Patients at West Park Hospital could soon find themselves visiting with a physician by internet at night, and hospitalists employed by Cody Regional Health will now work for a health care management company.
Those types of changes to how CRH provide hospital physician services could save more than $500,000 annually, said CEO Doug McMillan.
The West Park Hospital District Board of Trustees has approved outsourcing management of hospitalists to Sound Physicians Group, a company with headquarters in Tacoma, Wash.
A hospitalist is an in-patient physician who works exclusively in a hospital. The former system of employing six physicians has worked well, but is too expansive, McMillan said.
Last year the hospital’s average daily census was 11 patients per day. Providing physician services through the night became hard to justify, he said.
CRH began exploring options and the advantages of a management company and different hospitalist models were considered. The result was a recommendation to hospital trustees to contract with Sound Physicians and do away with having Cody hospitalists available overnight.
Patients who need services overnight will see a hospitalist remotely via telemedicine services.
McMillan said the management company is a physician-founded and physician-led company with a “community focus on better outcomes.”
“This is all they do,” McMillan said. “(Sound Physicians) work with rural providers.”
With Sound Physicians, if a vacancy occurs, the company can quickly put someone in place, providing temporary relief, he said.
In addition to recruitment services, the company provides its hospitalists continued education training.
“There’s a lot of benefits they can add through our partnership,” McMillan said.
Sound Physicians works with hospitals in Casper, St. Vincent Health, St. James Healthcare, Butte and Miles City, Mont., and many other hospitals around the country.
“We’re excited about the direction,” McMillan said. “(Sound Physicians) provides phenomenal support and care for inpatients.”
He expects the transition to Sound to be effective around June 1.
WPH trustees approved contracting Sound Physicians to manage its hospitalist program by a 4-2 vote in December.
Supporting the motion were Lenox Baker, Graham Jackson, Peggy Rohrbach and Howard Thompson. Catherine Schmidt was absent.
Concerned about giving up local management, trustees Jen Talich and Ty Nelson cast no votes.
“I didn’t feel ready to make a decision on it at that time, and I felt we needed to explore more options of keeping this management piece local,” Talich said by email Friday.
Nelson said he was concerned about outsourcing hospitalist services to an out-of-state company.
“I prefer to keep as much as possible under local management as a community hospital,” he said.
Both trustees said going forward they support the majority decision to work with Sound Physician Group to manage the hospitalist program.
Trustee Graham Jackson, who voted in favor of the contract, said the hospitalist discussion first came up during a board retreat last spring.
“Sound is a leader in the field and will assist CRH in all areas of the hospitalist program, including training and also recruiting, which has been challenging,” she said by email.
Jackson said CRH has a number of similar partnerships in various areas of its operation that are providing health care services in Cody as well.
“With this decision to approve the Sound contract, we are looking forward to working with the same company that assisted CRH when we first moved to the Hospitalist Program about 12 years ago,” she said.
The Cody hospital partnered with Sound Physicians for one year as the company helped recruit and hire the first three physicians, who worked 24-hour shifts – three days on, four days off.
Before presenting options, Sound Physicians looked at how CRH managed its hospitalist program. It recommended two models.
CRH chose a three-person telehospitalist model using one physician per 12 hour shift, 7 a.m.-7 p.m., a nurse practitioner for 10 hours Monday-Friday, 5 a.m.-7 p.m., and fewer hours on weekends.
There is no change to which days hospitalists are available.
The three-physician model uses three doctors plus two nurse practitioner hospitalists and telehospitalist coverage.
At night, hospital nurses will reach out to a tele-doc by internet. The “nocternists” work remotely.
“That’s their job,” McMillan said. “They work at night. They’re ready to respond.”
Under the model, a local physician will remain on call and available to go to the hospital for any critical patient care needs, he said.
Specialists such as pediatric doctors or surgeons will still see their own patients in the hospital.
“The hospitalist providers will be available to assist in admitting or consulting on all physician admissions with the exception of pediatric patients,” McMillan said. “This includes primary care and specialty physician admissions.”
The other option considered was a four-person model with a CRH physician on call at night. Had that been the preferred choice, all positions would have been retained.
McMillan said an estimated savings of more than half a million dollars is expected with either model.
From 2008-2016, hospitalists at West Park Hospital were always on call at night after working a day shift, and they were called for everything, McMillan said.
Those long hours working multiple days in a row plus night duty resulted in burn out and would bring into question a physician’s physical acuteness.
“From our point of view, it’s a safety issue,” McMillan said.
The telehospitalist model will allow staff to consult with physicians who only work at night to provide immediate support to hospital staff and physicians, he said.
It’s difficult to recruit hospitalists to Cody, McMillan said.
Cody Regional Health had employed six hospitalists until one left several months ago.
Finding it difficult to fill the vacancy, CRH stopped its search, reducing the number remaining to five through attrition.
The remaining hospitalists, some employed by CRH and some by Billings Clinic as contract providers, will now become Sound Physicians employees if they remain in their positions.
To retain their job, those on staff must reapply with Sound Physicians and successfully go through the interview process.
The company is interested in maintaining and keeping the hospitalists already employed by CRH, McMillan said.
Should Sound choose to not hire a current hospitalist, the physician will not necessarily become unemployed. The administration will look to place them in other health care areas within the CRH system, McMillan said.
“All our hospitalists have worked in other settings,” he said. “They changed to become hospitalists by choice.”
It’s up to the individual physician whether to accept an alternative position.