Patty Bianchi is blunt in her assessment of the condition of Pershing General Hospital five years ago:
“We were not financially viable,” says the chief executive officer of the hospital in Lovelock.
But today, the hospital has won national recognition for a turnaround that’s stabilized its finances, drawn new medical professionals to the town of 1,900 residents and bolstered outpatient services.
The magic solution? No quick fix, no single answer, but instead a grinding four-year initiative to look at every process, every job, every piece of paperwork in the organization.
With only 14 acute-care beds and a 25-bed nursing home, Pershing General Hospital nevertheless is a key element in providing health care to a wide swath of north-central Nevada.
Fernley is 61 miles to the west. Winnemucca is 72 miles to the east. Fallon is 55 miles to the south. And to the north? Pretty much nothing for 500 miles.
The hospital’s role is defined as “critical access,” both for the 6,750 residents of Pershing County and the travelers along busy Interstate 80 as it cuts across the county.
And state officials worry about the ability of rural critical-access facilities across Nevada to stay open.
“Closure of rural hospitals can be devastating to rural and frontier communities, denying local citizens access to emergency, outpatient, long-term care and sometimes even ambulance services,” says Gerald Ackerman, director of the Nevada Office of Rural Health.
As analysts thought about the problems of Nevada’s small hospitals during the past decade, they concluded that a fresh look at hospital operations from top to bottom holds far more promise than short-term efforts to improve cash flow.
The Nevada Rural Hospital Partners, a group of small-town institutions, worked with the Office of Rural Health at the University of Nevada School of Medicine to develop what they dubbed a “revenue-cycle initiative.”
It’s a fancy name for a lot of hard work, says Bianchi.
For the better part of four years, her staff spent part of every day analyzing every single process in the hospital from the time that a patient walked in the door until the moment that the final payment was posted.
“We discovered many broken processes,” says Bianchi. “Every rock that we overturned, there were small rocks underneath.”
Some processes were changed. Some of Pershing General’s staff of 72 found themselves in new jobs. Tighter control of expenses was put in place. The hospital promoted itself as the first choice for care for residents of the area.
That sort of hands-on involvement by top executives is critical to the success of the program, say executives of Nevada Rural Hospital Partners.
Steve Boline, regional chief financial officer for the group, has noted in presentations to professional groups that small hospitals can’t afford outside consultants, so they need to rely on themselves.
Besides, Bianchi says, executives need to be closely involved because the work of improvement becomes a never-ending process — particularly as the landscape of healthcare regulation and payments shifts on a daily basis.
On the other hand, tiny hospitals can be far more nimble than their big-city brethren in meeting the demands of change, says John Packham, director of health policy research at the School of Medicine.
“In a smaller organization, you can move culture and you can move process more quickly,” Packham says.
The project at Pershing General Hospital was one of two in the nation to be recognized in recent weeks by the National Rural Health Resource Center. The organization will be sharing the story of the Lovelock hospital’s turnaround with other institutions across the country.
While the initiative at Pershing General Hospital won national attention, it’s not the first success story for the revenue-cycle initiative.
South Lyon Medical Center in Yerington — a 14-bed facility — was losing close to $500,000 million a year and watching its cash reserves disappear when it became the first to undertake the revenue-cycle initiative.
When it completed the work in 2009, the hospital estimated the total improvement at $1.36 million a year from better billing practices and improved collections.