Dr. Clark’s annual report
The Medical Center is growing. The number and complexity of patients, the scope and quality of care continue to increase yearly.
This year we have seen increasing numbers of critically ill patients come through our doors. Often transport is complicated by weather. Sometimes delays result in sick patients remaining in the Medical Center under our care overnight or for many hours until the weather clears. Part of our mission moving forward is to continue to assure we are doing all we can to be prepared for those situations by ensuring our team is properly trained and our facility properly equipped.
In addition to increased acuity of care, we are seeing increased volume of patients seeking services: In 2017 the total number of patient visits was 4,922; in 2018 the total number of visits was 7,439 (5,605 clinic, 1,235 physical therapy, 369 wellness/risk reduction, 240 behavioral health.) This represents a dramatic 51 percent increase in use of Medical Center services in one year alone. A modest 10 percent projected increase in 2019 will result in 8,183 patient visits to the Medical Center, not including ancillary services (dental, massage, acupuncture, chiropractic, podiatry). The increase is due to the additional services we are providing and to an increasing dependence of Block Island residents on BIHS to provide their health care.
It is very rewarding as well as challenging to see how many islanders now consider the Medical Center to be their primary care home. Most notable among our added services are a thriving three-day/week physical therapy program, behavioral health and counseling, a wellness and risk reduction program with medically supervised exercise, nutrition counseling, and women’s health services. We have implemented a sliding scale payment and financial assistance program based on national standards to remove barriers to essential health care services. In 2018 we also added clinical hours (medical center open) with support staffing both days of every weekend during the summer and shoulder season, and have continued these extended ours for the benefit of our islanders and visitors this year. Every weekend during the summer and shoulder season we are open for urgent care from 9 a.m. until 1 p.m. —and, of course, continue to respond to emergencies 24/7.
In alignment with our mission to identify and proactively address vulnerable groups we have worked hard to extend and promote behavioral health services, add specialty services for women, to provide financial assistance to uninsured patients seeking our care, and to provide community education and outreach via community talks and preventive health articles in The Block Island Times. Moving forward, in collaboration with NAMI-BI, we are engaged in dialogue with partners at Brown University to implement a child and adolescent behavioral tele-health program in a place similar to the one that currently exists for adults. We continue to collaborate with the Senior Advisory Committee to identify and address the needs of our seniors and to identify programming specifically targeted for them. One example of this targeted programming is the success of our PT and wellness programs in reducing falls among our seniors and those de-conditioned by illness or injury so that they can safely remain on island where they want to be. Another example of this is our commitment to providing home and hospice care, in coordination South County Home Hospice, for our islanders with end-stage conditions, allowing them to spend their last days in their homes where they wish to be. The mainland company provides equipment and visits and we provide assurance that we are always here to provide home visits, handle emergencies and be present as needed at the bedside any time, day or night. That is the Block Island personal touch.
In alignment with our Mission Statement we are “honorable stewards of the resources entrusted to us,” we have taken robust steps to ensure maximal accuracy, efficiency and timeliness in our coding and billing — essential for our financial viability — as we simultaneously continue to be attentive to the needs of islanders and visitors. This year we engaged a professional firm to assist us to renegotiate our insurance reimbursement rates and have successfully achieved contract offers of rate increases with three of our insurers and are still working with others. This will increase our revenue and help us keep pace with the cost of the care we provide. We also engaged a company to assist us with our medical coding to ensure we are complying with insurance and Medicare mandates, ensure timely billing and maximum reimbursement so that the Medical Center can get paid for the services it provides. Under the outstanding direction of Terri Chmiel, our Finance Director, our budget is balanced and our revenue is increasing. Under her leadership our excellent front desk team has tightened our policies and procedures to ensure timely and accurate billing and collections. Our challenge remains to keep pace with the ever tightening health care dollars and increasing costs of care. It is worth pointing out that over the last four years we have continued to expand services and only sought increased financial support from the Town of New Shoreham in one instance. This $40,000 approved increase for fiscal year 2019 breaks down to only a 3.8 percent increase in funding assistance yearly since 2015.
When I came to Block Island four years ago and took on the role of Medical Director the main message I brought with me is that the standard of health care should be no different on Block Island than it is on the mainland. There should be no “Block Island Factor” in health care. It is too important. That is the same message that I bring today. Block Island deserves and needs nothing less. I am convinced that we are at a critical crossroads for the Medical Center. We have made many gains over the last four years but we stand to lose them unless we all remain committed to this ideal. That means that together we affirm the principles in our Mission Statement. Specifically, we must remain committed to continuous improvements in the quality and scope of care and outreach; continuous improvements in our integration with mainland providers; continuous focus on our patients, our community and visitors; and necessary improvements in our facility. Equally important, I believe it is imperative that we insist on the highest level of medical professionalism in all aspects of care and medical center operations and in particular with regard to patient privacy and confidentiality at all levels of the organization. If we continue to re-affirm and commit to these ideals and if we continue to follow through with the hard work it takes to achieve them, then I believe the future of the Medical Center is very bright.
Finally, I would like to thank all of you for your support and kindness over the last years and in particular this last month. At this time, I would like to inform all of you of my decision to rescind my resignation. Michael and I intend to stay on Block Island indefinitely to continue to carry forward the Mission of the Medical Center.