Oregon Health & Science University has taken over staffing at Columbia Memorial Hospital’s emergency care.
The hospital’s contract with North Coast Emergency Physicians, which had provided staffing for more than 20 years, ended Sept. 30, and OHSU’s doctors took over the next day.
The hospital’s leaders stressed the change in ER operators wasn’t about quality, but rather about OHSU’s ability to recruit physicians.
“The real decision around that was the leader of the physicians group saying he was stepping back,” Trece Gurrad, the vice president of clinical services.
“We kept it going as long as we could,” the former director of the doctor’s group, Dr. Larry Zagata, said, adding it was increasingly difficult to find doctors to come to Astoria. “I hope we took care of the community well. I think we did.”
Zagata, who is still working at the hospital, said he and hospital CEO Erik Thorsen started looking into the change a couple of years ago, first reaching out to Legacy Emmanuel and later to OHSU.
Coordinating the staffing for university is Anthony Ferroggiaro, assistant professor in OHSU’s department of emergency medicine and medical director of Columbia Memorial’s emergency department.
“The volume that we see right now that we need at times two providers to see patients and initiate patients,” Ferroggiaro said. “There are often three to four nurses in the ER throughout the day.”
OHSU has hired three physicians, so far. The goal, Thorsen said, is to have six full-time doctors dedicated to Astoria, along with part-timers to cover time off.
The hospital’s ER is a Level IV trauma center, providing advanced trauma life support and staffing at least one doctor and nurse practitioner throughout the day. Thorsen estimated the ER takes in between 1,000 and 1,200 patients a month. Zagata estimated at least half of those patients are eventually transferred to higher-level trauma centers, mostly in Portland.
Zagata said the single biggest source of trauma patients is from motor vehicle accidents, adding the ER sees patients off cruise ships and a lot of logging accidents. Columbia Memorial also takes trauma patients from the coverage area of Providence Seaside, which is not equipped as a trauma center.
Thorsen said the patient loads at the ER and in the hospital’s urgent care center have been increasing. He credited the Affordable Care Act, more Medicaid coverage and a local shortage of primary care providers seeing Medicaid and Medicare patients, whose government insurance provides a lower reimbursements.
“We prefer to work 11 shifts of 12 hours per month,” Ferroggiaro said. “There are doctors who work more or less, it also depends on the level of illness of the patients in the department.
“It’s easier of they have bruises or colds,” he said. “We have oncology (cancer) patients and cardiology patients who can become quite ill. It can take special focus and is oftentimes more taxing on the patient.”
The hospital’s cardiology clinic, a partnership with OHSU, started seeing patients in late 2010, and the CMH Cancer Clinic, another partnership, started in late 2011.
Thorsen said Columbia Memorial Hospital is the first rural emergency medicine department staffing OHSU has taken over, another in the line of groundbreaking partnerships between the two hospitals that stretch back to telemedicine in 2010.
Next year, the hospital will expand its ER and start hosting second-year emergency medical residents, state-licensed doctors working under supervision as they build a specific focus on ERs.
“Hopefully they’ll be open to working with us, if they haven’t practiced or lived here before,” Gurrad said.
Thorsen said these partnerships are calculated risks because of the investment in infrastructure, employees and the time it takes to build up patient bases for specialty treatments.
“It’s a wonderful partnership for CMH, and our community is able to receive care locally that they were otherwise leaving the community for,” Thorsen said. “I could not recruit cardiologists and oncologists to live and work in Astoria without the partnership we have with OHSU.”