Hospital patients "swing" close to home
By Janet Hefler
Published: November 20, 2008
When it comes to healthcare, people prefer to seek treatment close to home. Unfortunately, that is not always possible for Islanders.
Sometimes they must be hospitalized off Island for specialty medical care or surgeries, or when they get sick or injured away from home.
For those enrolled in Medicare, however, Martha's Vineyard Hospital (MVH) offers an option for returning to Martha's Vineyard for transitional care. The Swing Bed Program allows patients who no longer need acute care to return to MVH for additional hospitalization and inpatient rehabilitative services while recuperating near family and friends.
Many patients can benefit from swing-bed services. For example, a person recovering from orthopedic surgery such as hip or knee replacement can return to MVH for rehab care. A stroke or accident victim can receive physical, occupational, and speech therapy while recovering at MVH.
Starting to swing
Although the term "swing bed" sounds like playground equipment for the fatigued, it is used by Medicare to
refer to a hospital bed used for either acute or skilled nursing care. A three-day hospital stay at an acute level of care is required within 30 days prior to swing-bed care.
The Swing Bed Program is linked to MVH's designation as a critical access hospital (CAH) in 2002, which made it eligible for cost-based Medicare reimbursements. With less than 25 beds and an Island location, the hospital qualified as a rural facility, explained chief quality officer Dedie Wieler. As a CAH, she added, "The goal is usually to treat what you can here and discharge patients or prepare them for transfer to a tertiary setting."
When MVH's Swing Bed Program first started, it was geared towards an average stay of around two weeks. "We've taken away that restriction - as long as you need the skilled nursing guidelines, you can stay here for as many days as it takes," Ms. Wieler said. "There's a Medicare limit of 100 days. So theoretically, even if you have a long-term skilled nursing need, you could still be in the hospital wing as opposed to the Windemere wing."
Ms. Wieler credits the Swing Bed Program, which is regulated by Medicare, and federal and state agencies, for helping MVH turn around its bottom line.
Previously, the hospital was treating patients seven days a week and transferring many off Island who needed a higher level of care or a specialty not available on site.
"That meant we had to have a staff for the hospital but we didn't always have patients," Ms. Wieler said. "Before the Swing Bed Program, in the wintertime the inpatient census might be two or three, and you're got a whole staff. So obviously, it's almost impossible to make money, enough to stay open - we're non-profit but we do need to hit budget."
Putting on her quality control hat, Ms. Weiler noted that in addition to the program's financial benefits, it keeps the staff up on patient care. "If you only have a few patients over a period of time, your skills can lapse," she said. "So if you have a census of now 12 to 15 in the wintertime, although the level of care is different, you're still interacting with patients, passing medications, doing all those kinds of things. So it allows the staff to stay sharp, and most importantly, it allows patients who would be off Island much longer than they wished to come back."
MVH recently began advertising the Swing Bed Program because admissions slowed down. "We want to make sure people realize it's here, and we also want our physicians to realize it," Ms. Wieler said. "We want to empower patients to know that there is a potential for choice. So if a physician says I want to send you wherever, over in Falmouth or Boston, you can say as a patient, I know Martha's Vineyard Hospital has a skilled nursing rehab program. I'd like to go there for my rehab."
Getting into the swing
That's where director of case management Gayle Poggi comes in. "I'll either get a referral from another facility, from some of our physicians here who know that they're having a patient coming in, or from the patients themselves," she said. "What I generally do is gather all of their medical information, find out if they're medically stable and ready to be transitioned over to the skilled nursing facility level of care, and make sure that we can meet their needs and that their physician is involved."
Ms. Poggi also helps off-Island case managers with logistics. "They may not be used to dealing with the ferry, or how to get patients over here," she said. She works with social worker Gail Croft to meet patients' needs in the hospital and to arrange for support systems, equipment, outpatient services, and transportation when they go home.
"People go away knowing they can come back here, which is terrific," Ms. Croft said. "And we try to keep our residents on Martha's Vineyard, if we can do that. Windemere has openings, so we have a well-rounded, comprehensive plan."
Ms. Poggi advises potential patients to call her early in their planning process. She keeps track of admission dates and follows up with off-Island case managers and discharge planners if she doesn't hear from them. "Sometimes it comes down to dealing with somebody who's not familiar with the program or the case manager may not have enough time to investigate, and I want to make sure the patient has a chance to come back here, if they want to," said Ms. Poggi.
The Swing Bed Program also has helped terminal patients who wanted to come back to Martha's Vineyard to spend the last days of their lives close to their families, she noted, with Hospice staff also available nearby.
The program is not limited to Martha's Vineyard residents, Ms. Poggi pointed out. "We've actually had several people from other states who have family down here and after they've had an acute hospitalization, the family realizes, gee, Mom needs a little bit more help, I think it's time to bring her back a little bit closer," she said.
While the hospital's Swing Bed Program can accept most patient transfers, Ms. Wieler said those with both medical and psychiatric issues would be the exception. "Certainly if anybody has any questions about whether we can meet their needs, they're welcome to contact me," Ms. Poggi said.
All in all, the Swing Bed Program has been a win-win for the hospital and the Martha's Vineyard community, Ms. Wieler said. In addition to getting MVH out of the red, modest profits from the program over a few years allowed for the expansion of services such as the dental clinic. The hospital also added primary care physicians, recently brought in a second Oak Bluffs/GYN physician, and recruited an orthopedic surgeon who will start in January.
"If you're fighting to maintain the bottom line, you can't grow and fund those needs," Ms. Wieler pointed out. "So those are the kind of things you can do if you've got adequate resources; you can continue to work on meeting needs."
For more information about the MVH Swing Bed Program, call 508-693-0410, ext. 290 or 400.
