GMH discusses potential integration
By Molly Moser
As part of a national agenda to improve population health management, health care providers will soon be reimbursed based on level of patient satisfaction, quality of outcomes, and ability to keep costs low. Preparation to meet this triple aim, which will be the goal of the health care delivery system from this year forward, is driving partnerships across the country, and Guttenberg Municipal Hospital is no exception.
In order to meet the demands of the Affordable Care Act while facing a reduction in government reimbursement, the hospital board has begun a thorough investigation of potential affiliates to ensure sustainability. Work groups will meet in March, and GMH intends to engage in employee and community education in the mean time. Interested readers should visit www.guttenberghospital.org and watch for a presentation on local channel six for more information.
Because no formal decisions have been made at this time, many questions remain. “At the end of the day, we want patient services that are provided locally and are of high quality,” said board member Doug Reimer. “All that’s been done so far is to set a direction that’s positive for patients, employees, and the community.”
Dr. Jeff Hoffmann, GMH Chief of Staff, encourages the community to get involved with the process. “Be at meetings. Ask questions,” he said. Hoffmann is cautious about aligning GMH with a larger entity, especially in terms of retaining the independence to accept a variety of insurance products. “I’m not against integrating, it’s just to what degree,” he told The Press. His goal is to maintain the access to primary care that patients currently receive in Guttenberg.
“Primary care still is the center of the new nationwide health care. Primary care lowers the cost, increases the wellness of a community, and increases lifespan,” said Hoffmann. Kim Gau, GMH CEO, agreed that the community should participate in the process. “I’m finding that once we explain what affiliation means for GMH, people are more supportive,” she said.
The process of choosing a partner and determining the terms of any alignment is expected to take months. “We have the luxury, because things are stable, to go through the due diligence process with a fine toothcomb,” said board member Bill Allyn. The hospital’s strong condition puts the board in prime position for negotiation and thorough planning to ensure their goals – sustaining Guttenberg’s local hospital and providing primary care and prevention services for patients – will be met by the partner they choose. “The conversation will be between two strong entities. Yes, we’re the small one, but we’re also in good shape,” Reimer told The Press.
Board member Sue Osterhaus is also concerned with maintaining insurance coverage, so that patients can continue to see their physicians in Guttenberg. “We are taking small steps to get GMH ready for alignment with an affiliate which I believe will secure the hospital for the future,” she said. “One consideration is UnityPoint Health, because of the relationship we have had with Finley since 1998.”
UnityPoint Health is a non-profit healthcare organization made of nine senior affiliates. Finley Hospital is one of those affiliates. “Rural hospitals can connect by becoming a full partner of a senior affiliate (in GMH’s case, Finley), which in turn will provide us a full partnership status with UnityPoint Health,” explained GMH CEO Kim Gau. Each senior affiliate is a member of UnityPoint’s board of directors, and also keeps their own local board of directors.
“Their decentralization is one of the things we like about UnityPoint Health. Guttenberg would keep its own board and continue to make decisions at a local level,” Gau said. “The affiliation would increase efficiency through greater care coordination, increased supply purchasing opportunities, and more cost-effective use of technology. This would result in lower costs, while maintaining access to high quality care right here in Guttenberg. But the board has full discretion to change direction at any time throughout the due diligence process.”
GMH is already partnered with Finley Hospital and UnityPoint Health for a number of services, including support for clinical services like pharmacy, dietician, diabetes education and infection control. Staff training and education, the electronic health record system, purchasing of supplies and equipment and support for financial analysis and administrative functions are also currently being provided.
“The current relationship adds over $300,000 to the bottom line of our operations in terms of Medicare and Medicaid reimbursement to our hospital for the care provided to patients under these insurances,” said Gau. “In other words, if GMH were not affiliated with a health system in any fashion, and if our hospital were not licensed as a Critical Access hospital, we would have a tough time maintaining a positive operating margin. If the hospital becomes more closely related to a system, the financial benefit will likely improve,” Gau explained. “A positive bottom line helps us to sustain a quality health care delivery system and allows us to reinvest dollars into our patient care systems and equipment.”
“There are good reasons financially to do this, but that’s not all,” Gau said. Among the important reasons for alignment, she lists partnering to improve the quality of care delivered in rural communities, becoming more efficient, and growing services which could result in more local jobs. “When you collaborate, you become part of the system. Someone else is taking care of all that administration, and we can focus on patient care – which is where we need to focus in a rural hospital, with our limited resources,” she told The Press.
Dr. Hoffmann has a different approach in mind for rural practices. “My concept is to have the independent rural practices throughout the state come together as a group, so that we’re able to have better negotiating power with insurance products,” he explained. Hoffmann represents the local physician group as a board member of the Heartland Rural Physicians Alliance, an organization participating in the implementation of transitions that will benefit both patients and members, while maintaining their independent practices within their communities under the Affordable Care Act. “To keep our independence, we know that we have to be aligned, but we need to keep access open to all different insurance populations,” Hoffmann said.
“Going forward it will be important for our local clinic to be able to see the wide variety of patients that we are seeing, and not be limited by a larger organization saying they’ll only accept their own insurance company.” He went on, “If you really are independent, hopefully you are able to contract with other insurance providers so that people in rural communities don’t have to drive 20-30 miles to get care.”
Gau agreed, stating that insurance coverage is an extremely important consideration. “This will be an essential part of the discussion during our due diligence process.”
Gau acknowledged the complexity of the financial issues that will arise throughout the process. “In all UnityPoint Health affiliated hospitals, locally donated money remains in the local hospital’s gift fund and is used for the hospital locally. Guttenberg Hospital donations would remain in Guttenberg as intended by the donors,” she said. Other crucial financial details will be considered during due diligence and will be reported on as more information becomes available.
A committee made up of GMH board members Allyn and chair Penny Hansel, legal representation and appointed hospital staff will work with committee members from Finley to begin to discuss the possibility of a full partnership. Dr. Hoffmann has agreed to serve as physician liaison to the work group .
Said Dr. Hoffmann, “We all want the same thing – to accept all the insurances, to provide best care for everyone in the community, and to keep our hospital here. It’s the nuances in how to do that that need to be determined in the next phase of the process, and sometimes the small things do make a big difference.”