Lake Chelan Health to transition to hospitalist model

CHELAN – Lake Chelan Health Hospital recently announced the decision to contract with Rural Physicians Group (RPG) to provide hospitalists for inpatient care.

Under this new model, an RPG hospitalist will be on-site 24/7 for a week-long shift, rotating among the same three to four physicians.

Currently, the hospital partners with Columbia Valley Community Health (CVCH), whose physicians have provided inpatient care and labor and delivery services. CVCH doctors will still provide labor and delivery services after the transition to RPG on January 14, 2025.

Aaron Edwards, CEO of Lake Chelan Health Hospital, noted that since the hospital opened in December 2022, patient volumes across various departments, including the emergency room, imaging, and lab, increased significantly. 

However, inpatient admissions have steadily declined over the past two years, with some months remaining flat but most showing a slow downward trend. Given the usual correlation between emergency room visits and inpatient admissions, the hospital began analyzing metrics such as the emergency room length of stay (LOS) and time to inpatient bed and discovered that the numbers were higher than expected.

Currently the hospital’s daily inpatient census is a little over two inpatients and two swing beds. Swing beds are for someone that doesn't quite meet inpatient criteria, but might need a little bit more care before going home.

The hospital has 12 acute beds, nine ED beds, and 10 PACU or pre and post-operative beds.

“So our tertiary facilities, our big facilities that we refer to or we transfer to, if we need to transfer, they don't have the capacity to take extra patients because they don't have enough staffed beds,” Edwards said. “So we need to be judicious and very careful with what we transfer and what we don't transfer to not, you know, fill up their beds with lower acuity patients.” 

After reviewing a year’s worth of patient transfers, the administration found that about 80 patients who were transferred out could have been treated locally.

The hospitalist model aims to address this gap. Hospitalists specialize in inpatient care, offering continuous attention and spending more time with patients, which Edwards said will improve satisfaction and outcomes. 

“When we get quality feedback from surveying one of the things that we see is they want more time with their physicians,” Edwards said. “They want to know what this or that means. They want to know what's the next step, what you're doing, that's very hard on family practice docs that are, you know, across the street and not present 24-hours a day, like these hospitalists will be that we're bringing in.”

Contracting with RPG will not be an initial cost savings for the hospital. But the leadership sees it as an investment in the future of care.

While the move to RPG's hospitalist model represents an investment for the hospital, Edwards and the board believe it will ultimately be financially beneficial. Board member Doug Gibson pointed out that even though there might be initial costs, the program could be offset by retaining just 1.8 more patients per day—patients who are currently transferred to other institutions but could be treated in Chelan.

Dr. Matthew Hillman, Chief Medical Officer at Lake Chelan Health, said that the decision to shift to a hospitalist model was driven by the goal of providing better care for the local community, not by cost. The aim is to keep patients closer to home, avoiding unnecessary transfers to hospitals in other cities. 

“By moving to this hospitalist model, we have specialists who are trained differently,” Hillman said. “They have a completely different residency that they go through, and they specialize simply on the care of patients and in hospital settings, getting them better, getting them home.”

“And with this model, we’ll be able to care for patients just that much better,” Hillman said. “And really, we're pushing for the national standard of care for the people who live in Chelan, trying to give them the best care we can possibly give them.”

“Care in a hospital is complex and needs to be coordinated,” board member Doug Gibson said. “There are a lot of moving parts, and so if you have doctors who are dedicated to working just within the hospital, they get used to complexity, and they're here all of the time, so they're more efficient for the hospital to speed care through the system.”

Having a dedicated hospitalist can also improve wait times in the ED because patients can be moved from the ED to patient beds more efficiently.  

When the board reviewed the plan, they asked if it could improve care for the community. Although there may be an initial financial dip, they are focused on the long term. They believe the plan will at least break even and could potentially be a financial benefit for the hospital, enabling more local services, Gibson said.

Dr. Matt Pappy, a hospitalist and RPG CMO, echoed that sentiment that the shift is about more than cost. The time cost for patients waiting in an ER is significant, and the cost of transferring patients to distant hospitals adds up. But beyond that, patients need to be near their loved ones for support, he said.

Sometimes patients are well enough to leave the hospital but not ready to go home yet. This requires a transition of care, from the ER to the med-surg unit, or to a swing bed before heading home. Coordination between different medical disciplines is key to making this process seamless for the patient, allowing them to focus on recovery, Pappy said. 

