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Scrapped MCH program thrives in rural hospitals - Odessa American: Ector County Hospital District

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Scrapped MCH program thrives in rural hospitals

Partnerships set the tone for a national model

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Posted: Thursday, October 26, 2017 5:45 am

The Texas Tech University Health Sciences Center’s surgical residency program that Medical Center Hospital pulled the plug on last year ended up benefitting rural West Texas and now may be used to lay the foundation for a national model.

MCH President and CEO Bill Webster made the decision for the hospital not to participate in the residency program in April 2016, citing poor support from “key surgeons” active at the hospital.

TTUHSC’s Department of Surgery regional chairman Dr. Neal Ellis previously told the Odessa American he had the support of local surgeons, but not that of contracted surgeons. The contracted surgeons, he said, could not be a part of the residency program per the board of surgery or the residents review committee.

Ellis said in a May interview the program would have ultimately led to cutting the contracted staff from three to two surgeons and he had every intention to take back over general surgery call—something the contracted surgeons were handling.

The move would have led to cost savings at Medical Center since Texas Tech does not get paid to take call because they are a teaching facility. The hospital would have also received money for allowing the residency program because the state pays Texas Tech and then the university reimburses Medical Center for the cost, Ector County Hospital District 5 candidate Julie Molland said in May.

Molland, who ended up losing the election to Don Hallmark, took part in helping salvage the surgical residency program. The 12 residents expecting to begin the program at MCH in July, many of whom had already made plans to move to Odessa, instead were absorbed by surrounding area hospitals after efforts made by the regional department of surgery.

Molland said she worked as an administrator, setting up meetings with the CEOs of the hospitals so they could present what they were trying to do for the residency program. After intense contracting negotiations, once everything was in place to move forward with the project she helped coordinate the surgeons’ and residents’ schedules at the different hospitals.

“We were able to get through that difficult challenge and turn some good out of it,” Molland said Tuesday. “And instead what we’re able to do is offer care to all these rural community hospitals.”

On Wednesday, TTUHSC presented their findings from working in the rural hospitals at the American College of Surgeons Clinical Congress in 2017 in San Diego.

Some of the results included a reduction in rural area surgical costs, improved quality of care and an increase in revenue for the academic surgical programs, a news release from the American College of Surgeons detailed.

Lead author of the study, Dr. Saju Joseph, a Fellow of the American College of Surgeons and former TTUHSC Department of Surgery vice chairman in the Permian Basin, said the rural West Texas hospitals have a fair number of patients, but very few have a consistent surgical presence.

“On weekends, or any time they’re away, that hospital kind of shut down,” Joseph said.

Placing the academic surgeons in rural hospitals reduced the hospitals’ costs associated with recruiting and staffing surgeons.

“Since more rural hospitals had surgeons available on site, patient transfers were reduced. As a result of these partnerships, participating rural hospitals saw an average increase of $4.7 million in net revenue,” the news release said.

Getting surgical care was difficult for patients living in rural West Texas and Joseph said many of them do not want to travel 40, 50 or up to 100 miles for routine surgery or an office visit. Rural hospitals also commonly face difficulties in recruiting and keeping surgeons on staff, the release said.

“We set out to provide those services closer to home. It’s better for the patients, better for the community. We’re capturing those patients at an earlier time frame,” Joseph said, adding that many of the citizens wouldn’t drive to the hospital until they were “on death’s door.”

When the surgical residents began training in the rural hospitals, they ended up providing service so patients didn’t get to that critical stage. Joseph said they still take more complicated cases to Odessa, but for the most part they are able to provide advanced, quality surgical care close to home.

With patient transfers reduced by more than 70 percent in participating hospitals, Joseph and his colleagues found that patients were substantially more satisfied with their local service.

“In Martin County and Big Springs patient satisfaction has skyrocketed,” he said.

Molland said not having to travel as far and having to pay for costs associated with the travel, including a hotel room, may have also contributed to increased patient satisfaction.

“Patient survey results showed that on a scale of one to 10, average patient satisfaction jumped by an entire point due to the increased availability of surgical services,” the release said.

Due to the partnerships and the resulting decrease in transfers, the projected cost savings for the state of Texas is roughly $7 million, Joseph said.

“The way Texas works is unique because the counties pay for some patient transfers,” he said. “For one small town, saving that money on transfers provided them money to pave their main road. These improvements really show the community that there is something positive going on.”

Molland said cost savings from not staffing contracted surgeons helps, as well.

“When you’re having to hire locums to come in to cover your surgery call, you’re paying at least $5,000 a day,” she said. “By letting Texas Tech surgery come in and help, there’s still cost involved but not anywhere near what they were paying before.”

Molland called it a “win-win for everybody.”

Residents are able to train in an environment where they’re actually able to learn, the hospitals benefit, the local communities benefit and patients get to stay home where their families are, she said.

“Residents are really gaining an unbelievable experience, as well,” Joseph said.

The residents are at the hospitals seeing a patient as soon as they walk through the door, working the patients up, almost acting as a primary doctor sometimes and it has improved the outcome and quality, he said.

The academic surgery department also benefited. Due to academic departments relying on Graduate Medical Education funding to offset the cost of indigent care and education, the partnerships have helped mitigate GME funding reductions, the release said.

The Texas Tech research team was able to successfully develop partnerships for five hospitals in the area — Scenic Mountain Medical Center in Big Springs, Martin County Hospital in Stanton, Big Bend Regional Medical Center in Alpine, Permian Regional Medical Center in Andrews and Medical Arts Hospital in Lamesa.

Joseph said he believes this model is not specific to rural surgery in West Texas, but can benefit rural surgery in many different areas of the U.S. Joseph left the Permian Basin and has since moved to Las Vegas, but said he plans on implementing the same kind of residency programs in Nevada.

“I think it’s a great program and I think for West Texas it’s a huge success,” he said.

Molland said it has definitely laid the groundwork for a national model and she’s looking forward to seeing it grow.

“Without Dr. Ellis and Dr. Joseph’s vision this wouldn’t have been possible,” she said.

As far as the possibility of implementing a surgical residency program at Medical Center Hospital, Joseph said it would be a difficult process and Molland said she doesn’t see it happening unless there are major changes.

Joseph said MCH would have to completely restructure the way their credentialing works.

“No Texas Tech surgeon has been credentialed (at MCH) in the past five years,” he said.

Even with the CEO retiring in January, Molland said the same administration team and current leadership will remain, which likely won’t result in anything changing.

Molland and Ellis both said during May interviews they tried reaching out to the Ector County Hospital District’s board of directors to help continue with the implementation of the surgical residency program at MCH when Webster pulled the plug. But no phone calls were returned or meetings were set up. The board fully backed Webster’s decision to scrap the program.

The hospital board has since seen some turnover as a result of the election in May, with three new board members now serving. But the lack of MCH’s support that caused the department of surgery to reach out to the rural hospitals also resulted in a partnership with another local hospital, Odessa Regional Medical Center.

“In addition to the partnerships with the rural hospitals, the partnership with ORMC was also instrumental in the success of the rural surgery initiative — without this relationship, the surgery residency program may not be in place today,” Molland said.

She also said she doesn’t see any benefit trying to bring the program back to MCH because the hospital would be, in a way, funding the program and directing where those residents would be going.

“With Odessa Regional, they see the benefit and value that our residents bring to that hospital and it’s because of that we’re able to go into other communities.

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