Springfield Hospital changes stem from cost, quality factors, providers say

At the hospital’s board of directors meeting on Nov. 13, several hospital workers expressed concern about the planned change this coming April from the Emergency Services of New England, Inc. of Chester (ESNE) to Bluewater Emergency Partners of Brunswick, Maine

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Springfield Hospital changes stem from cost, quality factors, providers say SPRINGFIELD, Vt. — The Eagle Times as learned details about Springfield Hospital’s change of emergency care providers. At the hospital’s board of directors meeting on Nov. 13, several hospital workers expressed concern about the planned change this coming April from the Emergency Services of New England, Inc. of Chester (ESNE) to Bluewater Emergency Partners of Brunswick, Maine. Springfield Hospital decided to make the change to be more cost-effective with its emergency services, both emergency organizations told the Eagle Times. Moreover, in addition to any internal financial reasons it may have for changing the providers, the hospital is apparently seeking to meet national quality and cost-control standards as many hospitals across the nation are doing. The hospital told ESNE on Oct. 10 that it was exercising its right to terminate the agreement for physician assistant services in its emergency department, said ESNE president Cary Stratford. “While CEO Tim Ford expressed no displeasure with our past services, and indeed stated appreciation for the 40 years of continuous service, a specific rationale was not mentioned aside from improving hospital operations and finances,” he said. ESNE currently operates a schedule based on 50 hours of coverage per day in terms of personnel, Stratford said, using physician assistants, nurses, and other staff, and on-call physicians. Bluewater’s plan for service is a 36-hour model of coverage per day, which will include both physician assistants and at least one medical doctor in the facility 24 hours a day, according to Bluewater CEO James Mullen. Bluewater did not seek out the Springfield Hospital contract, but was approached by the hospital, Mullen said. “We’ve developed a great reputation in Maine,” he said. While not directly critical of ESNE’s operations, Mullen said he thought his company’s model of service could provide excellent patient care while being "more cost-effective." "Part of our experience is working with ... hospital administration,” he said. Some emergency department workers have said that the coverage change could have a negative impact on their overall compensation. At least one worker at the Nov. 13 meeting stated he would need to leave the hospital rather than continue under Bluewater. Hospital administrators have stated they are not forcing anyone to leave. For its part, Bluewater welcomes employment applications from existing hospital workers, Mullen said. However, he added, "not many have come forward ... it's hard when your team doesn't have the contract any more.” The changeover is scheduled to happen in April of next year, and “we've had one face-to-face meeting with ESNE” so far, along with other contacts, to transfer institutional knowledge and hospital information, said Mullen. Springfield Hospital is a “critical access hospital” or CAH, a designation applied to certain rural hospitals since 1997 by Centers for Medicare and Medicaid Services. Both CAHs and other hospitals are trying to reduce the high cost of health care by finding efficiencies while still providing good patient care. One of the groups that monitor that effort is iVantage Health Analytics, which each year designates a list of the “Top 100 Critical Access Hospitals.” The list is not available publicly but is circulated to the hospitals, said Billy Balfour, a marketing manager with IHI. In 2014, Springfield Hospital CEO Tim Ford issued a statement saying that Springfield Hospital was in the Top 100 that year. Springfield Hospital was not in the Top 100 for 2018, Balfour said. However, he cautioned, a direct comparison from one year to another is not possible because of changes in methodology of the report over time. The Chartis Group for Rural Health, which actually compiles the report, called the Rural Relevance Study, states on its website that more than 50 individual indicator variables are used to report metrics involving cost, quality, outcomes, and other categories that go into determining the Top 100. Another organization, the Institute for Healthcare Improvement, is the proponent of a standard called “Triple Aim,” that seeks to provide excellent patient care in hospitals at a lower cost. Bluewater is trying to meet that goal, but it is not easy, Mullen said. “It ends up being like Whack-a-Mole,” in that efficiencies toward one metric could impact efficiencies in other areas. “The IHI Triple Aim is a framework ... that describes an approach to optimizing health system performance,” the organization states on its website. New designs must be developed to simultaneously pursue three dimensions, and the three dimensions of Triple Aim are “improving the patient experience of care (including quality and satisfaction); improving the health of population; and reducing the per capita cost of health care.” With all health care providers dealing with insurance industry issues such as the Affordable Care Act and both industry and federal standards, Springfield Hospital is not alone in dealing with external cost and quality standards as well as internal ones.