The hospitalist will be able to conduct daily rounds with nursing staff and provide educational mentorship. This one-on-one engagement helps nurses improve their skills and work at the top of their licenses, which is essential for the hospital to effectively serve the community, Lake Chelan Health COO, Shawn Ottley said.

That type of ongoing education is also helpful in recruiting nurses, he said.

“If you're able to offer that ongoing daily education, you're going to become a place where people want to come work, because you have that culture of continuing education and that collegial relationship between the providers and the nursing staff,” Ottley said.  

“And not to say that that didn't occur with CVCH, because they are great providers, and they are very good at education, but they don't have the time needed within their day to spend one or two hours with our nursing staff to really help them work to the top of their license.”

“We work in over 40 rural hospitals,” RPG CEO Mike Patterson said. “We only focus on rural, mostly critical access (hospitals), but one of the successes we have is that we can help the nursing staff, we do in the moment, education, repair education.”

Without a 24/7 hospitalist model, night nurses, who are often less experienced, rarely interact with doctors. With this model, doctors are on-site around the clock, regularly rounding with night nurses, providing education, answering questions, and guiding patient care, improving overall support and communication, Patterson said.

“I think one of my favorite parts of the day, we set aside time every day called interdisciplinary rounds,” RPG CMO Dr. Matt Pappy said. “That's where all the medical staff come together to discuss each of the patients that are on the census, and we go through their plan of care and their goals of therapy and around the table.” 

“We're talking from nursing staff, respiratory therapy, physical therapy, occupational therapy, social work,” Pappy said. “We're talking about not just what's going on today, but what the plan of care is, what tracking what their plan of care looks like, moving forward and getting them home and back to their loved ones as soon as possible, or at the timely at a timely discharge.”

The shift to using hospitalists for inpatient care aligns with a broader trend in medicine, as hospitalists can provide continuous care and spend more time with patients, Edwards said.

“It is the number one growing specialty in the United States, hospitalist medicine, because we feel like, you know, patients, when we get quality feedback from surveying one of the things that we see is they want more time with their physicians,” Edwards said. “They want to know what this or that means. They want to know what's the next step, what you're doing, that's very hard on family practice docs that are, you know, across the street and not present 24 hours a day, like these hospitalists will be that we're bringing in.”

The board vetted two other vendors before choosing RPG because of their good track record, Edwards said.

“Where your time and your efforts and your heart is, that's what you're going to be good at, and that has come across in every conversation that we've had with them, that the physicians that will be here, and these will be this set same physicians that will come on a rotation, so it's not, you know, just random people coming at every different time they will get to know this community while they're here,” Edwards said.

However, the decision has raised concerns among some local physicians.

“I think that ultimately what drew me and what I believe drew many of my colleagues who practice primary care medicine to this rural community, what drew us here is the ability to have a broad and varied scope of practice,” Dr. Scott Hippe said. “You know, I love working in the clinic and knowing patients and developing continuity and taking care of family members of multiple different generations. And I like that. And then also I am energized when I get to have some variety or mix it up, and you know, for a week, I'm also rounding on inpatients at the hospital or delivering a baby or performing procedures like colonoscopies.”

“What has ultimately been heartbreaking about this decision is that element of variety and broad scope of practice that keeps us here is called into question by this decision,” he said.

“I'm speaking on behalf of myself when I say these things, like, I work at Columbia Valley Community Health, I'm in no way speaking for my organization,” he said. “I'm speaking as a doctor who has privileges at Lake Chelan Health.”

Hippie said the questions he is asked most often in the clinic is ‘do you like it here? You’re not going to leave like those other doctors, are you?’.

“I think people in the community want to have their doctors stay and continue providing care and that that relationship that's developed over a longer period of time means something to people,” he said.

“I guess I would maybe let every, you know, let every doctor and let the situation speak for itself,” he said. “But just that it was no accident that we came here seeking a certain style and way of practice and it's hard and might have impacts on the delivery of care in the community.”

“On the surface, it is a subtraction for the family practice doctors, because they have always had the ability to come into the hospital for their patients,” Gibson said. “But from the hospital side, it is more efficient to have hospitalists here. Having said that, we believe that we can work out ways where the family practice docs can spend more time doing exactly what they do best, which is seeing patients in the clinic, seeing more of our community in the clinic, and that is good for the clinic also” 

“So I think, as a board member, everybody wins in this eventually, and a lot of the grinding of the gears we're hearing now primarily has to do with just the noise from change,” Gibson said. “And as we get through the change process, I believe a lot of this will settle in, and people will say, ‘wow, we should have done that a long time ago’.”

Quinn Propst: 509-731-3590 or quinn@ward.media.