A growing primary care department, housing and tuition support programs for employees and expanded access to the opioid addiction treatment drug suboxone were a few of the accomplishments touted by hospital president and chief executive officer Denise Schepici at a public forum Tuesday evening.
Responding to community concern, Ms. Schepici also said the Windemere nursing home operated by the hospital will not be closed. She gave an update on ambitious future plans to build six twelve-bed facilities for a new model of nursing home care on hospital land in Vineyard Haven.
The forum took place at the Martha’s Vineyard Hebrew Center. About 60 people attended.
In an overview, Ms. Schepici said the hospital employs 633 people and operated at a gain of $156,000 last fiscal year. There were more than 14,500 emergency department visits, more than 30,000 primary care visits and 125 babies delivered during that time, she said.
Ms. Schepici said Windemere, which is currently home to 51 residents, is operating at a significant loss, ending last year $1.2 million in the red. She said state reimbursements are not enough to cover costs, and private pay patients generally do not elect to live in the facility.
“When you’ve got costs like this and reimbursements like this . . . that makes for a tough business model,” Ms. Schepici said, adding that staffing is another major challenge.
The hospital has lately been collaborating with a nursing home company called Navigator and with Healthy Aging Martha’s Vineyard on plans to build a new facility that follows the so-called green house model, arranging skilled nursing patients in home-like buildings organized around shared living spaces.
“How do we create . . . a transformative and sustainable solution for the care of our frail elders at Windemere,” Ms. Schepici said.
Plans are still in the early stages, with many regulatory hurdles still to be cleared, she said. Ms. Schepici said the hospital had hired an attorney for help applying to state agencies.
But she said she is focused on moving to the new model, not on increasing capacity at Windemere. During the question period, Vineyard Haven resident Len Morris asked whether the new nursing home would have enough capacity for the growing elderly population of the Island.
Ms. Schepici said while more services will be needed, there is not a high need for constant skilled nursing care. The hospital is licensed for more than 100 beds, but cares for just 51 residents.
“We don’t have the demand, Len,” Ms. Schepici said. “The demand to go into institutionalized care is not there.”
She said there are six men on the wait list because rooms are arranged in four-resident single gender pods, and most of the pods house women. Mr. Morris was unconvinced about the lack of demand, positing that perhaps there is a lack of information about services available.
“I think it’s a rather closed and quiet piece of our operation and . . . a pressing critical part of what the community needs now,” he said.
Ms. Schepici said it would probably take two years for the new facility to clear regulatory hurdles.
She offered a good-news report on primary care department, which was a major topic of concern when she took over in January 2018. Since then the hospital has hired new doctors, restructured the primary care department and broken ground on a new wing of exam rooms in vacated Windemere space. The department also has a new chairman, Dr. Steven Feder.
With the addition of four new doctors in primary care and pediatrics, there is capacity for 12,500 patients. Ms. Schepici said she plans to hire two more doctors in the near future. The department recently expanded hours and adopted the patient-centered medical home model, which provides care through a team of doctors, nurse practitioners and nurses.
The wait list for a doctor, which numbered in the hundreds last year, is now gone. New patients are encouraged to pick up new patient paperwork at the hospital to enroll.
“We’re really proud of primary care. We know we still have work to do. It’s not perfect yet, but we’re getting there,” Ms. Schepici said.
She said next steps include finishing the new primary care wing and establishing a call center to be able to take phone calls more efficiently. A part-time psychiatrist will join the department next month.
In an effort to retain staff, the hospital is investing in housing and education. In May, renovations on the Hanover House in Vineyard Haven were completed. The former inn can now house 15 hospital employees. Ms. Schepici said the hospital invests $2 million each year in housing for employees.
The hospital also reimburses for education expenses.
“We train a lot of . . . nurses, a lot of CNAs, only to lose them. They go back to the mainland because they can’t afford to live here,” Ms. Schepici said. She said a loan forgiveness program has been developed to encourage people to stay. The hospital also offers tuition reimbursement to employees.
Ms. Schepici acknowledged that the opioid crisis has deeply affected the Island.
“Because we’re small, it’s really magnified,” she said. In 2018, the hospital treated 13 overdoses and reported one death from opioids. In the first three months of this year, there were six overdoses and two deaths. “We still have a lot of work to do in the opioid arena here on this Island,”Ms. Schepicic said.
She said the hospital has worked to improve access to suboxone, an addiction treatment medication. Last year, the hospital employed only one physician who was permitted to write prescriptions for suboxone. This year, every emergency department physician can prescribe. Seven providers in the primary care department can also prescribe.
“Suboxone isn’t the end game, but it’s a bridge to recovery,” Ms. Schepici said. She said the hospital is collaborating with Martha’s Vineyard Community Services in a number of areas to help people overcome addiction.
For its part, the hospital now has opioid-free sedation options and a new protocol for screening patients before surgical procedures.
Questioned about whether there are plans to begin providing abortions at the hospital, she said there is not enough demand to provide the service on the Island.
She encouraged community members to participate in the community health needs assessment by completing an online survey.
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