UnityPoint Health — Fort Dodge Thriving

Medical facility heads into 2017 with innovative agenda

-Messenger photo by Hans Madsen Dean Barnett, left, gets a look at the decontamination room in the new Trinity Regional Medical Center emergency department with Terry Evans, ambulance supervisor, during an open house Thursday afternoon.

Michael Dewerff, president and chief executive officer of UnityPoint Health — Fort Dodge, has good news for area residents. Trinity Regional Medical Center has completed major enhancements in 2016 and is on course to strengthen further its ability to provide top-notch care to residents of north central Iowa.

“Our balance sheet is still very strong,” Dewerff said. “Financially, we are very strong. We have a great leadership team here and a great board. So, we have a great history of being able to execute our plans.”

TRMC’s well-being is important for the broader community not only because of the health care it provides. The medical center is also one of the county’s largest employers. With more than 1,000 employees, it contributes roughly $63 million to the Webster County economy each year, according to data provided by officials at Trinity and the Iowa Hospital Association.

Dewerff said key recent developments at UnityPoint Health — Fort Dodge include the following:

1. Completion of an extensive Emergency Department at expansion and upgrade at Trinity Regional Medical Center that has been underway since 2014.

-Messenger photo by Hans Madsen Sheri Hotobeck, an ER nurse at Trinity Regional Medical Center, shows off one of the acute treatment rooms to flight nurse Mark Dorr, at left, and his wife Pat Dorr, right. The room has a window and an adjoining room where family members can see their patient.

2. Continued participation in innovative Accountable Care Organization collaborations.

3. Evolution and enhancement of the medical center’s ongoing commitment to quality-of-care initiatives.

4. Success in recruiting new physicians in a wide range of specialties.

5. An array of certifications and recognitions have been received that document the excellence of the services offered by many of the components of the system in this region.

Dewerff said he is bullish about UnityPoint Health — Fort Dodge’s accomplishments and enthused about its long-term potential.

“I think we are in very good shape,” he said. “I believe that the best days of health care are ahead of us and that we are positioned well to take advantage of that considering the work we’ve been doing with the ACO and the change in the way we get paid away from volume and more toward value. That’s the way the health system is going. We are providing a good place for employees to work, physicians to practice.”

Emergency Department upgrade

TRMC broke ground in October 2014 on a major revamping of its Emergency Department. The finishing touches on that $5 million project took place in January. The extensive undertaking included both new construction and remodeling of the space that was previously occupied by the department.

At the time the project was launched, Dr. Dan Cole, then medical director of the Emergency Department explained why it was crucial.

“We are seeing between 21,000 and 23,000 Emergency Department visits a year, averaging 67 a day and 80 to 90 on weekends,” he said, noting that the configuration being replaced was designed to handle 12,000 patients annually. “We are short on space for all the new tools we have in the Emergency Department.”

Troy Martens, Trinity’s chief operating officer, said the increasing demand for outpatient services including those of the Emergency Department made a significant redevelopment of the medical center’s capabilities crucial. He and Dewerff both stressed that patients are experiencing a number of positive changes as a result of this investment with improved privacy being among the most important.

“The Emergency Department has more private rooms,” Dewerff said. “That will provide more privacy for patients. There is better triage than before. Also there is a bigger waiting room.”

The footprint for the Emergency Department has doubled, according to Martens. He said that made it possible to have more and larger examination rooms, a bereavement room and a decontamination room.

As part of this renovation, the UnityPoint Clinic’s Urgent Care unit was also expanded. That effort was accomplished in the early stages of the 18-month rebuild process. The number of examination rooms in Urgent Care increased from three to six.

Accountable Care Organization

In 2012, Trinity Regional Medical Center became a pilot site for a redesign of the health care delivery system to improve its flexibility to serve the full-range of patient needs.

TRMC and what was then named the Trimark Physicians Group were selected to participate in the federal government’s Pioneer Accountable Care Organization initiative. The local project was one of only 32 such pilots nationally. Importantly, it was one of just two that were focused on health care in a rural setting.

Improving patient care and enhancing the efficiency of its delivery were at the heart of the Pioneer ACO approach. According to a statement issued by Iowa Health System (now UnityPoint Health) in December 2012, through the Pioneer ACO Model, what is now UnityPoint Clinic and Trinity were working with the federal government’s Centers for Medicare & Medicaid Services Innovation Center “to provide Medicare beneficiaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination.”

