Cullman Regional is differentiating itself from the current trend facing many community hospitals that are closing or being sold to larger healthcare systems. With teamwork and the leadership of Chief Executive Officer James Clements and the board of directors, Cullman Regional has reversed a $13 million deficit into a 23 percent increase in volume along with new projects for hospital expansion and upgraded facilities.
Clements says smaller hospitals often face a complex management environment and a level of unpredictability that generally doesn't affect other businesses. "We all are experiencing an increase in uninsured patients probably caused by a reaction to the Affordable Care Act, cost or factors such as unemployment. We have unpredictable payment streams from payors such as Medicare and Medicaid," he says. "In addition, larger urban hospitals are marketing aggressively in our areas to pull patients into their profitable service lines."
When Clements joined Cullman Regional in 2014, he was determined to challenge those issues and find ways to increase the hospital's patient services and profitability. The first, and maybe the biggest, change was a shift from a political culture to one of accountability. "We ask our team to focus on quality and efficiency when they make changes, and we want them to be adaptable," Clements says. "Change management is hard, particularly in a small or medium-sized hospital that is not accustomed to a rapidly changing environment, so we hired new team members who are experienced in health care accountability. Finally, we have an engaged and informed board of directors. That is critical to our success."
Next, Clements and the board built a leadership team with two goals: to put patients' needs first and to grow volume so they can devote resources to the best quality care. "We educated our doctors and nurses about what 'patient first' means," Clements says. "It means that we don't put the doctor, nurse or hospital first in the equation. We expect that of every person in the organization. Because we have to rely on 1,100 people to make these decisions in a tense environment, we had to give them a framework to do so. We tell them that we will support every employee who has to make an independent decision as long as the patient comes first."
Clements is pleased with the progress of Cullman Regional's patient services and its current financial health. "We are definitely improving," he says. "We are in the top five percent in Alabama on all financial metrics. In the last three years, there has been a 15 percent increase of Cullman County residents selecting Cullman Regional as their provider, a 22 percent increase in patient volume, and a five percent increase in outpatient volume."
A self-funded expansion at the hospital and urgent care center will help with current volume issues. The primary purpose of the urgent care center expansion is to assist with emergency room overcrowding. "We are treating approximately 50,000 people a year in our existing ER. About 20 percent of those people could be treated more efficiently in an urgent care environment," Clements says.
A 30 bed expansion, set to open this fall, will be a surgery floor designed to improve quality of care along with features specific to family members. The nursing station will be moved to the middle of the unit to allow nurses quicker access to patients. "Amenities are being upgraded in each patient room to provide better access for family members," Clements says.
CRMC recently added tele-neurology coverage in the area and has purchased a controlling interest in a local surgery center. "This will be important going forward as we want to add more high-quality, low-cost options for our patients. Anything that increases quality and efficiency is a top priority for us," Clements says.
Having numerous projects in the works does not stop Clements from looking several years into the future of CRMC. "The biggest change I see in the next few years is a move from being an inpatient hospital to being a health system. We will have continuum of care that will include an inpatient hospital, outpatient urgent care center, emergency room, ambulatory surgery center, home health, and hospice," he says. "It is about the total health of the consumer, not just one point in their lives."