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Turn around time

With a $6.8 million loss behind it, UnityPoint anticipates breaking even in 2019

-Messenger photo by Hans Madsen
The front entrance to UnityPoint Health Trinity Regional Medical Center is pictured.

*Iowa Hospital Association

UnityPoint Health – Trinity Regional Medical Center generates 742 jobs that add $73,683,056 to Webster County’s economy, according to the latest study by the Iowa Hospital Association.

Trinity employees by themselves spend $24,082,974 on retail sales and contribute $1,444,978 in state sales tax revenue.

Iowa hospitals directly employ 76,203 people and create another 64,453 jobs outside the hospital sector. As an income source, hospitals provide $5 billion in salaries and benefits and generate another $2.7 billion through other jobs that depend on hospitals.

When Leah Glasgo took over as president and CEO of UnityPoint Health — Trinity Regional Medical Center, she was immediately confronted with financial challenges.

In 2018, the Fort Dodge hospital ended the year with a $6.8 million deficit, she said. Glasgo assumed her new role with UnityPoint in late January.

In the months since that time, Glasgo and hospital administration have worked to find solutions to help turn that deficit around and increase efficiency.

One of the reasons for the shortfall, according to Glasgo, is that during the last five years, reimbursement has increased slightly and expenses have increased by more than 3 percent.

“That trajectory does not match up and it turns our bottom line to a negative line,” Glasgo said.

She said that trend is not exclusive to Fort Dodge.

“This is happening all over the country,” Glasgo said. “But because we have a higher Medicaid and Medicare population, we are impacted more significantly.”

About 71 percent of Webster County is made up of Medicaid or Medicare patients, according to Shannon McQuillen, vice president of marketing and community relations.

“With that, our team has gotten right to work and created some mitigation strategies to help us right-size or transform the organization,” Glasgo said.

One of those strategies is the hospital’s participation in what’s called a provider-based Rural Health Clinic program.

“It’s a program from Medicare where we are able to, because of the size of our organization, we are able to receive cost-based reimbursement in our family practice clinic,” Glasgo said.

The hospital is eligible because of the number of Medicaid and Medicare patients it cares for.

Glasgo said any place where the hospital has family practice clinics, a cost report is submitted through a government-run program.

Centers for Medicaid and Medicare Services oversees the program.

The hospital is then paid the difference between the normal fee and the cost for the hospital to care for its population, she said.

“They pay us the difference,” Glasgo said. “It helps fill in the gaps and care for this community in the way we haven’t been able to from the business side of it. This helps us support the financial side of the organization.”

Urgent care is considered family practice care, according to Glasgo. And because of that, the hospital is moving its urgent care to the front of the hospital.

It will be renamed Family Practice Kenyon Road Walk-In Clinic.

Glasgo said that will allow the hospital to apply the reimbursement strategies of the rural health care clinic.

“The name will change,” she said. “But all of the services will stay the same.”

The new location will be adjacent to clinic registration.

The move is anticipated to be complete by Aug. 1.

“To be compliant with rural-based health care rules it has to be an adjacent space to family practice clinics and we felt this was the most convenient spot for patients,” Glasgo said.

It will allow patients to access valet parking, the retail pharmacy, and a coffee shop.

Glasgo said it will be more convenient for prescription refills.

UnityPoint has also ended its MD anesthesiology coverage.

“That was a decision jointly made with our board and medical staff,” Glasgo said.

She said that results in a $1.7 million annual savings.

“We have fully-staffed and quality CRNAs (Certified Registered Nurse Anesthetists) that deliver anesthesia services and they are allowed to be sole providers and deliver anesthesia services,” Glasgo said.

When the hospital began providing open heart surgeries in 2000, it was required to have anesthesiologists for those open heart cases, she said.

But when the hospital stopped performing open heart surgeries in 2013, the MD anesthesiologists were no longer needed and are not required by law, she said.

The hospital is also focusing on a general reduction of overhead expenses.

One example is negotiating supply costs with vendors to reduce the cost of medical supplies and equipment, Glasgo said.

A final area of emphasis has been a reconfiguration of some staff responsibilities.

On May 29, a decision was made that impacted one employee at Trinity Regional Medical Center.

That person, who was not named, had their role changed, according to Glasgo. The change will go into effect June 23.

“We have made some transitions in the organization and in our leadership structure,” Glasgo said. “There has been some difficult decisions, but we know we have a responsibility to keep this community hospital strong for a very long time. All of these decisions have been difficult, but we feel very confident that these decisions will positively impact the organization here in Fort Dodge to keep us a strong and vibrant health care organization long into the future.”

She added, “Health care is changing so quickly and we have to keep up. This is our effort and our responsibility to keep up with those changes.”

As a result of strategies implemented in recent months, the hospital is anticipated to break even in 2019. It is budgeting for a 1 percent margin in 2020.

Glasgo said while the hospital has pursued mitigation strategies to reduce expenses, it is also pursuing growth opportunities.

The recent announcement of orthopedic care being offered once again in Fort Dodge is an example of that.

“That’s an effort to grow on the revenue side and offer a greater service to our community here,” she said. “We are very excited about our partnership with CNOS (Center for Neurosciences, Orthopaedics & Spine PC).”

Dr. Richard Lawton from CNOS will provide services in Fort Dodge every Monday.

UnityPoint will also have a new OBGYN physician coming in July.

“We are growing our women’s and children’s care,” Glasgo said. “Growing our ability to do GYN surgeries here locally.”

The hospital is growing its urology care too.

“Surgical cases here in Fort Dodge, in partnership with UnityPoint Health — Waterloo physicians,” Glasgo said. “Those are all areas we are focused on growth.”

Throughout her short time in Fort Dodge, Glasgo said she’s been pleased with the efforts of employees and volunteers who have contributed to the hospital.

“We have an absolutely phenomenal group of staff members that really care about the community,” she said. “The people are the most important thing about our organization. Our employees, our physicians, our volunteers.”

In 2018, the hospital had more than 20,000 hours of volunteer work contributed to the organization.

Glasgo is optimistic in how the hospital will deliver care in the Fort Dodge area going forward.

“Our future is very bright,” Glasgo said. “We are 100 percent focused on our patients and caring for our community with a goal to be the best rural hospital in the region.”