My best friend had told me what to expect. She predicted that my husband would come up with his own helpful ideas for burning some calories and that I needed to be prepared.
“Husbands always come up with the same brilliant idea about new ways to exercise,” she said with a slight tone of disgust.
She was right. My husband broached the subject just a few days ago, suggesting that:
1. It’s something we can do together
2. It’s fun
3. We already have the right equipment. No need to run out and buy weights, trampolines or a thigh-master when we’ve got all we need right here, babe.
All of the women out there know exactly what I’m talking about, right ladies?
Yup, he wants me to golf with him.
Golf has become my husband’s passion in life. It’s grabbed him by the throat and dragged him from his home and family, separated him from his lawn mower and hunting dogs, and left me with broken tees rattling around in my washing machine.
For my birthday, I got golf clubs. For Mother’s Day, I got lessons with a pro. My husband apparently believes that I should put aside my hostility toward his addiction and join him.
In my quest for less fat and more muscle, I’ve embraced walking, bike riding, and light hiking. I’ve been invited to try Zumba, some of the local fitness centers, and yoga. All of these activities make sense to me. Golf doesn’t make sense.
I don’t find anything physically natural about a golf swing. Let’s see: wrap your hands thisaway with your thumb here and your palm there, twist your body like a spring (a spring!), don’t bend your elbow but do cock your wrist, keep your head down, stick your bottom out, pivot your weight from this foot to that foot, and for some icing on the cake, hit the ball. Are we having fun yet?
The main problem that I have with golf is that I’m a beginner. I feel awkward and I can’t wear the cute golf-girl clothing. So far, the only thing I like about golfing are the spunky little carts and drinking an ice cold beverage on the 8th hole at Targhee Village golf course.
Do I want to close myself off to learning new things? No, even though my enthusiastic attempt to learn how to snowboard ended abruptly with a double-fractured tailbone and a four-week intimate relationship with a blow-up chair donut, I do want to be open to new experiences. It’s time to swallow my pride.
For the betterment of my mental health by learning something new, I’m going to golf with my husband and take lessons. For my physical self, I’ve set a goal to be able to walk 9 holes by the end of September.
Disclaimer: This blog discusses my personal wellness goals and is in no way a soapbox to tell anyone else how to eat, exercise and/or live their lives.
Disclaimer: This blog discusses my personal wellness goals and is in no way a soapbox to tell anyone else how to eat, exercise and/or live their lives.
Last week, I was riding my bike at a sure and steady pace as my teenage children shouted words of encouragement from their positions at least 46 miles ahead of me. I noted the upcoming hill and geared down. My kids were perched on top of the hill and looked concerned. My son shouted that I should get off my bike and walk up, perhaps fearing that he and his sister would be unable to drag me home when I collapsed mid-incline.
Hah. Watch this, nonbelievers!
I made it to the top of the hill by furiously stomping on the pedals. After some fist pumping and Rocky-like chest pounding, I glided downhill. The wind rushed against my cheeks, the leaves on the trees were fluttering. What a great feeling to be back on my bicycle! I had a total ankle replacement last October and although my surgeon had told me I’d be able to ride a bike again, I had been worried. Not anymore.
Over the next four days, I walked like a first-time bull-rider. Apparently, my big push up the hill mountain resulted in various pulled muscles between my lower abdomen and upper thigh. (Okay, it’s my groin area. It’s not funny.)
I spoke with a physical therapist from High Peaks Physical Therapy, Michelle Christensen. After hearing my tale, Michelle suggested that I should have progressed more slowly and eased into my hill-climbing activities; plan a warm up and a cool down. She was pretty certain that my adductor muscles had been strained, and the lower abdomen pain showed weakness in my core muscles. A cyclist herself, she also recommended that I avoid zipping straight to the lowest gear on my bike and instead try higher gears with more efficient revolutions for incline cycling.
“Hills first, then mountains,” she said gently, not realizing that truthfully, my “mountain” was a slight incline.
It occurs to me that portion control – or lack thereof – has contributed mightily to my health decline. When I apply portion control to my recent wellness adventure, I can see that I took too big of a portion of bike riding. I understand the benefits of pushing myself and getting sore muscles, but I don’t need to injure myself in the process.