That undertaking proved so successful that UnityPoint Health — Fort Dodge has now progressed to be part of the next phase of ACO development, according to Dewerff.

In January 2016, according to information provided by the medical center, UnityPoint Health Partners, the ACO of UnityPoint Health, was selected to participate in the new accountable care organization approach implemented by CMS called the Next Generation ACO Model. This next-stage endeavor builds on the experience gained from the Pioneer ACO Model.

“Under the Pioneer ACO, it was just the Fort Dodge region — Trinity and Trimark,” Dewerff said. “We were standalone in the Pioneer ACO. Now in the next generation ACO we’re part of the larger UnityPoint Health. It’s all UnityPoint Health regions except two. The first year of that contract was 2016. It’s three years.”

Dewerff said the underlying philosophy for the ACO project is unchanged.

“The principles are still the same,” he said. “If you lower the cost of care and improve on your quality metrics, you will share in the savings.”

Dewerff said the ACO experience has been beneficial to both UnityPoint Health — Fort Dodge and area patients.

“From a culture standpoint and learning about this new world of health care, this was a huge plus,” he said. “We learned a lot. The culture has caused a lot of collaboration and affiliation with partners maybe we didn’t partner with before. Public Health is a huge partner, the pharmacies in the area, the nursing homes in the area. Now we are working together like we have never worked together before.”

Dewerff said the enhanced care coordination is intended to improve the quality of care while introducing efficiencies that will keep the cost of care within acceptable limits. That is a win for both providers and patients, he said.

Quality of care

Looking ahead 2017 unfolds, Dewerff said the overarching mission of UnityPoint Health — Fort Dodge remains fundamentally unchanged.

“Our goal continues to be what it has been as far as a focus on the good patient experience,” he said. “The ACO work has created a culture here of making sure our patients are at the right place for care. That includes a seamless transition not only from our rural affiliates to Fort Dodge if they need to come to Fort Dodge, but also a seamless experience from Fort Dodge to our sister hospitals around the state.”

Both Dewerff and Martens said there is an increased emphasis on tracking patient satisfaction with the care they receive and making use of feedback from surveys and other contacts to improve the care delivery system.

“We’ve made some really good progress in patient experience,” Dewerff said.

Martens strongly agreed with that assessment.

“Clinical competency has always been at the core of what we expect of our staff,” he said. “Patient experience and how you relate and communicate and support and alleviate anxiety that is now also a core competency. It’s an expectation, that’s part of what we do to provide health care. That is a lot different than if I went back 10 years ago. It’s what we do today.”

With that in mind, Martens said patient satisfaction surveys are management tools that hospital personnel take very seriously.

“Everyone in the senior staff looks at those surveys,” he said.

Physician recruitment

Recruiting the physicians who are at the heart of the health care system is a major concern for hospitals everywhere.

It is obvious to even the casual observer that talented physicians and midlevel providers are key ingredients in any sophisticated health care system. What may not be so apparent, however, is that finding and keeping the right physicians is a complicated undertaking.

The simple truth is that the competition among communities and hospitals for top-quality physicians is quite intense and almost certain to become more so.

According to a fact sheet released by the American Association of Medical Colleges, there is already a physician shortage in the United States that could grow to a shortfall of 124,000 to 159,000 physicians by 2025. In rural America, the problem is especially severe. The National Rural Health Association has estimated that about one-quarter of the U.S. population lives in rural areas, but only one in 10 physicians practices in these regions.

That means an ongoing focus on recruitment is always a major concern at UnityPoint Health — Fort Dodge.

The good news is that despite some obstacles, physician recruitment is going well, Dewerff said.

He is quick to acknowledge, however, that getting physicians to consider relocating to a rural community isn’t always an ease sale.

“To be honest, it’s spouses — male or female — that are the main obstacle,” Dewerff said. “Physicians come here, they tour the hospital and they meet their potential partners and conclude this would be a great place to practice. The spouse if they are a non-physician has more questions. … We work well with the growth Alliance regarding employment for spouses. … Once we get them here, we can recruit them. They are often surprised at how much recreation we have around here, the quality of life, the schools really are pretty good.”

Martens said the progress Fort Dodge and Webster County have made in making the region attractive to businesses is paying dividends for the hospital in terms of physician recruitment.

“The perception of Fort Dodge has improved,” he said. “I think the quality of life, the appearance of Fort Dodge, the retail growth, the expansion of other jobs, the ag business are all helping. Economically, I think Fort Dodge is on the right track. It shows well.”


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