Responding to Our Changing Healthcare Environment

by Steven R. Gordon, CEO

Steven R. Gordon, CEO

During the past 18 months, Brattleboro Memorial Hospital has taken several measures to ensure it is prepared to continue providing the highest standard of medical care for the families of Windham County and surrounding areas. Some of the changes were necessary for more efficient operation of the hospital, while others were in anticipation of potential changes in Vermont’s healthcare system.

Bringing Costs Under Control

In the first half of 2011, BMH was projecting a $2.5 million budget deficit. Every department looked long and hard at costs not directly related to patient care to see where savings could be found. In just six months, the hospital was able to cut the deficit by more than half. BMH also joined the New England Alliance for Health, whose 15 member organizations control costs through group purchasing agreements, sharing services, and staff training and development. These efforts have enabled the hospital to achieve break-even status for the past several months.

BMH Physician Group

The BMH Physician Group was established to improve patient access to primary care, pediatric and medical specialty practices. Hospital-owned practices have been a standard model of health care delivery throughout most of the U.S. for over a decade. With many physicians in the Brattleboro area nearing retirement, it was an essential move to aid in recruiting new physicians to our community.

The new Brattleboro Family Medicine practice was established to make more primary care physicians available to the community. Brattleboro Cardiology also welcomed cardiologist Mark Burke, MD, back to practice in Brattleboro, and new ENT and OB/GYN physicians will be on board in the next few months.

There have been physical changes as well. Brattleboro OB/GYN and Putney Family Healthcare relocated to larger spaces that better accommodate the growing number of patients, and Brattleboro Internal Medicine and Windham Internal Medicine merged into a single practice.

Hospitalist Program

Another change in how health care services are provided has been the advent of hospitalist programs. These are teams of physicians specializing in internal medicine who see patients coming to the hospital with acute conditions. They are on staff 24 hours a day, seven days a week to see patients who require a hospital stay. A hospitalist communicates with a patient’s primary care provider while they are at BMH, ensuring a seamless transition between inpatient and outpatient care. Nearly all of the area physicians now participate in BMH’s Hospitalist Program, knowing their patients will receive the highest standard of care.

Dr. Carolyn Taylor-Olson helped found BMH’s Hospitalist Program and was the medical director until this past May, when she accepted the position of Medical Director for the hospital’s Post-Acute Care Services. In her new position, Dr. Taylor-Olson coordinates care between the hospital and residents of Vernon Green, Thompson House and Pine Heights. The current hospitalist team consists of Dr. Aida Avdic (medical director), Dr. David Albright, Dr. Christopher Meyer, Dr. Amy Gadowski and Dr. John Silkensen.

Blueprint for Health

The 10 practices that comprise the BMH Physician Group share a practice management system for patient scheduling and billing that provides greater efficiency. Electronic health records are being integrated into the practices as well. Once complete, resources can be devoted to getting each primary care practice qualified for the Patient Centered Medical Home (PCMH). This program is part of Vermont’s Blueprint for Health which includes coordinating care under the federal Affordable Care Act. So far, Windham Family Practice and Brattleboro Primary Care (an independent practice in the community) are National Committee for Quality Assurance certified PCMHs, but others will follow next year.

Emergency Department Expansion Project

BMH’s most important endeavor for meeting the growing number of patients is just now beginning. Our current Emergency Department was built in 1982 to a scale that would accommodate 6,000 patients annually; yet in 2011, the Emergency Department served 13,000 visitors. The Emergency Department project will enable doctors and nurses to see patients at a faster rate, and with greater support and privacy than before. At the same time, the MRI that is currently in a trailer outside the ED will move to the previously built space in the Richards Building. Additionally, the hospital will have a new front entrance complete with a gift shop and cafe.

Preparing for the Future of Healthcare

Oversight of Vermont hospitals has just been turned over to the newly formed Green Mountain Cares Board and the hospital is actively participating in deliberations around payment reform efforts. With Medicare reimbursements to BMH projected to be cut by $1.5 million, the hospital must continue to build on our initiatives that improve the quality and efficiency of patient care. It is an exciting time to be in healthcare, especially as Vermont leads the nation in looking at new ways to both deliver and finance healthcare!