I think that portion control has a lot to do with quality, too. I can choose to eat three milk chocolate Lindt truffles or a grilled halibut with green beans and the calories may be the same but the benefits to my body are quite different; not that I’m giving up on Lindt truffles. Similarly, exercising appropriately for one hour has to be better than overdoing it.
I know that riding my bike was a good choice, and I have another trip planned this Saturday as long as my strained muscles heal. (Not funny, folks!)
Meanwhile, I’ve lost a pound.
As part of its employee wellness program, TVHC set up a wild edibles workshop for employees with local Ayurveda practitioner Cate Stillman.
A TVHC YouTube video is featured on a national health care blog.
Teton Valley Health Care donates $2,000 to Valley nonprofit Teton Valley Recreation Association as a way of promoting wellness in our community.
Teton Valley Health Care donates $2,000 to area rec association in the spirit of promoting community wellness.
The price of medical care in the US is a topic of conversation that leads to sharing of personal stories that can be frustrating at best and shocking at the worst. At TVHC, we agree that overall, healthcare should be more accessible for everyone. The devil is in the details and to get to the details, it’s crucial to understand what drives costs for small rural hospitals in particular. Here are some answers to many of the questions I hear about our hospital costs.
How much does it cost to meet your daily, monthly and yearly expenses? Do you know how much of your expenses are fixed and how much you can vary? A fixed expense is one you pay regardless of usage, like your mortgage or a car payment. You pay the same amount each month whether you are in the house or on vacation, and regardless of the number of miles you drive. A variable expense is where you pay based on usage and have some control over how much the bill will be, like your cell phone bill or cable bill. Why am I talking about this? Because we want you to understand that Teton Valley Health Care, like other companies, has fixed and variable costs, and that we have to ensure that our revenue covers both types of costs.
Like many firms, our biggest expense is the cost of salaries and benefits for our employees – this consumes over 60 percent of our monthly expenses. Some of our staffing costs occur regardless of the number of patients we treat. We staff 7×24 nursing coverage. We average 1.3 inpatients at any time, yet a single nurse could manage 6 or more patients simultaneously. We staff providers at all times in the ER, yet we average only 4.43 ER visits per day. I can go on with examples in the lab, the pharmacy, x-ray and imaging, etc. Why do we do this? Isn’t this the waste and inefficiency Washington keeps referring to? We staff to provide appropriate levels of local care 365 days a year, so we can be there when you need us.
I would love to “fully utilize” our RNs and ER providers. But we can’t staff an RN for only 10 minutes an hour, and you wouldn’t want us to have to call in a provider every time someone visits the ER. Not only would it significantly degrade the health care we provide, it would also put us at odds with some of the regulations governing critical access hospitals (not all regulations are bad). I don’t want to imply that we cannot control our staffing costs, in fact, 43 percent of our staff is part time or pool, and we always keep staff on call for surges in usage. Our ER providers also offer clinic coverage on the weekends and cover our hospital inpatients. Our neurologist, pain management specialist, and general surgeon are only here part time. But there is a base level of staffing (i.e., fixed cost) that we must maintain. Our costs are higher than larger hospitals because this base level of staffing is not as fully utilized as at larger hospitals; our cost is spread over fewer patients.
We maintain a 13-bed hospital and average 1.3 patients at a given time. We have some of the best imaging equipment around and use it 1/100 of the time that larger hospitals do. We have to follow the same regulations, reporting requirements, and documentation requirements as other larger hospitals, but we have fewer patients. We need the same electronic medical record systems as larger hospitals, but we spread that cost across fewer patients. This is not a gripe, this a fact of life for most rural hospitals. It costs more for us to operate per patient served than larger hospitals.
So what do we do? Our community has clearly said that a local hospital is a requirement. We agree. Without a local hospital, people would suffer more debilitating injuries and more people would die from emergency medical conditions. We would lose jobs, productivity, property value, and potential new community members.
We are working to grow, to become more efficient, and to better serve the community. We know that healthcare is expensive and that every dollar counts. We are committed to reviewing and adjusting our prices, making prices more transparent to the community, and working with those in need to assist in payments. But no matter what we do, we are, at times, going to be more expensive than other alternatives for health care that you may find. I don’t want to mislead anyone. The price of having a local hospital is that it will be more expensive. Is it worth it? Absolutely!
