In order to survive, Sitka Community Hospital needs to overhaul how it does business. That was the message of an outside consultant to the Sitka Assembly Thursday night (7-13-17). (Emily Kwong/KCAW photo)

Sitka Community Hospital is in the early stages of a make-over. Building upon the recommendations of an outside consultant, Stroudwater Associates, hospital leadership is directing changes to make Sitka Community a standalone operation. Those include discontinuing the labor and deliver program, reducing surgical coverage to daytime appointments, and expanding the clinic.

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“This is one of the swing beds,” says Sitka Community Hospital CEO Rob Allen, as he enters the part of the hospital devoted to long term care.

The rooms are decorated with art and stuffed animals. One resident has propped a photo of Elvis against her window. Of all the recommendations in Stroudwater’s 100-page report, changing how these beds are licensed could reap the largest financial reward for the hospital.

See a Powerpoint of Stroudwater’s report here: Stroudwater Presentation to Sitka Assembly

Hospital CEO Rob Allen takes in a portrait of a former resident. Long term care would continue at the hospital but under the new plan, all beds would be converted to swing beds. (Emily Kwong/KCAW photo)

“We’d take our fifteen long term care beds and put them into that same swing bed status,” Allen says. “It wouldn’t change the way we provide care, but it would change the regulations that we’re working under.”

Patients wouldn’t notice the difference, but the hospital would be reimbursed through the federal Medicare program instead of the state Medicaid program. Stroudwater estimates the bed conversion could mop up a financial return of $1.1 million, but it requires some paperwork. “We also need the state [of Alaska] to go along with it and agree to the change,” Allen added.

Other cost-saving measures don’t require a rubber stamp from the state, but would change the hospital’s relationship to family medicine. Earlier this year, hospital leadership wrote it into the budget to discontinue the obstetrics program, though continue to offer prenatal and postnatal care. Stroudwater supports the idea and estimates the financial impact to be $170,000, but it’s hard to put a price on losing this option for childbirth in Sitka.

The main labor room at Sitka Community Hospital. Phasing out obstetrics would help the hospital’s bottom line, but the idea has been met with resistance by many in the community. (Emily Kwong/KCAW photo)

Nurse Vicki Akins walks us through the OB unit. “We have a whirlpool in the hallway because Sitka women are strong and good labor mamas,” she chuckles, before entering the main labor room. The design is a cross between surgical and spa-chic, with a floral woodcut on the wall. “This is where my daughter was born,” Allen murmurs.

Births at the hospital have declined, from 60 in 2005 to 35 last year. That’s part of the logic for cutting OB, but Akins has her own opinions on that. “In the lower 48, OB units don’t make money either. If we lost this unit, it would be a great loss to the community here,” she says.

Next month, Allen will talk to SEARHC to see if Sitka Community’s family doctors can get credentialed to deliver babies across the bridge. “That’s one of the advantages of having one spot. You could split that up among more doctors and they don’t necessarily lose as many weekends to being on call,” he said.

The surgical unit at Sitka Community Hospital, where a plaque hangs in memory of David Knox, RN. His son Kevin serves on the Sitka Assembly. (Emily Kwong/KCAW photo)

Scheduling is also driving proposed changes to surgery. We pass by the surgical wing next, where Stroudwater says the hospital could save $190,000 by changing the business model. Dr. Richard Wein’s contract was not renewed in February due to an undisclosed personnel matter, a decision met with public disagreement.

Allen wants to move towards scheduled surgeries, Monday through Friday only, and away from 24/7 surgical coverage. “Dr. Wein – that was his style. He’s an old-style surgeon.  And people aren’t interested in providing that kind of coverage on their own,” he said.

Amid these suggestions of where to reduce, Stroudwater said in emphatic terms that the area for growth was in the clinic. They challenged the hospital to increase annual patient volume at Mountainside Family Healthcare by 2500 visits. Manager Patrick Williams believes it can grow by 5000.

KCAW: What tells you it [patient volume] can grow?

Williams: Every provider that we have has a waiting list. We know people want to come in and by seen. I get calls every day, “Can I get in? Can I get in? And we just don’t have the room or the space available.

The space designated for a modular unit that attaches to the clinic, which would require approval from the Sitka Assembly. (Emily Kwong/KCAW photo)

In seeking space for more examination rooms, the hospital wants to purchase a $400,000 modular unit. Ultimately, Allen’s hope is to offer patients same-day appointments and more preventative medicine.

“We want to proactively reach out to people and remind them, ‘Hey, you’re due for this test or you’re due for this.’ Our goal is to develop a team approach to healthcare. You’re not just coming here because you’re sick. We’re working with you to keep you well,” he said.

Since the report became public, every department developed an action plan to get the ball rolling on this new vision. But is the hospital being outlined on paper one that patients would want to visit in person? At least one individual  sitting in the audience at Stroudwater’s presentation said no.

“It seems to be me the model they’ve presented would create a hospital that is an empty shell. A business that doesn’t really provide the services that people need,” said patient Karen Lucas.

She’s also frustrated by the insularity of the two-hospital conversation this past year, which began with collaborative talks under the stewardship of an outside consultant and ended with SEARHC seeking a merger. The Assembly was poised to consider their offer further, until two owners of a local hotel said they were interested in buying the hospital and the city became wary of a sole-source contract with SEARHC. At every stage of the process, Lucas feels the public was left out.

“A hospital is just as foundational as a school. These are life and death issue. This is where people cried and they laughed and they died and they lived and they did all these human things. I think that value has not been honored as it should be,” Lucas said.

The Sitka Assembly will meet this evening at 6 p.m. to discuss the future of Sitka Community Hospital and take action on its management. They could support the hospital in this new vision, put its management out to bid, or something else entirely.

Raven Radio will broadcast the meeting live.