The Martha’s Vineyard Hospital has begun renovating the no-longer-used emergency room in the old hospital building for use as a walk-in clinic. Hospital leaders said the new clinic is necessary to address a longstanding shortage of access to non-critical health care for Islanders.
In a conversation with The Times on Wednesday, Tim Walsh, hospital CEO, and Dr. Jeffrey Zack, director of emergency medical services, discussed this newest addition to an expanding scope of services that the hospital now offers.
The hospital officials said the addition of a walk-in clinic would provide an alternative to the emergency room and become part of a continuum of care that includes emergency care, primary care and inpatient care overseen by hospitalists, all linked by a system of electronic medical record keeping under the umbrella of the hospital’s parent organisation, Massachusetts General Hospital (MGH), which now provides the Vineyard hospital with radiology, anesthesiology and oncology services.
In March 2007, Martha’s Vineyard Hospital became an affiliate of Massachusetts General Hospital and a member of Partners HealthCare.
“This is part of a system-wide overhaul that we’ve been doing over the last few years to better accommodate the needs of our patients on the medical end and also the financial end,” Dr. Zack said. “The goal here is to design a system that can cover from the very sickest to the non-critical patients, and the walk-in facility has been a big hole in our delivery system.”
Dr. Zack said all too often, patients utilize the emergency room (ER) because they may not have a primary care doctor. “Emergency medicine is here for the sickest of the sick, yet over the last 10, 20 years we’ve started to take care of everybody. We do a lot of primary care, especially here on the Island. It isn’t the most cost-effective way to deliver quality care. This [walk-in clinic] fills that need of ‘not too sick but can’t wait for an office visit in a week.’”
Dr. Zack said that the walk-in clinic will also help manage the surge in patients when there’s an outbreak of the flu or a virus like the one currently spreading in the midwest. “Historically this overflow would go into the ER, which diverts resources and is a costly way to practice medicine. But up until now, there’s been very little options for folks on the Island.”
Staffing and hours
The medical personnel staffing the walk-in clinic will be a mixture of physicians and mid-level providers, such as physician’s assistants and nurse practitioners. Mr. Walsh said the hours of operation will be tailored to demand.
“We’re going to study and figure out the hours as we go along,” he said. “If there’s a need to stay open after hours, we’ll see what we can build around that. We’re hoping to play off the community. If there’s a real need to keep it open, say, until 7pm at night, then that’s what we’ll do. We’re open to figuring that one out.”
Long range benefits
In addition to the benefits in patient care and cost containment, Mr. Walsh said the clinic will help balance the books in the long term as well.
“Looking down the road at the Affordable Care Act, and where they’re trying to go, it’s really about population health management,” he said. “For a given population you’re responsible for everything that happens to them. We’re rethinking how you do it. They want to do global payments in the future, for every person that comes into your system they’ll pay you $25,000 a year — you take care of the health care. Right now, it’s about volume, the more you do, the more you make. That’s going to change to: the more you do, the more your expenses are. So you’re not making more money. That’s where a walk-in clinic can save money. A $300-dollar visit to the ER can be done instead for $100.”
Mr. Walsh said the goal is to make the walk-in clinic operational by next summer at the latest. “I’m hoping we can get it in by next February, but we got sidetracked with repairs to the air handling system in Wing 1 in the beginning of the summer. Replacing a new unit costs over $700,000. The next move will be to install air transfer in the old ER It’s interesting times around here.”
Increased demand
The walk-in clinic is the latest in a series of improvements and upgrades. These include the addition of a new MGH oncology unit, the recently completed $2 million transfer to electronic record keeping, and a $1 million investment in hiring hospitalists, doctors who solely treat hospital inpatients and thus provide consistent care and free up overwhelmed primary care doctors.
The expanding system was put to the test this summer, which according to hospital statistics, was the busiest in the hospital’s history. Patient days in acute care were up 28 percent, and patient days in skilled nursing facilities (SNF) were up 74.4 percent.
“We were busting at the seams,” Mr. Walsh said. “Because of our expanded services like the hospitalists, we were able to hold on to more patients here and not transfer off-Island. The ICU was much busier. It’s stunning how much volume we did. We were boarding in the ER, which is unusual for us. We had it happen in the past but not to this extent. Not even close.”
One goal is to avoid transfers to mainland hospitals when possible. “I don’t think the number of patients went up significantly; it’s the number of people we’re keeping in the system,” Dr. Zack said. “That’s the overall goal here. Our patients don’t want to go to Boston. They want to stay here with their families. So we’re adding more resources one bit at a time so we’re able to do that. Now looking at the big picture, we need to address the lower acuity stuff.”
Doc docs
The recent conversion to electronic records will enable the growing departments within the hospital, and partner hospitals off-Island, to instantly access critical medical information within the Partners Healthcare network.
“It’s an all-in-one system,” Dr. Zack said. “There’s no fishing around at 2 am trying to find information — it’s there. That time can be important, and maybe life-saving.”
“If you go from here to Mass General, they see the primary care records, the ER records, they see everything. And vise versa: when the patient comes back, we see everything they did in Boston,” Mr. Walsh said. If the hospital shows “meaningful use” of the electronic records system, according to an upcoming Medicare evaluation, it will receive a significant rebate to defray the cost of the system.
Choice is good
Mr. Walsh and Dr. Zack said the recent sale of Vineyard Medical Services, presently the only walk-in clinic on the Island, had no bearing on today’s announcement. “This has been on my radar for two years,” Dr. Zack said. “For us the hospitalist program was more important to get up and running; so that took precedence.”
“I talked to Dr. Jacobs several times over the years about buying his practice as a satellite facility,” Mr. Walsh said. “I like Dr. Jacobs, he’s a great guy. We’ve always had a really good relationship. The problem is the licensures. When you’re talking about a hospital satellite, you have to meet hospital code, and the standards are brutal, as they should be. The air-exchanges demands are extremely high. I don’t think any house could meet them.”
Mr. Walsh is supportive of the new walk-in venture. “It’s good for people to have choice. It’s on us to deliver a good product,” he said.
