Physical Therapy Offered in Cedarville Soon
Mackinac Straits Hospital, Medicare To Install New Pay-for-performance Insurance Reimbursement Program
By Amy Polk

Cedarville will be the site of a new rehabilitation center, expected to open as early as May. The center will be housed in three rooms of Dr. Blake Slater's office building on M- 134, and will be a joint venture between Mackinac Straits Hospital and Health Center in St. Ignace and War Memorial Hospital in Sault Ste. Marie.

"I'm excited about it," Dr. Slater said. "It will do a lot of things for this area, and if it works out, hopefully we could expand it in the future."

Mackinac Straits Chief Operating Officer Rod Nelson updated the hospital authority Monday, March 24, reporting that things are moving along in the negotiation phase.

"Hopefully we can have that up and running by this summer," Mr. Nelson told the board.

Dr. Slater thinks rehabilitation services, including physical and occupational therapy and speech pathology, will be available as early as May.

An increasing number of people need these services, said Jim Haglund, vice president of rehabilitation at War Memorial Hospital. Patients often need rehabilitative therapy after a stroke, surgery, neurological damage, or a muscular or skeletal affliction.

Patients may need therapy as much as two to three times a week, and now have to drive or find transportation to hospitals or clinics in Sault Ste. Marie, St. Ignace, or Petoskey.

"With the price of gas these days, it's difficult for people to have to drive significant distances," Mr. Haglund said.

Mr. Haglund, who is heading up the venture, said the hospitals and Dr. Slater identified a need for rehabilitation services closer to the residents served in Cedarville. Dr. Slater and physician's assistant Kathy Duman serve a population base of about 3,000 year-around residents in Clark Township and the outlying areas. The population nearly triples in the summertime, when cottagers and the transient population seek services at the Cedarville office.

Mr. Haglund could not estimate how many patients will seek rehabilitation services in Cedarville, but believes the joint venture will be cost effective for both hospitals. Mr. Haglund has already hired two new therapists to help staff the office. They will not only work in Cedarville, he said, but probably also in Sault Ste. Marie.

The Cedarville rehabilitation center will start with conservative hours, Mr. Haglund said, probably two to three days a week, on an "asneeded" basis. Additional days and hours will be offered as the need grows.

"I think it's a service that has been needed for some time," Mr. Haglund added.

Insurance Reimbursements

To Be Performance Based;

Medicare Scaling Back

Mackinac Straits Hospital may qualify for more reimbursement from Blue Cross and Blue Shield through a new pay-for-performance program the insurance company has adopted. Hospital performance will be evaluated annually, and top-performing hospitals can earn up to 4% more in reimbursement payments than if performance is standard.

"More and more of our future reimbursements will be tied to quality, so quality will be very important in the future," Mr. Nelson told the board.

The insurance company has a detailed list of the kinds of quality performance it will reward hospitals for, such as malnutrition evaluations upon admission, pressure ulcer risk evaluations, implementing a tool that can detect and respond to medical errors, and following specific "perfect care" instructions for identifying certain illnesses or infections.

The incentives are being implemented by Blue Cross and Blue Shield to help raise the standard of health care, increase efficiency, and cut the number of preventable problems by paying more reimbursement to hospitals that work harder to meet the higher standards. By 2010, Blue Cross and Blue Shield will raise the reimbursement incentive to 6%.

Medicare's new policy to refuse reimbursement to hospitals for eight conditions it considers preventable is a similar initiative Mr. Nelson reported on.

"If someone falls at the hospital and breaks a hip, Medicare won't pay for it in the future, if it is the fault of the hospital," Mr. Nelson said as an example, adding that Medicare is still defining its list of preventable conditions.

The eight conditions listed now include falls, mediastinitis (an infection that can develop after heart surgery); urinary tract infections that result from improper use of catheters; pressure ulcers; vascular infections from improper use of catheters; objects accidentally left in the body during surgery; air embolisms, and blood incompatibility. Medicare's new policy is supposed to be effective October 2008.

