Case Study: Pioneers Memorial Hospital
Situation
Pioneers Memorial Healthcare District (PMHD) is a 107-bed acute care facility about 60 minutes north of the Mexico/California border. The hospital opened in 1950 and boasts of its history of innovation and commitment to expand services for all residents of the Imperial Valley.
PMHD had an existing contract with another management company which was no longer meeting their needs. While the program had been generally successful, a burdensome risk-share model with high costs and a declining value proposition prompted a move towards self management. They chose Wound Care Advantage to provide ongoing management consulting services to assist in the operations of the program and provide additional help as needed.
Challenges
- The program director was facing the possibility of losing her position due to a non-compete clause in the previous arrangement.
- Under their previous contract, all staff except for the physicians were employed by the management company. The staff desired to be integrated back into the hospital
- The medical staff disagreed with the Clinical Practice Guidelines provided by the previous management company and were understandably skeptical of another company coming in to the clinic and dictating how they practiced medicine.
- The hospital had recently built a new wound care and HBO suite and wanted to move operations to the new location while transitioning management companies, with as little disruption to patient care as possible.
Solutions
- We assisted the hospital’s legal counsel in petitioning for the right of the program director to remain with the facility, allowing someone born and raised in the city of Brawley and dedicated to the community to oversee the service line.
- We negotiated a flat-fee management model where WCA provides consultative support to the program, giving PMHD access to all of the necessary tools, including Luvo EMR, to run a successful program.
- All nursing and non-clinical staff were retained and became hospital employees.
- We introduced suggested treatment pathways based on the Wound Healing Society Guidelines into the program and worked with the medical director to create Clinical Practice Guidelines that all medical staff could accept.
- With just two days of clinic closure, all program staff were trained on the new EMR system and workflows, and the program was relaunched with a successful Go-Live in the new suite.
Results
The program has been successful across all measures and remains profitable, competitive, and continues to grow. Ongoing changes occurring at the center have demonstrated the value of building a strong consulting partnership.
Since transitioning to WCA, the program faced the loss of a long-standing clinical coordinator and the retirement of the medical director. WCA assisted with the training of the new clinical coordinator and continues to work with the medical director to ensure Clinical Practice Guidelines are followed and stay relevant.
Approximately a year into the contract, the hospital reached out for assistance due to an increase in denied claims from both CMS and private payers. WCA assisted with a preliminary review and offered solutions for improving the hospital’s denial rate. We worked with the clinical and medical staff to fix documentation issues and offered recommendations to the business office to help decrease denial occurrence and improve revenue cycle processes.
PMHD continues to benefit from the partnership with Wound Care Advantage in having a strategic partner that can address concerns related to all aspects of outpatient wound care and hyperbaric medicine. By lowering their monthly management fee, the hospital now has additional funds to put back into the wound care program and is considering an inpatient partnership with WCA to provide wound treatment support across the continuum of care.