Catching up with … Casey Meza [Lewiston Tribune, Idaho]

Dec. 18--Casey Meza, chief executive officer of St. Mary's and Clearwater Valley hospitals and clinics, was Business Profile's 2005 Business Person of the Year. Earlier that year, the hospitals' management team was designated best in the nation for small hospitals by HealthLeaders Magazine.

This year, the hospitals were named Outstanding Rural Health Organization by the National Rural Health Association.

We caught up with Meza via email to ask about those honors and the challenges in rural health care over the past six years.

Business Profile: What benefits has national recognition brought you? Do you know of other health care facilities that have followed your leadership example?

Casey Meza: Because we've been honored on the national stage, we've been invited to make presentations to audiences from around the country. Not only our awards, but our participation in a national effort to transition primary care clinics into patient-centered medical homes has also brought us a lot of attention.

There's been a huge interest in our tele-medicine program because rural health care clinics, regardless of their location, face similar issues. One of which is, "How do we provide access to specialty care in our rural areas?" When they hear that we provide tele-cardiology, tele-pyschiatry, tele-dermatology, tele-emergency and tele-hospitalist services, they want to know how to set up a tele-medicine program in their area. We're able to help walk them through that process and put them in touch with the right people.

It's a two-way street, though. Because of our national involvement we've also been exposed to other exciting programs, helpful initiatives and people willing to assist us with expertise and ideas on how to meet the challenges of rural health care in the future. I think we're positioned well to meet those challenges and continue to serve our patients now and in the future.

BP: Your hospitals were in the process of switching to electronic patient records six years ago, a move you anticipated would enhance care by giving physicians quicker access to patient information. Has that indeed been the case? In what other ways has digitizing records affected patient care?

CM: Instituting electronic medical records is a long process. We're lucky to have initiated it early on compared to other rural facilities. The health care reform act will provide reimbursement for the purchase of EMR systems if you can prove "meaningful use." The longer a facility waits to introduce EMRs, the lower the reimbursement rate.

It's pretty complicated, but we're positioned to receive the highest reimbursement rate. Reimbursement from Medicare and Medicaid will eventually hinge on having EMRs. We don't really have much of a choice in the matter.

That's primarily of interest to administrative and financial types, but the really important part is the difference it is making to our patients. Our health care providers have been trained and we have implemented Centricity EMRs in our clinics and are in the process of introducing them on the hospital side. It has changed our world from a paper system to an electronic system, which means staff are having to be retrained, if they choose, and doctors and support staff are becoming more efficient.

That's not to say we're spending less time with the patient. The EMRs can identify any medication conflicts and raise a red flag. They can automatically print out patient education materials based on diagnosis. They can compile X-rays, medical images and lab work into one record, and, certainly, they can make a person's medical records instantaneously available anywhere in the world if a patient should have an accident or illness far from home.

BP: Expanding relationships with regional care centers, including in Lewiston, Clarkston and Moscow, was a goal you identified in 2005. Each of those facilities has taken on new leadership since then. How have your hospitals' relationships with these regional centers grown and changed?

CM: That's an excellent and timely question. We have always worked with other facilities in the region. We depend on one another. We provide referrals to the larger hospitals for services we can't provide, so they depend on us and we depend on them to provide the quality services our patients need. We have to work together to guarantee good communication between doctors and facilities. Our doctors need to feel confident that our patients will receive the best care after we refer them elsewhere.

Recently, the hospitals in the area entered into an agreement designed to improve our communication and strengthen our partnerships. We have to continually solidify those bonds, especially because future reimbursement structures will require strong regional systems of care, plus it makes the best sense for the patients. I'm looking forward to working with other area hospitals to continually improve care in the region and make it a seamless, high-quality system for our patients.

BP: Do you still have clinics in Orofino, Kooskia, Pierce, Cottonwood, Kamiah, Nezperce and Craigmont? Has keeping rural health clinics open during the recession of the past few years been difficult?

CM: We also opened a medical clinic in Grange-ville in 2010. So we now administer eight satellite medical clinics and four physical therapy clinics.

One of our biggest challenges is recruiting family practice physicians. So many medical school graduates are choosing to go into specialties. You can't blame them, because they graduate with huge medical school debts, which they need to pay off.

It's also harder to recruit physicians to rural areas. It takes a very special person to practice away from a city with all its medical support and cultural offerings. That's one of the reasons we work so hard to update our technology and give them access to consults with medical specialists using our robots. We can provide the stability they need because both our facilities have health care providers that have been with us for years, plus we have the current technology they became accustomed to in medical school. I think that's why we've had such good success in recruiting for our area.

BP: You previously mentioned the need for mental health services in our region. What progress have you seen in this area over the past several years?

CM: I'm happy to say we've made great strides in mental health services in our area. In 2008, I was appointed to the Region 2 Mental Health Board and it became even more clear that we not only had a lack of services in our area, but we are one of the areas with the greatest need. Our doctors were meeting our patients' physical health care needs, and, although they have many skills and a lot of expertise, there are times when they need to refer to a psychiatrist.

In 2009, we began partnering with St. Alphonsus Regional Medical Center in Boise and, through a variety of grants, were able to contract with two psychiatrists, one of whom is also a child psychiatrist, to "see" patients regularly using our RP-7 robots in Cottonwood and Orofino. Between February 2009 and August 2011, the two psychiatrists have had 766 sessions with adult patients and 1,331 pediatric patient consultations. It is very gratifying that we found a means to help patients trying to cope with their mental health issues.

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Tatko may be contacted at [email protected] or (208) 848-2244.

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