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Health Care Model Less Hospital-Centered, Bringing Care Closer to Patients

Photo by Nora Edinger An exam room awaits a patient inside WVU Medicine Wheeling Hospital’s urgent care center on Market Street downtown.

WHEELING — If it feels like various outcroppings of WVU Medicine are moving closer to home — maybe a new urgent care down the block or a primary doctor at the neighborhood strip mall — it’s not your imagination.

“We track ZIP codes,” explained Douglass Harrison, CEO of WVU Medicine Wheeling Hospital, one of several hospitals in the Ohio Valley to link with the West Virginia University system in the last couple of years. “If there’s a big caseload in a particular ZIP code, what are they coming in for?”

Harrison offered a specific example of how today’s health care model is matching location to need, or at least patient population.

Two ear, nose and throat (ENT) specialists — Dr. Christopher Tiu and Dr. Jeremy Tiu — have an office in the Woodsdale neighborhood, atop a hill dominated by SpringHill Suites by Marriott.

Wheeling Hospital Center for Audiology — and the hearing tests ENT patients might need — is next door in a lobby-sharing kind of way. Wheeling Hospital Center for Sleep Medicine — and the sleep apnea testing that ENT patients could require — is at the bottom of the hill.

“Interestingly, consolidation doesn’t mean under one roof,” said Jim Kaufman, president and CEO of the West Virginia Hospital Association of the switch from a hospital-centered model to health care systems that are linked in a multitude of ways and locations. “You can move care closer to patients.”

If all this sounds calculated, both Harrison and Kaufman, who represents the interests of hospitals around the state, said that’s the point — and it will take such precision in placement and planning to keep both Mountain State and U.S. health care well in a new health care era.

DATA AND SCALE

While quality of and access to care are also drivers, the root of local health care’s remapping is money or, sometimes, the lack thereof, both administrators said.

“The federal government is pushing a lot of this,” Harrison said of cost-control policy changes at the U.S. Centers for Medicare & Medicaid Services. Outpatient care is in.

While the change is national, Kaufman noted that what the federal government wants matters greatly in West Virginia. He explained 75% of Mountaineers are insured through the federal Medicare and Medicaid programs or the state Public Employees Insurance Agency.

All three government payers — or, more specifically, their lower payouts – are linked to many West Virginia hospitals running in the red on the patient-services portion of their income, Kaufman said. Prior to the anomalies of COVID, two-thirds of the state’s hospitals were in this situation.

“How do you provide quality care and make it as good as possible but reduce costs?” is the question, Kaufman said. And, the answer of the moment seems to be both systems and the economy of scale they provide plus data-driven delivery.

Harrison noted Wheeling Hospital – already in the WVU Medicine system – is monitoring both local and national data.

The sleep center’s placement is an example of responding to local data, but it is not alone, he said. The hospital is always looking for ways to be cost efficient, such as bringing four PCPs scattered around a community under one roof. Suddenly, a neighborhood can have an outpatient clinic with a lab or other on-site services.

Zoom the data out – using national algorithms – and Wheeling Hospital can see how many such PCPs are needed to serve an entire population cluster, Harrison explained.

Compare that number to actual doctors on the ground and he knows whom and how many he needs to be courting and where they need to set up shop.

“There’s a lot that goes behind it,” Harrison said of hitting that sweet spot of supply versus

demand. “You don’t want a practice on every corner.”

You don’t necessarily want a practice inside the hospital, either, he noted. Wheeling Hospital, specifically, has a long-range plan of reserving in-hospital office space for its growing stable of specialists.

He said this is part of a WVU Medicine move toward making the hospital the regional hub for higher-level surgery and inpatient care while smaller hospitals such as WVU Medicine Reynolds Memorial in Marshall County provide in-community access to general services.

Eventually, non-specialists such as pediatricians and PCPs that are inside Wheeling Hospital now will likely be moving into a nearby outpatient center that is in the planning stage, Harrison said.

Even the number of inpatient beds in the region is getting a data look-see, he added of one traditional element that must remain at the hospital. Right now, Wheeling Hospital has 223 beds.

That might not seem like a lot, given that the 2019 closure of Ohio Valley Medical Center took 300 beds out of the region. But, it has turned out to be plenty for day-to-day inpatient care given the trend toward an outpatient-based model, Harrison said.

He has the numbers to back that statement.

Prior to OVMC’s closure, he said the two hospitals were running inpatient occupancy rates in the 50 percent range. This was far below the 80-to-82% occupancy that national models suggest gives peak financial efficiency. Yet, even now – COVID’s height excluded – Wheeling Hospital is only running in the 70% range.

MANY ROOFS

This kind of data analysis and strategizing can ultimately lower costs, both Harrison and Kaufman said, but it can also improve both access to and quality of care if it’s done right.

“You’ll always have hospitals and that critical-access point, but you may see hospitals that are looking different,” Kaufman said.

He noted it is important to make sure smaller hospitals such as Reynolds Memorial can maintain both community access and a place to stabilize patients needing specialized care before transfer to a hub like Wheeling Hospital or a top-tier center such as WVU Medicine Ruby Memorial Hospital in Morgantown.

“Not every community is going to have enough population to support every service.”

But, Kaufman added, every community better have plenty of tech as health care unfurls.

“Broadband is a health care issue.”

Harrison also sees broadband and the tele-health potential it represents as yet another part of the many-roofed, outpatient-based model of health care. He hopes that Wheeling Hospital will reach 10% tele-health visits in the near future.

That’s a large goal, considering such visits, sometimes done via smart phones from a patient’s bedroom, now hover at 5%. But it’s not an unreasonable one, given the WVU Medicine partnership, he noted.

A big partner can mean big speed. When COVID hit in March 2020, Wheeling Hospital was able to go from no telehealth to a full network for all its doctors within two weeks, he explained.

He noted that kind of flexibility comes naturally in a many-roofed model.

During COVID, for example, Wheeling Hospital staff notably worked under tents set up in parking lots and in empty storefronts – and alongside Ohio County’s public health officials and, at times, volunteers.

“It’s taking a look at the resources,” Harrison said.

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