Bastrop , Texas Hospital CEO works long-distance for Cimarron Memorial Hospital

Dave Peyok, of Bastrop Texas assists with the day-to-day management of Cimarron Memorial Hospital , (for now at no pay), staying in touch with CFO Kevin Conner and the hospital board by phone, e-mail and fax.

Asked how a long-distance relationship worked, Peyok grinned and replied, “It's almost like I was here. I'm on the phone and get e-mail and 200 page faxes.”

Asked how and if the hospital could be turned around, Peyok said, “It's gonna take a mind change; because doing the same thing over and over and expecting a change [at the hospital] is the definition of insanity.”

Peyok admitted that enacting a mind-set change in the employees would be the most difficult, especially since he wants to make drastic changes in the way the facility operates. His plan is to de-license the nursing home and expand the hospital. However to do so will call for changes such as piping oxygen into the present nursing home and turning those beds into swing beds. [Peyok e-mailed questions and answers about the recommended changes, they are included in the article.]

“I want to take long-term care and change it to swing beds. I want to take the facility and turn it into a hospital. The changes needed, the oxygen and other changes will be reimbursed by Medi-Care at the end of the year. It's like taxes,” he said.

“The last time I did this in a facility in Montana , it went from losing $110 thousand a month, to a profit of $400 thousand a year.”

Asked how he would sell the idea to the community and the nursing home residents, Peyok replied that it's “Educational”.

“The families in the places this has been done haven't noticed any difference, (in services and expense), if a resident is self-pay, they save money.”

Peyok says all that is necessary is to talk to the state licensing authorities, and then to give a notice of 30 days.

He admits that there are social considerations, that some wouldn't welcome the changes, while others might welcome the idea of being in a hospital instead of a nursing home.

Asked how he'd find the money to make the needed changes, Peyok replied that, “It's easy to find funds when they know they'll get it back at the end of the year.

Peyok said he has made an environmental walk-around of Cimarron Memorial and for the most part, likes what he sees.

“The hospital is not bad right now. But we'll have to be careful with the remodel. [Not to violate the structure's grandfathered regulations.]

Asked what he'd like for medical staff, he said he'd like to bring in a Nurse Practitioner and to set up a clinic in Keyes.

De-licensure of Long Term Care Benefits

· I thought the nursing home “made” money, why would we get rid of it?

The Federal reimbursement for the hospital is more beneficial than the long term care reimbursement system. The hospital reimbursement system is a Federally Legislated program that reimburses the hospital based on the costs associated with hospital care. The LTC system is based on how much “care” a resident needs, regardless of how much it costs to provide this care.

Since Boise City is a rural facility it pays a premium for supplies and utilities, which is reimbursed under the hospital system but not under the LTC system. This cost based reimbursement system was designed by Congress to ensure that small, rural hospitals could continue to provide needed health care services as pharmaceutical and equipment costs continued to rise.

F What will happen to the Residents of the nursing home after it is de-licensed?

For the most part the Residents and their families will see very few changes. What will be noticeable is that each patient of the hospital will have a private room. On the day the nursing home is de-licensed; most Residents will simply become hospital Patients. A few Residents have third party insurances that will only pay if the person is in a licensed long term care facility. These Residents will need to decide if they wish to stay at CMH or find placement in another facility or change insurances.

F What changes in employee staffing will occur as a result?

There will be very few if any changes in staffing, as a result of this change. For the most part, CMH will be taking care of the same people with the same personnel in the same facility. What will occur is that hospital and nursing home staffs will be combined. This combination of staffs was not allowed due to the LTC regulations, once those are eliminated the staff of CMH will be one big happy family.

F Is the hospital reimbursement program a stable program or is it a temporary government fix?

While CAH status may not be an option for all rural hospitals, the program is already proving successful in other states like Colorado , Kansas , Nebraska and West Virginia . Some rural hospitals in other states have already realized a significant increase in funding. The Critical Access Hospital program has been around since 1996 and since that time the government has only added benefits to the program and has not made one reduction to the benefits of the program.

F How long will it take for the hospital to de-license the nursing home?

First the CMH Board will need to approve the de-licensure, then the facility will have to give thirty (30) days notice to the Residents. During the thirty day period the facility will ensure all of the insurance issues and final placement of Residents is completed. On the thirty first day, the LTC license will be eliminated and the nursing home space will be incorporated into the hospital operations.