By Lindsey Bright
In May, the Centers for Medicare and Medicaid Services (CMS) awarded 113 Health Care Innovation Grants, one of which was awarded to the Pagosa Springs Medical Center in the amount of $1.7 million.
The Innovation grant is to be awarded and implemented over a span of three years, starting July 1 of this year.
It was at the end of last week that the operational plan for the Innovation Grant was approved.
The main goal for the project is to reduce cardiovascular (CV) risk and improve cardiovascular patient outcomes, while creating healthier community and reducing healthcare costs in southwest Colorado by 2012.
Medical center CEO Brad Cochennet explained to SUN staff the four subgoals of healthcare that the grant will help PSMC address: 1) Expanding a cardiovascular early detection and wellness program; 2) implementing a telemedicine acute stroke care program; 3) implementing remote cardiologist consultation using telemedicine and remote diagnostics; and 4) upgrading and retraining of Emergency Medical Services Division (EMS) to manage urgent care transports and in-home, follow-up patient care.
First, the wellness program, which is already in place at the PSMC. Cochennet said that according to his current numbers, the wellness program serves 12 percent of the community. The grant would like to see this number grow in the next three years to 15 percent. This program works as an early detection and screening program as well as helping in follow-up care and helping the patient reach various goals toward health. One addition that is needed, Cochennet said, is a way to store data which would help the clinic in following up with patients.
Second, neurology. It was in the beginning of this year that the Pagosa hospital welcomed Rosie, their telemedicine machine, onto the staff. Cochennet said that since Rosie came to PSMC, around 10 patients have been saved a medical flight to Swedish hospital in Denver, which involves an approximate $30,000 price tag.
“We’ll be adding an accute care follow-up program element to help patients get well,” Cochennet said. This, he hopes, would help sustain health instead of being reactive to a potential stroke.
The third subgoal is closely knit with the second, adding a cardiovascular capability to telemedicine. This would allow the potential heart attack patient to be evaluated in Pagosa via telemedical devices. Through this evaluation, a care plan will be determined whether it be the administration of a medicine, a stint put in place or open heart surgery.
After this, follow-up will also be added.
“A lot of people don’t follow up because they have to drive to Durango,” Cochennet said.
The fourth subgoal brings all three steps, particularly the last two, together. The fourth step is the EMS component. The EMS will acquire critical care level designation. The current paramedics, Cochennet said, will become outreach and community critical care paramedics. The community part of this means that it will be the paramedics who will go to the homes of patients for follow-up sessions. So, the district could not only offer rehab and follow-up for strokes and heart attacks at Pagosa Springs Medical Center, but also make use of the portable telemedicine equipment installed in the clinical care designated ambulances. Through these means, Cochennet said, it will be easier for patients to maintain compliance with their aftercare plan.
As of now, Cochennet said neither Medicare, Medicaid, CHP+ nor any other insurance he knows of covers this type of healthcare. Cochennet continued to explain that with health care reform and the passing of the Affordable Care Act how reimbursement is done is changing. “They will be paying for health instead of paying for sickness,” Cochennet said. However, how this will look, or if it will even be done, is still unknown.
“We’re inventing a program for a different reimbursement model,” Cochennet said.
As a result of the grant, PSMC brought on Julie Bridges as the Innovation Grant coordinator. Prior to joining PSMC, Bridges worked as a resident nurse and case manager in the Emergency Department at North Suburban Medical Center in Thorton, Colo. Bridges will be in charge of keeping the grant moving, making sure the measurements and timelines are met. As Cochennet explained it, Bridges’ job will be to keep an eye on what is happening in the hospital and with the grant and determine that affects the overall goals and objectives.
Bridges said she will be evaluating what equipment needs to be purchased or leased, what alliances and contractual agreements with physicians and/or hospitals are needed, what type of portable EKG as well as transportable telemedicine machine is required, and then see how information for follow-ups can be gleaned and stored in the wellness program.
This grant will also fund five positions, so Cochennet said staff will be evaluating which positions will be created.
Cochennet also said that, since much of the innovative healthcare in this grant is interconnected medicine, such as telemedicine relying on doctors in other locations, Health Information Exchange (HIE) is a concern. However, the grant does not fund HIE.
“We are looking at the grant and HIE together,” Cochennet said, and explained that finding an efficient, affordable HIE system is a global challenge.
Cochennet also clarified that the healthcare innovations in the grant are not reliant on HIE. He explained it with this analogy: “It’s like having funding for cars and trucks but not having roads built … You can get there, but it’s nicer when there is a freeway.”