Our hospital has one of the only ORs fully equipped for orthopedics in a wide swath of western Nebraska, encompassing seven to nine counties with a total population of about 35,000. You’d have to drive 70 miles away to find a larger facility.
Several years ago, we had had more than two FTEs in orthopedic surgery on staff, but then that number fell to one. We were aggressively looking for a second orthopedic surgeon when, in July 2008, the last remaining surgeon left town. Going from thinking we’d soon have two orthopedic surgeons to having none at all was quite a shock.
It was also a big financial hit. Orthopedic surgery represented 40-50 percent of our surgery volume. For three or four months after the surgeon left, we did not have any orthopedic surgery. The surgery staff had to focus on other procedures — general surgery, ophthalmology, ENT and the like.
To get our orthopedic volume up again, we decided to ask orthopedic surgeons from other areas in the state to make regular visits. It would mean they’d have to drive one or two hours each way, but surgeons in Nebraska are used to long distances. And in return they would get extra patient volume and the opportunity to use our fully equipped ORs. They would enjoy more scheduling flexibility in our small facility than at their larger hospitals, and they would still have access to highly skilled staff and a fully equipped orthopedic OR. Of course, our community would also benefit because patients wouldn’t have to drive hours for an operation.
Even though we were very selective about choosing the visiting surgeons, there was quite a bit of interest. We chose three. Two general orthopedic surgeons, from Grand Island and from Hastings, visit once a week and an orthopedic hand surgeon from North Platte comes twice a month.
This arrangement has helped us gain back about half of the orthopedic volume we used to have. This was a key factor in getting us into the black for the year. For the fiscal year that ended on June 30, the hospital generated $1.9 million in revenue in excess of expenditures of 6.7 percent. We have also seen a growth in the volume of CT scans, scope room procedures, ultrasound tests and specialist clinic visits.
To prepare for a $30 million building project, we secured a commitment from the U.S. Department of Agriculture for direct loans and guarantees for commercial loans in amounts up to $17 million and $15 million, respectively. During 2009 we purchased a post-discharge electronic medical record, computerized medical imaging and archival software for radiology tests, an in-house MRI and expanded a rural health clinic. We are also breaking ground on the building project, which includes a patient wing, OR and outpatient services area.
Elective schedules for orthopedic surgery are still backed up but not too much. If elective patients see a long wait, they’ll decide to go to hospitals farther away. Now we are working on trying to flip OR cases faster. We want to improve the OR turnover time so that the orthopedic surgeons can be more productive with the limited hours they spend in McCook. We are limited by the OR schedule. The OR is generally open only during weekdays for elective cases.
The hospital has been limited by the number of ORs that can be used for elective surgery. Just one of our three ORs is sized properly for orthopedics and we can use a second OR for some minor orthopedic cases. However, as part of the new building project, we will create larger ORs, planned for completion in spring 2012.
The hospital is still looking for a full time orthopedic surgeon. The part-time surgeons accept that. There is enough orthopedic surgery here for two FTEs.
Learn more about Community Hospital at www.chmccook.org.
