Submitted by Kate Stephens, abridged by The Montanian
The Hospitalist Program at Cabinet Peaks Medical Center is being recognized around the world for its innovation and excellence in patient care. Here’s why:
Changing Health Care Models
Historically, a primary care doctor would provide patient care both in and out of the hospital, independently meeting almost all patient care needs. Increasing demand on primary care doctors, as well as dramatic increase in complexity of medical care has made this old model unsustainable and hospitals across the country are now staffed by “Hospitalists,” health care providers who specialize in the care of numerous or complex medical problems that require hospitalization.
“The Hospitalist program in Libby started because it was impossible for providers to continue to see patients in the clinic and in the hospital,” said doctor Greg Rice of Libby Clinic. “We used to be able to see patients in the hospital before seeing our patients in the clinic during the day. Now, there’s a lot more researching and looking things up required for each patient. The number of drugs alone is 100-1000 times greater than when I started. Treating patients in the hospital takes more time now. We would try to start office hours, but then have to cancel seeing maybe 12 to 15 patients in the clinic in order to see 5 or 6 in the hospital.”
Challenges in Rural Communities
Having to cancel those outpatient visits creates a burden on a health care system that is already facing significant challenges. Rural communities across the U.S. are estimated to have a shortage of 45,000 physician providers by 2020, a crisis affecting over 90 million rural Americans. Additionally, more than 75 rural hospitals have closed in the United States since 2010. More than one third of rural hospitals, 673 facilities, are currently as risk of closure due to low patient volumes, low funding levels, decreased hospital revenue, and low physician employment pools.
Keeping small, local, rural hospitals open is not only important for the physical health of individuals, but also the economic health of entire communities. On average, each Critical Access Hospital (a designation given to small rural hospitals more than 20 miles from the nearest healthcare facility) contributes 150 jobs to the local economy and invests 7.1 million dollars into its local community through benefits, wages, and salaries.
Local Solutions to National Problems
In early 2015, Cabinet Peaks Medical Center CEO Bruce Whitfield, together with the community based Board of Directors, proposed a strategy to keep CPMC from becoming a statistic and to keep local hospital based care available to residents of Lincoln County. With the support of local primary care physicians, who were unable to continue providing both full time clinic and hospital based care, CPMC’s Nurse Practitioner Hospitalist program was developed.
The Hospitalist role is increasingly being allocated to Nurse Practitioners (NPs) in response to the physician shortage crisis, a nation-wide shift that is supported by federal health care organizations. NP Hospitalist program have been shown to increase quality of care, decrease length of stay, improve patient safety, and decrease overall cost of patient care.
CPMC’s NP Hospitalist program is a unique model that combines on-site NP care with real time physician support through telemedicine. Each patient admitted to CPMC has a physician Hospitalist at Kalispell Regional Medical Center (KRMC), located 90 miles away, directly involved in co-management of their care. Local NP Hospitalists provide direct hands-on assessment and evaluation and a collaborative care plan is established. Because of this real time interaction, more patients can be safely kept and cared for in Libby with continued interaction with specialty services through telemedicine to provide higher levels of care. CPMC continues to see a decrease in the number of patients transported elsewhere to receive medical care since the introduction of the NP Hospitalist Program. This benefits Lincoln County’s patients, hospital, and community overall.
Outcomes of Innovation
Telemedicine, the use of medical information exchanged from one site to another electronically, is increasingly used in rural CAH’s as a strategy to meet patient care needs. Over half of all U.S. hospitals now use some form of telemedicine.
CPMC’s NP Hospitalist program is a new model that keeps hands on patient care in local hospitals.
In 2018, the international peer-reviewed academic Journal of Telemedicine and Telecare published an article describing CPMC’s unique NP Hospitalist Program. Factors including deaths, readmissions, length of hospital say and rating of provider communication were compared, and there was no statistically significant variance between the NP or physician Hospitalist program at CPMC.
Dr. Michelle Boltz, DNP authored the article and since publication, there has been international interest in learning about the program’s contribution to cost savings while maintaining quality of care and increasing access to community based physicians.
CPMC NP Hospitalist Program
Dr. Rice said that community physicians are now able to focus on caring for their patients in the community with confidence that patients in the hospital are getting excellent care too.
Libby’s NP Hospitalist program recently added Georgi Coon, NP to staff. Georgi brings nearly two decades of experience as an NP with special post masters acute care training. She and her husband Steven Coon, who works as a physical therapist, have just returned home to Libby and will live full time in the community to provide care.
Michelle Boltz, DNP is a Nurse Practitioner with a Doctorate of Nursing Practice. Boltz who has been part of the CMC NP Hospitalist program since 2016, has deep Libby roots and brings over a decade of NP experience to the program. Her grandmother arrived to Libby in 1948 and served as a nurse through the 1970s.
Learning from Libby: Pioneers of Telemedicine
Our little community is gaining big recognition in the world of rural health care. Using telemedicine for remote physician support of on-site NPs serves as a new model for other rural CAHs seeking to maintain financial viability and access to care in rural communities.
This spring, Boltz will be presenting her research findings at the 5th World Congress on Nursing and Healthcare, in London. She has also been invited be representatives of New Zealand’s Ministry of Health to headline that country’s National Rural Health Conference and will be hosted at facilities around the island nation to exchange challenges and successes in rural medicine. These opportunities showcase Libby as a pioneer in telemedicine.
Dr. Brent Pistorese of KRMC was instrumental in supporting the establishment of the CPMC NP program. “In my opinion, CPMC represents a novel success story of improved rural care from every aspect; a valuable story that should be entertained by similar rural and frontier hospitals across the nation,” he said. Pistorese said that improvements resulting from the program include better access to primary care providers for patients, and less pressure enabling better retention of community physicians, improved financial stability of the hospital, and more prompt availability of bedside care.