Long Term Care, Acute Care,

Employee Safety Incidents

Reported by Human Resources

Medical errors in the Long Term Care Unit were down in 2007 by 48%, from 172 in 2006, Human Resources Manager Karen Cheeseman reported. There were 90 errors in 2007. Total resident occurrences, which include things like fracture, physical aggression, and property damage by residents, decreased by 25%, with 642 in 2006 and 482 in 2007. Falls increased from 197 in 2006 to 230 in 2007. Comparing the days of the week that most occurrences and medical errors took place, Fridays had the most, and Mondays had the second most. Sundays had the fewest.

In the acute care unit, occurrences decreased from 52 to 44 between 2006 and 2007.

In summary, 2007 was a good year for employee incidents, Mrs. Cheeseman said, with fewer workers compensation claims and reported incidents.

Employee occurrences, including accidents like sprains, bruises, burns, or pain, decreased 28%, from 165 to 119, between 2006 to 2007. Workers compensation claims dropped from 51 to 48, from 2006 to 2007. Thursdays had the fewest incidents and Friday had the most, Mrs. Cheeseman reported. The hospital celebrated the low incident rate with an Employee Safety Day November 27, when 16 prizes were awarded to staff members.

New Hospital

Construction Update

The new hospital site plan is close to completion, Mr. Nelson said, and now staff are picking out a color scheme for the new facility.

"We're trying to reduce the cost of the project to fit within our budget," he said.

The budget is $26 million, and the project was originally to include 140,000 square feet of facility space, but is now being scaled back by 30,000 square feet, to 110,000. The facility will be built on State Street in St. Ignace, and is expected to be finished in 2009.

"We're focusing on the most reimbursable spaces right now," Mr. Nelson said, explaining that the most money will be spent on dedicated space that will earn more revenue for the hospital.

The new facility will have an emergency department, radiology and laboratory services, acute care, oncology, and dialysis services. Future assisted living services have also been discussed.

The United States Department of Agriculture has approved $37 million in loans for the new hospital project, which includes the $26 million cost of construction and $2.4 million to pay off the Mackinac Island Medical Center's construction debt. The balance of the loans will pay the financing costs. The loans will be repaid over time using hospital revenue.

June 4 is the anticipated closing date on the bonds, Mr. Nelson told the authority.

Long Term Care Survey

Asked by authority members what corrective action has been taken on three citations at the Long Term Care unit, Mr. Nelson described staff efforts to correct those problems. Overall, he said, the Long Term Care survey was positive, and the citations were not about patient care or staffing.

Staff corrected the citation that 15 room separation curtains were too short by replacing seven and lengthening eight of them, he said.

Catheter drainage bags are now hidden discreetly, after a second citation noted they were sometimes visible.

The third citation was that patient trust funds were not being returned to patients or their families quickly enough. Trust funds are small accounts held at the hospital for a patient's personal expenses like trips, telephone bills, or haircuts.

The facility used to hold accounts to cover bills that may come after the patient leaves the facility. The policy is now to refund the account balance upon discharge, and any bills that come will be forwarded to the patient or family.

Hospital Auxiliary

Geranium Sale May 16

Kay Hoppenrath of Mackinac Island won a quilt raffled off as a fundraiser for the Mackinac Straits Hospital Auxiliary, hospital secretary Shannon Doran announced. Linda Lozen of St. Ignace donated the quilt, and the drawing was March 20. The auxiliary made $136 from the sale of raffle tickets.

A Karen's Uniform Sale will be Thursday, April 3, in the hospital's education room. Hospital staff can buy uniforms, shoes, and other apparel there, and Mrs. Doran said the event has saved time and money for hospital staff, who can make purchases there rather than having to drive elsewhere to get apparel.

The auxiliary's annual geranium sale will be May 16, and details will be announced closer to the event. The 2007 sale raised $1,432 for the hospital auxiliary.

Money raised by the auxiliary is used to buy equipment for Mackinac Straits Hospital. The auxiliary also plans to give $1,000 this year to the new hospital project.

New Hospital

Documents at Library

Mackinac Straits Hospital has placed a number of documents related to the new hospital at the St. Ignace Public Library, which are available to the public. The documents include the feasibility study, the hospital asset transfer agreement, Public Act 47, biographies of the new hospital's architect and engineer, the USDA funding approval, and a question and answer sheet about the new hospital.