St John's Medical Center proposes major overhaul

Wednesday, July 11, 2007

By Lucille Rice

Jackson Hole, Wyo.-Acknowledging that the atmosphere at St. John’s Medical Center has been fraught with tension and conflict for the past decade, Jackson Hole’s 50-bed hospital has embarked on a strategic planning process, outlining the obstacles that are preventing it from being among the best small hospitals in the nation.

Ed Riddell, vice chairman of the SJMC board of director and chairman of its strategic planning committee, intends to surmount those obstacles.

New leadership – four new members of the board elected last fall and a new CEO, Jim Schuessler, hired in January – jump-started the process. A strategic planning committee was formed shortly after Schuessler was brought on board, a first draft of the plan was completed last month, and SJMC is currently seeing public comment.

The draft plan reveals faults in the fundamental operations of the hospital, such as the need to emphasize quality health care, the lack of standard medical procedures, and facilities suited to the changing and growing needs of patients.

 Riddell added that political and personal agendas of past officials affected the medical center’s ability to keep up with the changing health care needs of the valley.

“What we found out is that there are things we should be worried about,” Riddell said. Although the draft paints the picture in broad strokes, Riddell noted it is primarily an attempt to get a dialogue going and to honestly expose the problems the hospital faces.
St. John’s was built based on an inpatient model, where patients stay overnight and medical staff monitors recovery.

Years and leaps in medical technology later, the majority of today’s procedures do not require an overnight stay. The result is money wasted on staff not needed for the quick, quality, in-and-out service provided by outpatient care.

Riddell observed that over the past decade, many outpatient clinics have opened, taking potential customers away from St. John’s. The competition has been fierce, contentious and ultimately detrimental to SJMC’s patient volume. Not only does the decrease in patient volume cut into hospital revenues, it deprives physicians of the practice that keeps them current with procedures and nimble in their work.

Riddell’s preferred strategy to combat the issue is to provide the best quality care and customer service. He said the whole committee agrees poor leadership and miscommunication on all levels of the medical staff overshadowed that a basic goal.
Other issues that surfaced during the analysis include a need for additional employee housing, and financial burdens caused by health coverage laws and state laws regarding reimbursement of care for uninsured patients.

St John’s Medical Center currently provides housing for 15 percent of its employees, but is seeking to increase that number to 25 percent to attract and keep quality staff. The SJMC Foundation has been instrumental in raising funds for land purchase and employee housing and will continue to do so in this next phase.

As a board member, Riddell insists that the hospital provide emergency care to patients regardless of their ability to pay. Besides, federal law obliges hospitals to do so. Generally, hospitals are reimbursed for these costs, but a new state law makes it impossible for medical centers to be reimbursed for care given to uninsured, undocumented patients – a Catch-22 that costs the hospital thousands of dollars a year.
“We are being financially punished for being good citizens,” said Riddell.

The committee consulted statisticians that lent insight into the effects of the valley’s changing demographics. According to the draft report, Jackson Hole’s insured middle class is shrinking. Meanwhile, the high-income class that often seeks medical care elsewhere is growing, as is the lower-income class that is most likely to be uninsured and unable to pay hospital bills.

That’s just a sampling of issues identified in the draft plan, which is currently open for public review and comment. The hospital invites the public to a forum at 5:30 p.m. on July 18 in the Teton County Library, which will mark the end of the public comment period. The draft and comments will then be submitted to the SJMC administration, which will have two months to compile a plan of action with specific strategies, a budget and assigned accountability.

 If all goes according to plan, the proposal will be returned to the board for final review in late September.

“People who know me know that I am a really stubborn guy,” said Riddell. “I didn’t spend all this time making this proposal to see it sit on a shelf somewhere.”
He believes the team working on the overhaul could not be better suited for the job and expects to see a lot of the goals accomplished within the next four to five years.
“I am going to see that it happens,” he said.

The draft plan is available online at www.TetonHospital.org or at the information desk at the Teton County Library. Comments can be sent to info@tetonhospital.org or to St. John’s Medical Center, P.O. Box 428, Jackson, WY 83001.
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