When Hill Country Memorial Hospital opened its doors in 1971, it was a true community event. Residents of Fredericksburg, Texas, went door-to-door collecting donations in Mason jars to support the hospital. For CEO Jayne Pope, that seed money means there’s a real return on investment for the community. Hill Country is bucking the trend of most rural hospitals. It has a strong bottom line, multiple locations—including an 84-bed hospital—boasts a highly successful joint replacement program, and more. It was also a 2014 Malcolm Baldrige National Quality Award winner. Pope spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: How has Hill Country been able to thrive when so many rural hospitals are struggling?
Pope: We are very strategic about what services we are able to provide from a skill base. We are constantly evaluating and thinking on the forefront of what we can do.
I don’t ever want to say we’re better than another hospital. We’re not. We’re just very strategic in the services we offer and can offer with excellence so we provide the highest-quality care.
We are in an accountable care organization (and explore) how we partner with our physicians so we can provide the best and highest-quality care and, what might seem like shooting ourselves in the foot, keeping patients out of the hospital.
MH: Most CEOs say similar things about their strategy—offering the highest-quality care, etc. But with so many rural hospitals struggling, you seem to be doing something different.
Pope: We have about 25 specialties and a very strong primary-care (program). We have vascular surgeons. We have pain specialists. We have orthopedic surgeons. That enables patients to stay in our community to get their care.
MH: That level of specialty service is unique for a rural provider.
Pope: Yes. We know that for those people who put coins in the jars, the reason why this hospital started was because they wanted to have these services at home. We won’t do just any service. We look at community health and what is the highest need and what is it that we would be able to participate in and do with expertise.
We also have home care and hospice in our wellness center. There’s been foresight in looking at what the necessary services are to serve that patient. We haven’t needed to go out and find a partner for hospice or home health or find a wellness partner.
MH: How often are you evaluating the market to see what services are needed?
Pope: Part of our community health needs assessment is looking at what the specific needs are. As we develop our strategy, we go to our key constituents—community physicians, employed physicians—and ask them, “What do you need to provide the best services?”
Part of our strategy is also looking at our threats, opportunities, weaknesses and strengths—we SWOT backwards. We go to our community, our team, our physicians, our patient advisory groups and they give us those inputs. That’s a great opportunity for us to examine what changes we need to make through incremental improvements. What metrics do we need to track to ensure that we are going in fully informed about what services are needed? And we have to look at (what’s needed) to provide those services and if we can do it with expertise.
MH: Are there areas where you see some growth opportunities?
Pope: Through our accountable care organization where we have partnered with our primary-care providers. We have the opportunity to look at areas of the greatest needs—behavioral health, exercise—services that we need to put in place in order for it to keep people out of the hospital, which is the highest-cost place to provide care.
MH: You have a highly successful joint replacement program. Can you talk about how that’s grown?
Pope: It started in 2011. One of our surgeons came to us and said, “We serve so many … people on Medicare. I’ve heard about a program where we could look at some best practices and put some ‘oomph’ behind the program.”
So we partnered with the orthopedic surgeons and looked at what are some best practices? We know it’s educating the patient before they come in to have their surgery, educating their family, making sure that they get mobile, managing their pain.
The patient and their family have to identify a coach. Their coach is a part of the whole process. They have to commit that they’re going to come to pre-op class and do a lot of education before they even get in the hospital. Once they’re here, their coach is with them the whole time they go to therapy.
We consolidate the orthopedic surgeries for the major hip and knee procedures on Monday or Tuesday so that they can mobilize together. They go to those classes together. They have a competition about who can get the most steps this week and we post that. And the coaches are there the whole time.
We also have a farewell lunch and a reunion and it’s fun to see the reunion because I never can figure out who was the patient and who was the coach.
We call this program Restore. We have the Restore council, which includes the orthopedic surgeons, the anesthesiologists, the therapy staff, the nursing staff, including those in the operating room and out on the Restore unit. And the pharmacists are key to that as well. What’s pushed us forward with that program is all of those interdisciplinary care partners sitting down and saying, “What could we be doing better so that we can help our patients mobilize faster and use less medications and get back to their lives?”
MH: You are also doing some interesting things in the wellness centers, including behavioral health programs, right?
Pope: We have a wellness center where we gave (underinsured and uninsured people in our community) a subscription. They needed to participate in exercise three times a week and track their blood pressure every two weeks. In each cohort we have anywhere between 100 and 110 patients.
In the last cycle, 78% graduated. We’ve seen dramatic changes in people’s blood pressure and in their A1C levels. At least 20 participants in the last cohort lowered their blood pressures to a safe level and reduced their dependency on medications. I just heard a story about a patient whose blood pressure was so much lower that she’s off all of her medications.
MH: As you said, a lot of these efforts lead to keeping people out of the hospital. How do you reconcile with the fact that it is still largely a fee-for-service world?
Pope: It would be the easiest thing just to have patients come into the hospital and not be forward-thinking. But it’s not the right thing to do for our community or our patients, and it’s not the right thing to do long term (because of) value-based payments.
We’re constantly (asking), “Do we need to look at telemedicine for certain offerings? Do we need to look at partnering with somebody around a certain service line?”