You have every right to ask what steps we are taking to lower the cost of health care. Those steps include:
- Increasing the amount of services we offer and therefore the number of people who use the hospital and clinics – when we increase usage, we reduce the average cost per patient
- Consolidating purchasing, constantly reviewing what we spend, and partnering with other facilities to help share or reduce expenses.
- Making smart decisions on what services are necessary — offer those services with the greatest benefit to the community and the most attractive cost profile for our size of hospital
- Partnering with other local hospitals to expand medical services that we don’t have the volume or capabilities to offer locally – expanded oncology care is one good example; we offer chemotherapy now and would like to offer further exam and treatment services.
In my next column, I’ll talk more about prices- how we set them, what we are doing to adjust them, steps we are taking to make pricing more transparent – and how to compare prices for healthcare. As always, I welcome comments and suggestions from the community. Please email me at firstname.lastname@example.org.
I hope you’re aware of TVHC’s hospitalfocus 2015 project. This project is focused on planning for the future of our hospital to ensure that our services are relevant and well-supported by our community in the coming years. It’s not possible to plan for the future without hearing from you, and one method of communication has been through community forums that we have held.
During our series of forums last fall, you told us you were interested in several primary areas: affiliations, billing accuracy and pricing structure. We’ll talk about affiliations and billing now, and discuss pricing in the next article.
Let’s talk about affiliations first. The overall goal for affiliations at TVHC is to sustain the long term viability of TVHC as a local hospital. Whatever the outcomes may be for small rural hospitals through mandated healthcare reform, we can trust that cost reimbursement rates will drop. This means that we have to increase our utilization – adding services that utilize existing staff and facilities so revenue goes up faster than expenses; and become more efficient in our spending. As we discussed in our meetings, regulatory changes, combined with advances in technology, have to be integrated with community needs and desires for healthcare. This will require collectively broadening our view about the delivery of healthcare.
Core services, such as the ability to perform X-rays and staffing a round-the-clock Emergency department, must remain at the hospital. Some core services, such as general surgery and pain management, can only be supported on a part time basis given our community size. Certain services can be performed remotely, such as reading X-rays (currently outsourced to Medical Imaging Associates) and coding our bills (outsourced to a firm in Wyoming and to Madison Memorial Hospital). Certain functions are best performed if we are part of a larger group, such as being part of a purchasing organization (we currently belong to Amerinet) or sharing clinical resources.
We need to function effectively. We can read X-rays 24 hours a day because we contract (like many hospitals in the region) with a group of radiologists. We do not have enough volume to hire a radiologist to cover 24/7 on-call; our current affiliation lowers our cost per X-ray read. We are also exploring telemedicine alliances with specialty facilities, and sharing back-office duties. As a small hospital serving a small community, we do not have depth in key roles. Establishing management agreements to improve our capacity is key to our long-term survival.
Next up is billing accuracy. Nationwide, the number one complaint about hospitals is related to cost for services. Hospital billing runs a close second. TVHC has had significant problems in the past with billing and billing accuracy. This has had significant impact on both our financial performance and on the community. Moving forward, we continue to improve billing timeliness and accuracy. We know we have to enhance readability and the level of detail in our bills. What does all of this add up to? Better accountability for you.
In November and December 2012, we served 2,978 clinic patients and 1,487 hospital patients for a total of 4,465 people. Complaints received for the same time period equaled 21 with 18 directly referencing billing. Most of the billing complaints were resolved through an explanation of services rather than finding errors on the bill. While the percentage of actual errors was very low, several complaints led to finding an error in our process that caused a small percentage of bills to be stated in error. We have corrected the process and we’re grateful for the patients who posed the questions. Fortunately, although the printed bills had errors in amounts owed, our internal systems maintained accurate balances. We’ll continue to share our patient complaint status report with you every two months, and as always, we encourage you to share your concerns with us.
We’re making progress on the subjects that you consider to be most important. Our next article will focus on hospital pricing structure with tips for you about price comparisons.
Our next hospitalfocus 2015 forum, is scheduled for Thursday, February 28 from 6 – 7 p.m. at the Senior Center in Driggs. I hope to see you there. If you have suggestions for us but can’t attend the forum, please feel free to share your thoughts via Facebook or email@example.com.