New equipment, upgraded ER are top priorities

By Ann McCreary

Three Rivers Hospital in Brewster will ask voters in the hospital district to approve two tax levies in November to replace equipment and upgrade the hospital’s emergency department.

The hospital is placing a levy lid lift and an excess levy on the general election ballot. The levy lid lift would increase the ceiling on taxes paid to the district, and the excess levy would provide for a one-time collection in 2016 on all taxable property within the hospital district.

The current levy for Okanogan Douglas District Hospital 1, renamed Three Rivers Hospital in 2011, is 63 cents per $1,000 of assessed valuation, or $63 per $100,000. The levy lid lift would add 12 cents per $1,000 valuation, bringing the tax bill to $75 per $100,000.

The second levy proposition provides for a tax of $1 per $1,000 of assessed valuation, or $100 per $100,000, to be paid one time in 2016. The tax would expire in 2017.

Three Rivers Hospital is seeking the additional tax revenue to upgrade equipment and facilities, said Terri Orford, recently hired as the hospital’s business development coordinator.

“Much of the hospital’s patient care equipment is near the end of its life and is in need of replacement,” Orford said.

The equipment includes patient beds, centralized patient monitoring, EKGs, X-ray equipment and surgical beds. The levy funding would also be used to make improvements to the hospital’s emergency department, which is too small and doesn’t allow medical staff to see all patients in the department.

The hospital wants to relocate the emergency department to a more recently remodeled clinic area that will provide a centralized nursing station that allows views of all patients in the unit. The new space will allow the hospital to expand its emergency department from four exam rooms to eight, Orford said. In order to use that space, the hospital must upgrade the air conditioning systems to comply with health codes, she said.

Critical care

Three Rivers Hospital is a public, nonprofit hospital and is certified as a Critical Access Hospital (CAH) by the federal Department of Health and Human Services. Certification allows CAHs to receive cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates, with the goal of helping small rural hospitals financially and reducing hospital closures.

As a CAH, Three Rivers must comply with a number of requirements, including having no more than 25 inpatient beds; maintaining an annual average length of stay of no more than 96 hours for acute inpatient care; offering 24-hour, 7-day-a-week emergency care; and being located in a rural area, at least 35 miles drive away from any other hospital or CAH.

The hospital has struggled to meet some of these criteria, such as providing around-the-clock physician staffing of its emergency department. Recently, the hospital began contracting with a company called Coast to Coast Healthcare Services that provides visiting emergency medicine doctors who work long shifts at the hospital to provide that service, Orford said.

“It solves the dilemma of staffing the emergency room 24/7, which is very costly,” Orford said.

Three Rivers serves a large area of Okanogan and Douglas counties from Mazama to Monse to Mansfield. It has been in debt for many years, using loans from Okanogan County to pay for operating costs. A state audit found that the hospital owed the county about $2.9 million in 2012. That amount had been reduced to $1.5 million as of September, and the hospital “is on budget for a net profit in 2015,” Orford said.

“We have a goal and are working closely with the country treasurer … to pay off the warrants to the county in 2016,” Orford said.

Improved situation

The hospital directors hired a new chief executive officer, Scott Graham, about 18 months ago. Orford said the hospital’s financial situation has improved due to factors that include an increase in patients using the facility, adopting management approaches that increase efficiency, and improved billing practices.

“There’s been a real focus on capturing charges and not providing services for free,” she said.

The hospital has also adopted a program to reduce customers’ hospital bills by giving credit for the amount that is paid into the district through property taxes.

“For instance, if you are paying $162 a year in taxes, you’ll get that as a credit on your [hospital] bill,” Orford said.

“We want to encourage people who are paying taxes to our district to use the service they’re paying for,” she said. The hospital benefits when patients use the facility and their health insurance reimburses the hospital for the services, she said.

Three Rivers Hospital, like many CAHs around the nation, is struggling financially because it has a high volume of Medicare and Medicaid patients, and reimbursements for those patients don’t cover actual costs of health care they receive, Orford said.

“The federal government puts the onus on communities to support those CAHs,” she said. “This levy is going to be a real indicator to us as to whether or not this community wants this hospital.”