After years of planning and fundraising and a year and a half of construction, RiverStone Health is a little more than a week away from seeing patients in its new, much larger clinic.
“Every time I come over here, there’s something new and different,” Barbara Schneeman said Thursday morning. “It’s amazing.”
Schneeman, RiverStone’s vice president of communications and public affairs, and RiverStone President and CEO John Felton showed off the new digs at 123 S. 27th St. on Thursday and talked about the long history that brought RiverStone to this point.
The $11 million expansion will give RiverStone a new clinic with 31,780 square feet and 48 exam rooms, compared to 17,000 square feet and 26 exam rooms in the existing clinic. Better yet, Felton said, the new clinic was designed in close consultation with more than 100 staff members, all focused on creating an environment that encourages maximum efficiency and comprehensive patient care.
Clinic plans open house
Riverstone Health Clinic is having an open house Wednesday, Jan. 17, five days before it opens for business.
The event will run from 4 to 6 p.m., with tours taking place every 15 minutes, and with remarks scheduled for 5 p.m. The new clinic is just south of the existing clinic at 123 S. 27th St.
RiverStone Health is a community health clinic, the first and largest in Montana, whose mission is to provide access to health care to all, regardless of their ability to pay, though most of its patients are covered by Medicaid, Medicare or private insurance.
A key part of the new clinic is that it was built to accommodate a team approach to treating patients. The 48 exam rooms are divided into four pods of 12 rooms each, and each patient will be assigned to one of the pods, so that he or she will always see the same group of doctors, nurses and support staff.
And when a patient calls, it won’t be to a general operator but to an operator in the pod he or she belongs to, to encourage more familiarity and personalized care.
“You can’t know 16,000 patients, but you can know 4,000 patients,” Felton said. “What we’ll have instead of one big clinic is essentially four smaller clinics.”
In 1995, what was then the Deering Clinic had 9,000 patients and 20,000 annual visits. Now it has 16,000 patients and between 80,000 and 90,000 patient visits a year. Those patients are obviously making more visits to the clinic, but Schneeman said that’s one of the paradoxes of the medical industry: the more you see patients, the less you spend, since prevention is almost always cheaper than treatment.
The new clinic is designed to give even more emphasis to what is called “the patient-centered medical home” model. Besides providing as much preventive care as possible, RiverStone groups all its caregivers — doctors, nurses, nutritionists, behavioral health experts, care coordinators and others — on one campus, so that people get as much care as possible at one place during one visit.
The new clinic was also designed to make the most of RiverStone’s Montana Family Medicine Residency, the first graduate medical education residence training program in Montana. The clinic takes on eight new residents each year for the three-year program, for a total of 24 residents on staff each year.
Each resident will also be assigned to one of the four pods and will stay there for the duration of the three-year program, allowing them to work more closely with doctors and patients.
The residency program has been popular — 1,500 applicants vied for the eight slots this year — and good for Montana. Of the 121 doctors graduated since 1995, 75 of them are still practicing in-state, and of that number 30 are still practicing in Billings.
The $11 million fundraising campaign was seeded with $4.5 million that RiverStone Health amassed through planning and fiscal management, and with a $1 million federal grant. The $5.5 million community campaign was jumpstarted with a $1 million gift from Bill and Merilyn Ballard, whose last name will go on the building housing the new clinic.
To date, RiverStone has raised $3.78 million of the $5.5 million goal, and officials there are confident the rest will be raised. Felton said he was particularly proud that RiverStone’s 380 employees donated a total of $510,000 to the campaign.
As the patient load kept growing over the years, Felton said, RiverStone responded by improvising to keep up.
“We basically took every square inch into exam rooms,” he said, including one former bathroom. The result was a hodgepodge of rooms of different shapes and sizes, averaging 90 square feet. In the new building, all 48 exam rooms have 120 square feet and identical layouts, which will make them much more efficient and easy to use.
The new clinic also has four procedure rooms for performing biopsies, casting, splinting and the like, as well as consultation rooms where behavioral specialists can meet with patients. As it is now, such consultations take place in exam rooms, making them unavailable for medical visits, often for long periods of time.
The lobby of the new clinic will have two kid-friendly waiting areas with small furniture, character chairs, playtime activity tables and reading nooks. Each of the four teams of providers will have a central area for team meetings. The middle of the clinic will have rooms that can be used by all the teams, including care manager and pharmacy consultation rooms and the X-ray room.
As one example of the way employee input changed plans for the building, Felton said that at one point there was a discussion of where to put “the” baby scale, since there is just one such scale in the old clinic. Several workers pointed out that each of the four pods should have its own baby scale.
“That’s the kind of thing, unless you’ve carried a naked baby through the building, you wouldn’t think of,” Felton said.
Phase 1 of the project will officially end when the clinic opens on Jan. 22. Phase 2, set to begin next month, will involve demolishing a portion of the original Deering Clinic that sits between the old and new buildings, constructing a new connection between the two and remodeling part of the existing clinic into a wellness center.
The older building will continue to house the dental clinic, with 12 chairs, as well as a full-service pharmacy, the Women, Infants and Children program and other family-health services. The four-story building on the RiverStone campus is the Lil Anderson Health Center, completed in 2010. It houses administrative offices, the RiverStone Foundation, public health offices, and a hospice.
RiverStone grew out of the Yellowstone City-County Health Department, created in 1974 by an interlocal agreement between Yellowstone County and the cities of Billings and Laurel. The clinic opened as Deering Clinic in 1984, but RiverStone still serves as the county health agency. Felton, besides being the head of the RiverStone, is also the county health officer.
The way he described it, RiverStone has the authority of government but operates like an entrepreneurial nonprofit, able to act more quickly and nimbly than a typical government agency.
A unique aspect of RiverStone is its governance. The overall agency is governed by the county Board of Health, and the clinic is overseen by a separate board that is required to include a majority of clinic users. Over the years, he said, the board has included people who were homeless, suffering mental health problems or dealing with addictions.
In addition to the clinic in Billings, RiverStone has satellite clinics in Bridger, Joliet and Worden, as well as school clinics at Orchard School on the South Side and Medicine Crow Middle School in the Heights, where the clinic opened just last month.
Like public health agencies all over the country, RiverStone has to deal with uncertainties over funding on both the state and national levels, but Felton is confident that RiverStone will continue to receive adequate funding. The clinic saves the Montana Medicaid program $33 million a year because its cost of care for Medicaid patients is 24 percent lower than other primary-care clinics, according to a RiverStone fact sheet. It also has an annual economic impact of $21.8 million, according to the same fact sheet.
Felton said RiverStone consistently receives strong support from elected officials from both major parties “because it’s demonstrated that it works.”