YRMC works on wait times, healthcare costs
Hospital ceo updates supervisors on activities
Yuma Regional Medical Center is working to improve wait times and address cost concerns voiced by the community, according to Dr. Robert “Bob” Trenschel, the hospital’s president and CEO.
In a presentation to the Yuma County Board of Supervisors on Monday, Trenschel noted that surgeries and deliveries remained relatively consistent while inpatient volume has dropped to about 15,000 patients a year in 2022.
“That’s been declining, and that’s really what’s going on across the country. Everything’s moving from the inpatient environment to the outpatient environment. Oftentimes, it’s less expensive and sometimes it’s even safer,” he said.
But the Emergency Department continues to stay busy, with 66,774 emergency visits in 2022.
The organization built a new Emergency Department because the previous structure was “very inefficient and ineffective,” Trenschel noted. However, patients continue to complain of long wait times in the Emergency Department and delays in getting a bed, especially during the winter season.
Usually, the busiest season starts in January, but this past year, the hospital was slammed earlier than expected due to patients seeking treatment for COVID-19, RSV and the flu. From October to November, visits to the Emergency Department jumped by more than 1,000.
On average, wait times were from 4 to 6 hours from arrival to discharge for patients who are not admitted.
“We need to do better. We realize some of the wait times are extended and not what people want. But we continue to … try and make it one of the best EDS in the country,” Trenschel said.
He also acknowledged that the community has raised concerns about the cost of healthcare within the organization.
“We realize that our price structure is a concern for individuals, and we look at every opportunity we have to lower prices, provide lower cost of care in various environments, but healthcare is expensive,” he said.
YRMC is a not for-profithealth system. That means that any excess revenues over expenses are put back into the system. “It does not mean that we don’t charge. It does not mean that we provide free care. It does not mean that we cannot make a profit. It just means
that we put those excess revenues over expenses back into the organization to benefit our community,” Trenschel said.
Trenschel has previously stated that YRMC has annual revenues of about $680$700 million. The hospital receives 76% of its revenue from either Medicare or Medicaid (Arizona Health Care Cost Containment System) and 14% from commercial insurance. Two percent is paid directly by patients, and 8% comes from a mix of other sources.
Revenues fund healthcare advancements such as staffing, technology, facilities and research. These investments are what allows the hospital to keep up with the latest technology and recruit and retain “high quality” healthcare providers.
“We’re a very strong organization financially, operationally and clinically, and what that does is attract high quality talent. Nobody wants to practice in a mediocre hospital. Nobody wants to practice in a hospital that doesn’t have the latest and greatest robots, toys, radiology, lab. So all these things are where we excel and we’ll continue to do that really for the benefit of our patients and for the benefit of our community,” Trenschel said.
When Trenschel joined the organization in 2015, the hospital board gave him several objectives, with the top three tasks being to improve clinical quality, reduce wait times and expand availability and access to care.
These three objectives are achieved by recruiting and retaining the “best talent” to deliver care closer to home. Over the last 10 years, YRMC has recruited more than 200 new providers to Yuma, enabling it to add 35 new and expanded services to the area that it did not have before.
YRMC determines what it needs to focus on through regular community health needs assessments conducted by a scientific survey firm. It aso uses quality data from national and state external third parties and patient feedback.
For example, the 2013 assessment defined cancer care and shortage of primary care physicians and specialists as the most significant needs for the community. In 2013, to address that problem, YRMC started the Family and Community Medicine Residency Program. The three-year residency program has graduated 43 as well as two sports medicine fellows.
“I’m proud to say that close to 50% of the individuals that graduated from that program stay in our community. So that’s important. We are growing our own,” Trenschel said.
By increasing the number of physicians in the Yuma community, YRMC has decreased the number of days it takes to see a primary care physician from 100 days to nine days. This has enabled the organization to increase its patient volume to 3,000.
The assessments have indicated a huge demand for healthcare in the Foothills and East County. In 2018, YRMC opened a Foothills Primary Care Campus, and in late April or early May, the YRMC Foothills Medical Plaza will offer a full fledged Emergency Department and primary and specialty care with more to come.
“We’ve got 35 acres out there. So we’re putting together some other plans for that area as well,” he added.
In South County, YRMC is looking at expanding its services. “It’s a small practice we have down there, but the growth in that area is just so significant. We are looking at opportunities that we have there right now to expand services there.”
The 2019 assessment showed behavioral health as a top need as well as increased issues regarding substance abuse in our community. In 2022, mental health and substance abuse again rose to the top of the local needs.
YRMC recruited the first psychiatrist here and opened a behavioral health practice in 2019. It now has four providers who see more than 9,000 patient visits every year, “but it’s still just the tip of the iceberg,” Trenschel said.
In 2022, YRMC opened a 24-bed behavioral health hospital in Yuma. Future plans call for a geriatric behavioral health facility.
Also to address this need, YRMC will start a psychiatry residency program in 2024. It will start with four psychiatrists in each class. “So it’ll be a cohort of 12. It’s a three-year program I believe, and hopefully those will stay in our community,” he said.
In addition, Trenschel noted, “we know that detox and substance abuse is something that we have to address, and we will do that.”
YRMC has also invested significantly, not only in the hospital structure, but also in the entire health system. It has two surgical robots and the “premier” surgical robot surgeon in the country who trains other physicians from all over the country in Yuma, Trenschel explained.
In partnership with Arizona Western College, YRMC will continue to “grow its own” through an allied health training facility. “They could work for our health system, they could work for other health entities in the area, but doing this will allow those individuals to stay here,” Trenschel said. “Arizona Western is going to provide the content, we’re going to build the building, and we’re going to build the classrooms and we’re going to build the labs and we’re going to have that right on the hospital campus and to provide members of our community a chance to live and train here and stay here.”
To more directly address the concerns of the community, YRMC has hired its first chief experience officer. This individual will provide the data and the feedback to every node of the organization to see where it needs to improve our care experience not only for patients but for visitors and also for our staff,” Trenschel said.
“This is an individual that will have a seat at the executive table and will have a strong voice in terms of what they need to do from a patient experience perspective,” he noted.
Trenschel added that YRMC is “highly focused” on enhancing the patient experience. “We know we do really good most of the time. We need to do excellent all of the time, and that’s really the journey that we’re on,” he said.
“And we realized that we fall short sometimes and we have some improvements to make and we’ll continue to effort into that, and that’s the thing, continually improving the organization.”