CCMSD sees significant increase in patient numbers

After hearing concern from the community that patients are no longer choosing to make use of the facilities offered by Crook County Medical Services District, board chairman Mark Erickson and CEO Micki Lyons felt the need to make sure this wasn’t the case.

To do that, they ran some numbers. Specifically, they looked at the figures for outpatient visits, swing beds and visits to the ER in the years 2019 through 2022.

For this year – because, obviously, there are a couple of months yet before it ends – they used the run rate through August to project the final tally.

The results showed significant growth in all three areas.

“It’s black and white when you look at numbers,” says Erickson.

It’s news they feel compelled to share with the district’s stakeholders because, believes Erickson, this growth is at least partly due to the move back to community-focused healthcare since bringing management back in-house. In 2019, the board of trustees chose to end a period of several years in which CCMSD was managed by external companies.

“The change was made to become truly an independent, community hospital where the goal is to take care of your local residents, first and foremost, versus an overriding, corporate-type goal,” says Erickson.

“When we retained management firms, their goals were different than the community’s goals, whereas now it’s back to where it started as its inception: as a community district.”

CCMSD returned to its roots, no longer considering the district a for-profit venture and instead pouring money back into new equipment, new ambulances, training and other needs. After this decision was made, he says, “The turn was almost immediate.”

The numbers themselves tell two different stories. On the one hand, the number of patients using swing beds – and, to some degree, the number of ER visits – speaks to CCMSD’s recent efforts to expand capability in these areas.

On the other hand, the increase in the number of people visiting the clinics or choosing to come to the ER reflects an uptick in local usage.

Swing Beds

The use of swing beds within the Crook County Memorial Hospital has almost tripled over the last few years. “Swing beds” is an industry term that refers to patients who are recuperating and require specialist care while they do so.

Since 2020, the CCMSD team has been building its team and portfolio of available skills specifically to provide that rehabilitation care.

“Typically, those are rehab services that are provided in a skilled nursing facility,” says Lyons. “When you have a critical access hospital, it’s more beneficial from a payment standpoint to do that in your actual hospital as opposed to a nursing home.”

One of the benefits of being able to provide swing beds, she says, is that, “It allows the people of this community to receive those swing bed services close to home.” Meanwhile, says Erickson, many patients appreciate being cared for by members of their own community, with whom they are familiar.

For example, if a patient has surgery in Rapid City and needs a month of physical rehab or IV-based medication, they can come back to Sundance for the duration. The patient’s family can visit them in town, rather than driving back and forth to South Dakota.

“We have physical therapy, occupational therapy, speech therapy all available, and we can do it right here in this facility,” Lyons says.

Before 2020, says Erickson, the hospital did provide swing bed care if it was requested. However, it wasn’t something the district pushed for as a goal.

“It wasn’t a conscious decision as a service that could be offered,” he says. However, he continues, it seemed important to provide something that could truly be of benefit to patients and their families.

“Micki made the decision when she came on board in her role that this was a service we could provide, and we could do it very well,” Erickson says. “We’ve got the staff, and we’ve got a community that would like to use these services because it’s convenient for them.”

Running the numbers, Erickson and Lyons found that CCMSD reported just 537 swing bed days in 2019. This statistic is reported in terms of “days” because an individual patient may be occupying one bed for several days, or even weeks.

By 2020, that number had increased modestly to 673. The next year, it jumped to 1001 swing bed days, with another estimated leap to 1486 by the end of 2022.

There’s a limit to how much this figure can continue to grow – a building has only the number of rooms it has, after all – but the district intends to keep things going in a positive direction.

“Our intent is to continue to work with the four physical therapy places in the county to find out what they can do to help in that process,” says Lyons.

For example, the district is seeking therapists with specialty interests, such as physical therapy for vestibular issues like dizziness or stroke recovery. This, she says, will expand the range of issues that the district can assist a patient with during their rehab.

Visitation

Visits to the clinics have seen a steady increase, according to the figures provided by Erickson and Lyons. In 2019, a total of 4454 outpatient visits were recorded, rising to 4738 by the next year.

In 2021, this increased again to 4932, jumping this year to an estimated 6000.

Visits to the emergency room have also increased significantly since 2019, when 758 were recorded. The next year, this rose to 877 visits.

In 2021, recorded ER visits rose to 1041. By the end of this year, an estimated 1234 people will have made use of the hospital’s emergency care department.

“Part of that has come from word of mouth,” says Lyons. “We have four fantastic providers who are very high level in their skill in the ER – we’re not a band aid station. You can come here to our ER and you’re not just going to get packaged up and sent off; if we can take care of it here, it will be taken care of here, but if you need a higher level of care, we will get you there.”

The increase in the level of EMS care has also helped, she says, with paramedics on staff. Having them available has also increased the comfort levels with emergency providers working together.

Bolstering the ER department has been about filling in the gaps in what the hospital was able to provide. CT, MRI, x-ray and ultrasound scans are now possible, which strengthens the diagnostic possibilities.

Long gone are the days when an x-ray had to be sent elsewhere before it could be read.

“If you came in with a spill and we didn’t have the ability to make sure you didn’t puncture something or have a bleed in your abdomen, you would have to be sent to Spearfish,” says Lyons.

“Now, you get a scan and we say you’re good to go or we can keep you here.”

Lyons’ leadership style has also leaned towards giving providers the freedom to come up with new ideas and empowering them to figure out solutions as a group.

“We’ve put a huge emphasis over the last two years on leadership. We’ve put our management team through leadership training for over a year, we’ve done quarterly leadership with an outside group, which has been very beneficial,” she said, noting that the latter was itself a suggestion from a provider who had taken it himself. “It’s been a huge drive for us to figure out how we all work as a team.”

There are no plans for active growth in terms of ER usage, says Lyons, other than to work on marketing to the community to ensure everyone knows what the hospital can do and how it can help.

CCMSD will also continue its push for training, she says, to make sure staff are up to speed with the various traumas that might arrive in the ER.