerable patients at home and away from elevated risk environments,” James reported.
James also noted that chronic care management enrollments for Medicare and Medicaid patients with two or more chronic conditions is increasing and now has 33 participants in the program.
James gave the trustees an update on the progress of implementing an online self-scheduling appointment program for the clinic. She said she expects the program to be up and running sometime in June. The program will allow patients to schedule their own clinic visits and will also include an automated appointment reminder feature.
Director of Nursing Michael Henley, who was not present at the meeting, submitted a written hospital census report for the month of February. His report noted that there were 12 patients admitted for observation. Three were admitted for respiratory-related admissions like pneumonia, three were due to dehydration and electrolyte imbalance, two were trauma related with the need for observation after falls, with the remaining for individual events like abdominal pain, suicidal ideation, kidney infection and acute back pain.
Henley’s report noted 12 patients were admitted for inpatient care, some for respiratory care, infections, treatment for dehydration and pain management. Patients occupied seven swing beds during the month; three were referrals from Billings Clinic, two were from St. Vincent Healthcare and one was from Cody Regional Healthcare.
The trustees discussed the importance of revenue from these types of referrals to the hospital’s revenue stream.
Henley’s report also noted that there were two admissions for brief recovery (24 hours or less) after surgeries that took place at the hospital. There was only one admission in February related to COVID.
Connell introduced James Ellis, CRNA, who began working at the hospital this month. Ellis, a highly trained and experienced nurse anesthetist, is working with surgeon Dr. Michael Hill. He will also be performing pain management services to patients using new equipment approved for purchase by the trustees at the meeting.
Both Connell and Hill praised Ellis at the meeting. Hill, who had worked with Ellis for only two days at the time of the meeting, described his work and skills as “outstanding” and explained how having a staff anesthetist on board, with the kind of experience Ellis has demonstrated, has streamlined procedures and made the process more efficient.
“When a patient comes in, a lot of things need to happen before they can go into the operating room,” explained Hill. “But because James is on the team, he can do a lot of those things in advance, like review medical records, for example. So, we have cut down time in the OR, which allows us to do more each day.”
Connell said he met James two years ago through a colleague and wanted to recruit him for some time, noting that he came highly recommended. He added that it was perfect timing to have someone like Ellis, with extensive experience, join the surgical team.
Dr. Hill reported that surgeries are already booked “several weeks out,” and days have been added to accommodate the busy surgical schedule. He said he is receiving a lot of referrals, not just for robotics, but for regular surgeries from other doctors and hospitals. He said he has seen patients from nearby Cody, Powell, Basin and Greybull as well as patients from as far away as Worland and Thermopolis.
“In the past about 90 percent of the patients we saw were from the Lovell area,” he said. “Now, it’s more like 75 percent.”
Hill said he performed his 14th robotic surgery earlier that day using the hospital’s recently acquired equipment and has 11 more robotic surgeries scheduled. Hill has extensive experience and training to perform surgeries using robotic equipment.
“We’re way ahead of where we thought we would be right now,” he said, thanking the board for its support and for the foresight to invest in the equipment that allows the hospital to offer robotic services before many of its competitors.
In addition to equipment for pain management, the board also approved the purchase of lawn equipment and discussed, at length, the benefits of purchasing a DEXA scanner in the future.
The $62,000 DEXA scanner would be purchased, in part, with proceeds from a $41,800 donation to the district from the Caryl Turner Memorial through the North Big Horn Hospital Foundation, with the balance requiring board approval to fund.
Connell said he thought adding the service would be a good idea.
The equipment would allow the district to offer bone density analysis as well as body fat analysis. Medicare patients are allowed a bone density scan every other year and currently seek those services elsewhere. Additionally, DEXA provides one of the most accurate measures of body fat testing, which is something very popular with athletes and other health enthusiasts.
 “DEXA is used to measure bone density and provides important information about the risk of osteoporosis,” said Connell. “This is an especially important test for women’s health.”
Connell said management is evaluating the feasibility of adding DEXA as a service, noting that extra space is available for the machine in the area of the hospital formerly occupied by its administrative offices. He said to expect more discussion in the coming months regarding the equipment.
Connell reported that New Horizons Care Center management structure is under review, with an eye toward “balancing the workload, which is tilted heavily toward the director of nursing” at this time. Another reason mentioned was related to “financial sustainability.” He cited the revenue difference between the center’s pre-COVID census of 70 patients and current average of 55 patients has reduced revenue by $1.2 million per year.
He did not mention any planned staffing reductions in his report but did say vacant positions should be carefully considered before filling.
“When our census increases again, we may again revisit our structure. But for now, we need to be very cautious about replacing positions simply because that was how we operated previously.”
Connell also reported on the progress of the care center roof and lab projects. He said the demolition phase on the roof is complete, revealing obvious failure points in the roof membrane that allowed a path for water to leak into the interior. He noted that, with state approval, it might be better for the lab to move to another available location within the building during the construction.
Connell reported, though revenue was strong in February, a cybersecurity attack on one of the district’s outside providers of payment services affected the district’s bottom line. Though not a direct attack on NBHH, it nonetheless impacted several areas of the district’s financials, including cash receipts, flow, receivables and allowances for doubtful accounts.
In spite of the event, revenue for the district was strong in February, coming in at $540,000 more than expected. Expenses, though slightly over budget, were within one percent of target.
“This results in a much more muted financial outcome, but once the clearing house is back online and payments resume, those estimates will be reversed in future months,” he explained.
Respiratory therapist/cardiac rehab manager Kimmy Curtis thanked the board for approving cardiac rehab system software, 4-lead sets, a monitor and a Cerner software interface. The equipment was approved at the board meeting held in February.
The trustees briefly discussed changing the day of the month the regular board meeting is held, but the matter was tabled for future discussion.