Featured letter: Changes at the Block Island Medical Center?
As you may have heard, there may be changes ahead at the Block Island Medical Center. As president of the board, I am frequently asked to explain what we are doing, why we are doing it, what impact it will have on our staff and the community, and if we considered the negatives of any change.
Our existing health center model has worked well for a number of years but it is threatened by rising costs and the impact of major changes in health care nationwide. We are challenged because this is a small community and the number of visits is not growing. Patient revenues have never covered our costs, and the gap is widening. It is clear that the current model is not sustainable in the long run. The Block Island Health Services (BIHS) board has spent the past two years studying the current model, its challenges, and our options. We have obtained advice from health care delivery experts and have hosted seminars for the staff and board to look at the challenges and options. We held a number of “listening” sessions to obtain input from the community. We did research to determine how other communities with similar challenges have resolved their problems of isolation, small size, increasing costs, decreasing revenues, and growing demand to use new technologies. All indicators point to the need to establish an affiliation with a larger entity that can provide services more efficiently and less expensively. Larger centers can afford to invest in the technologies demanded by insurers and the government.
Health Care Issues at the National Level
Nationwide there has been uproar over the rising cost of health care when accompanied by no improvement in the nation’s health. Compared to other developed countries, the United States spends twice as much as the next ranked country but has glaringly inferior health statistics. This is a nation that can provide the most technologically advanced treatment for some serious illnesses but more progress is needed in preventing or treating chronic health conditions that are experienced by much of the population and that consume the largest share of total health care costs. These chronic problems include diabetes, heart disease, hypertension, arthritis, depression, and asthma to name a few. Medical care is criticized for being highly specialized, expensive, fragmented, uncoordinated, difficult to access, and offering no guarantee of quality. There is no incentive to keep people healthy as health care dollars are reimbursed for treating people who are sick.
Electronic Medical Records
The federal government has addressed the problem by promoting change in how health care is provided and paid for. It is demanding that medical professionals demonstrate they are providing appropriate, effective, and comprehensive services to keep people as healthy as possible. This accountability becomes evident and is monitored through the use of electronic health records (EHR). Primary care involves treatment of episodic illness but most importantly it addresses regular screening (early detection), education (to prevent disease, promote healthy lifestyles and nutrition), and the coordination of care when the patient needs to be sent to a specialist or for additional testing. Primary care of patients with chronic diseases involves frequent monitoring of specific measurements that reflect the effectiveness of treatment. These measurements, obtained in a local medical office, can be compared to the same measurements of like patients on a national basis. A standard of care is established that can help local providers evaluate the quality of their clinical practice. In addition, it is far easier to coordinate a patient’s treatment among multiple providers when information can be shared through an EHR.
Patient-Centered Medical Home
Financial incentives help motivate health care practices to create a user-friendly, patient-centered destination for primary care. Patients can choose a medical “home” that becomes responsible for their ongoing health. Providers are encouraged to take the steps necessary to be identified as a Patient-Centered Medical Home by the National Committee for Quality Assurance. Such recognition requires that the practice have electronic health records. Changing from paper to digital records is costly and time consuming, even with help from federal grants. But the change is happening and offices report that it is worth it in the end. Once a practice demonstrates that it has achieved a required standard of care for its patients, there are increases in the rates of reimbursements from private insurance companies, Medicare, and Medicaid, which eventually off-set the cost of the new system. Moreover, there are disincentives for not taking these steps; in the near future reimbursements will be cut to practices that have not adopted these changes.
Thundermist Health Center
Thundermist Health Center with operations in Woonsocket, West Warwick, and Wakefield, is a Patient-Centered Medical Home. All three sites have been awarded the highest level of distinction from the National Committee for Quality Assurance. Thundermist has electronic health records in place and is using this technology to provide the most effective treatment and services to over 35,000 patients in Rhode Island. Their success as a demonstration of quality health care was recently recognized by Kathleen Sebelius, the US Secretary of Health and Human Services. Thundermist was identified as one of the top Patient-Centered Medical Homes in the country. It should be no surprise that they have been rewarded with millions of dollars in funding for expansion and capital projects.
Thundermist and the Block Island Medical Center
Our medical center staff and board were invited to Thundermist’s West Warwick location last summer. We toured the facility and heard senior officers give presentations on clinical medicine, finances, information technology services, and funding/fundraising. A paperless environment was a new experience for most of us. Following this visit, we had discussions about the options available to both organizations. Thundermist is willing to assist Block Island in developing a primary care medical home model using their electronic health record technology. This will occur through a Management Services Agreement between Thundermist and Block Island. Under the agreement, Thundermist would help us install the hardware and software needed to use their systems. Thundermist will also provide training for our staff in using the systems. The technology would provide electronic scheduling, billing, coding, and medical records as a beginning. Thundermist staff will work with us in writing grant proposals to help fund this project. They will review our current organization, management, quality control, policies, and clinical practices in an ongoing effort to update our operation. Thundermist has had impressive success in increasing access to health care for the underinsured and uninsured. Their process for assisting those in need through sliding scale fees will be useful on Block Island.
Not a Merger or Takeover
It is important to emphasize that we are discussing an affiliation with Thundermist, not a merger. A management services agreement will generate expenses to be borne primarily by BIHS but it is expected that savings from economies of scale and improved reimbursements would offset much of the cost of the improvements. Block Island Health Services has an endowment that is managed by a group of dedicated volunteers with expertise in investments. This endowment, as well as the building and properties (owned by the town) will not be “taken over” in any way by Thundermist. Our existing staff will continue in their current positions.
Benefits of a Thundermist Affiliation
For BIHS to independently establish itself as a Patient-Centered Medical Home with electronic health records would be an impossible undertaking. An affiliation with Thundermist creates an opportunity for us to move into the mainstream of health care delivery and offer a standard of care we could not otherwise achieve. We will be qualified for funding sources and resources not currently available to us. We will be able to generate data through measurements of patient outcomes that will provide ongoing feedback on the effectiveness of our care. BIHS will become more efficient, saving money by buying through a larger group, eligible for higher reimbursements, and able to provide state-of-the-art primary care. We will be better able to coordinate patient care with off-island specialists. BIHS can take advantage of all the experience Thundermist has accumulated over the past 35 years
In conclusion, the board sees this affiliation as a win-win opportunity. Thundermist will gain recognition for having the insight to extend itself to a small, isolated community and expand its citizens’ access to services. Block Island will have an opportunity to adopt innovations being demanded by insurers and the government. Our staff will be able to become proficient in technologies and approaches that will allow them to practice at their highest level of potential. They will also gain mainland colleagues and access to resources to enhance services to the Block Island community. We think it is a wonderful opportunity for all of us.