Healthcare News & Insights

Rural hospital integrates healthcare apps to drive revenue with better patient outcomes

Prospering in today’s healthcare system isn’t easy, but it can be done. In this guest post, David Dallago, former chairman of McKinley County Commission, and Donald Voltz, MD, medical director of the main operating room, department of anesthesiology, Aultman Hospital, offer an uplifting real-life story about how one rural hospital did just that with a little help from technology.


McKinley County, New Mexico, is the namesake of the assassinated 25th U.S. President William McKinley. Many locals, particularly those Native Americans of Navajo decent living on reservations, have also been the victim of assassination, but in character in addition to physical attacks. Three decades ago Gallup, New Mexico, which borders on the Navajo Reservation, was known as “Drunk Town, USA.”

For many years Northwest New Mexico’s Gallup ranked No. 1 nationally in the number of alcohol-related deaths. This reputation also killed many resident’s spirits, contributing to addiction, joblessness and homelessness, further highlighting the need for behavioral health care in this region. Native American youth have the highest rates of alcoholism of any racial group in the country, according to the National Institutes of Health.

Despite the drumbeat of bad news and discouraging statistics, organizations such as Gallup’s Na’ Nihzhoozhi Center Inc. (NCI) has 26,000 admissions every year and is the nation’s busiest treatment center with many repeat customers. The detox center was the result of an effort 30 years ago which began when more than 5,000 people marched from Gallup to Santa Fe to demand assistance from state lawmakers and received $400,000 for a study to build a detoxification center. The hospital then received a $2 million ongoing yearly federal grant out of which NCI was born.

The leader of that effort in the 80s and 90s was David Conejo who returned in 2014 as the CEO of Rehoboth McKinley Christian Health Care Services (RMCHCS). When he became CEO of RMCHS a few years ago, he took a financially failing hospital and turned it around with the help of William Kiefer, PhD, who is the hospital’s COO. Recognizing the root cause of the region’s health problem was addiction, Conejo revitalized a former rehab building on the hospital’s grounds and with some fundraising he launched the Behavioral Health Treatment Center.

Hospital fights addiction with behavioral health apps

From this traditional form of behavioral health addiction treatment, Conejo has turned to health information technology in his pursuit of behavioral health care remedies while leveraging government insurance changes in Medicare and Medicaid, under the Obama Administration. Rather than traditional acute care services, the Centers for Medicare & Medicaid Services (CMS) began to shift its focus on preventive care, identifying a 6:1 cost savings ratio.

Conejo recognized that RMCHCS would benefit by offering preventive care services which fit perfectly with his behavioral care plans while creating a new revenue center through reimbursements by CMS. To achieve this, he recognized the need for the convergence of hospital information across clinical, financial and operational systems.

He began by integrating data from the hospital’s three clinics – the College Clinic for family and internal medicine, the Red Rock Clinic for general surgery and the Acute Clinic for emergencies and occupational health. He used a cloud suite application which integrates and streamlines data from CMS, including annual wellness visits (AWV), chronic care management, and care transition between physical and behavioral health services.

Integrating data and patients

The cloud application streamlines data from AWVs and integrates it with the hospital’s electronic health record (EHR) systems. The app also allows for the management of tracking for patient wellness visits, provides a physical assessments guide through preventive exams and maps out the risk factors for potential diseases for patient follow-up visits.

In addition, the app includes other services that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurer requirements for organizations like Blue Cross/Blue Shield. The app’s time tracker capability automates invoices for faster billing.

RMCHS business is growing with full or near-full coverage compliance. And with its accountable care organization (ACO) in startup mode, RMCHS is also receiving a bonus check from Medicare for containing costs, in addition to the new revenues being generated. During the first five months of using the app, the new revenue has matched the financial incentive from its ACO, with the outlook of at least doubling the bonus from the ACO. Furthermore, RMCHS doesn’t increase its current operational cost to achieve this type of outcome.

Joe Wright, the hospital’s director of clinical services, has found the apps provide significant time savings for the nurses and medical assistants when disparate EHR data is integrated and streamlined. He also notes more patients can be seen. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, and if a physician saves 10 minutes per patient, at 18 patients a day, that’s an extra 180 minutes.

In addition, his chronic care patient practice has grown significantly since the recent implementation of a chronic care management app where many patients suffer from diabetes. Patients participating in AWVs have grown to 250, a 50% increase since the apps have been installed. The AWV appointments also mean less patient visits to the hospital. At the hospital’s Behavioral Health Services facility where addiction to alcohol and opioids are the main patient affliction, all 68 beds are full.

Telemedicine next step

Conejo’s next big technology push will be a telemedicine program enabling reservation patients to be seen by mobile healthcare physicians connected by satellite to the Internet to extend the hospital’s outreach to patients who can’t travel to the hospital. This will enable patients to be treated as if they were at one of the hospital’s clinics with all their data entered into the appropriate systems and ready to be whisked off to the insurance organizations.

David Dallago is the former chairman of McKinley County Commission, and Donald Voltz, MD, is the medical director of the main operating room, department of anesthesiology at Aultman Hospital.


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