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Directions in the management of Coulee Medical Center are aimed at providing for the long-term survival of the hospital, despite shorter-term difficulties, its top administrator and board chairman said this week.

Chief Operating Officer Scott Graham and hospital district President Greg Behrens spoke with The Star Monday, seeking to add their perspective on the developing controversy that has filled recent board meetings with citizens concerned about everything from prices charged for services to cutbacks in staff scheduling.

The hospital district, which took on millions in debt to build its new facility three years ago, has not missed a payment, Graham said. But it is facing financial challenges common to rural hospitals everywhere in the country.

Behrens said he has served for three years on a statewide committee on rural hospitals.

“Everything that I’ve seen in the last three years that all these other rural hospitals are struggling to do and meet these obligations — the changes in the healthcare enviroment — we’re doing all those things and are ahead of the curve,” he said. “I’m always just extremely impressed how our little facility here is thinking ahead and adjusting for those changes way ahead.”

Basically, that means CMC has to run a “tight ship,” Graham said, just as all hospitals do in this era when the entire health care industry is shifting to meet new, forced changes in the way they do business.

Soon, customer satisfaction surveys will be an important factor in the rate of reimbursement from Medicare. CMC is already contracting with Press Ganey, a company that surveys patients and employees about their satisfaction with the hospital.

Graham said that data and more will soon be available on the new CMC website for anyone to see, including their monthly patient safety goals and links to data on comparative pricing.

“We look at our prices all the time,” Graham said. “In many things we’re very competitive, far below what you’d get in Spokane, but it depends on the service, too. You’ve got different kinds of services realized here versus there.”

The hospital tries to remain competitive, he said. To do so, containing costs is essential. He noted the hospital has cut back on its use of contract labor — doctors and nurses brought in from outside the organization — in favor of using its own employees.

CMC has budgeted $344,000 for such outside services in 2014. It paid nearly $1.5 million in 2010, according to the 2014 budget. On the other hand, costs for salaries and physician fees have risen from $9.4 million in 2010 to an expected $11.5 million next year.

Graham noted the hospital has focused on a management style used by Virginia Mason Hospital in Seattle, originally developed for making cars — the Toyota Performance Improvement program. A consultant group works with groups in the hospital to identifiy gaps in performance and find ways for improvement. And CMC has adopted just-in-time inventory control.

“We’re a work in progress,” Graham noted.

Graham said there have been no lay-offs, but the hospital does use a “low census” policy that sends workers home to draw vacation time if the number of patients being served — the census — is low.

The 25-bed hospital’s goal is to average 21 patients a day. It’s been about 19 lately. And the clinic is averaging about 70 per day, up from the low 60s where it stayed for about six months. The goal is 80.

Citing privacy and personnel laws, Graham wouldn’t talk about negotiations currently underway with CMC’s health care providers — doctors and registered nurse practitioners — who took a vote of no confidence against him Nov. 9 and have reportedly threatened to leave.

“We don’t want them to go,” Graham said. “We don’t think that’s a good solution for our community. … We have to be mindful, though, that people can move on with their lives … so you have to be prepared.”

Graham said difficult decisions have to be made “always with the object in mind of making sure that the coulee region always has a hospital.” He recently read an article about another critical access hospital, in South Carolina, that folded due to management not “staying ahead of the curve.”

“I don’t want to be that guy,” he said.

Added Behrens: “There are a lot of really popular decisions that any hospital could make in the short term, but it doesn’t do a darn thing for the survivability in the long term.”

Commissioners Jerry Kennedy and Kris Hare have met with the doctors and mid-level providers and have more talks scheduled with other groups, Kennedy said Tuesday. He said he’s gotten a lot of comments from community members and employees.

He noted that reports from three committees that sprang from discussions at a special board meeting Nov. 18 should be ready for the next regular meeting, scheduled for Dec. 18.