More than 20 years ago, Dr. Linyee Chang and her colleagues at the St. Charles Cancer Center made a bold decision that I’m guessing many Central Oregon residents haven’t heard about.

The cancer team was a fairly early adopter of National Comprehensive Cancer Network (NCCN) guidelines, which are standards of cancer care created by 33 academic cancer research centers across the nation. Dr. Chang and her colleagues throughout the region — who were not all employed by St. Charles — agreed in 2004 to collaboratively follow these guidelines when treating patients with the most common types of cancer diagnoses. They worked together to regularly review the research-driven protocols, make sure what they were doing was having the intended result and have maintained quality care standards for decades that mean cancer patients treated in Central Oregon have impressive outcomes.

I like to say that at St. Charles we hit above our weight class in terms of the types of care we are able to provide for a relatively small-sized health system. Our cancer team is a shining example of this truth. In fact, when visited by our accrediting agency in the fall of 2022, the reviewer said that he could find no useful suggestions for improvement at St. Charles Cancer Center. Our oncologists’ treatment plans concur with NCCN guidelines nearly 100% of the time; the exceptions are those rare or complicated cases where definitive research doesn’t yet exist.

It’s because of this commitment and decades-long track record of excellence that we have been able to launch a pilot project in collaboration with PacificSource Health Plans. The instant approval process means patients who are covered by PacificSource health insurance who receive a cancer treatment plan that falls within NCCN guidelines from the St. Charles Cancer Center are automatically approved for insurance coverage and can start treatment immediately if they choose. We were able to come to agreement because most health plans rely on the same NCCN guidelines when they authorize cancer care. By looking at the information together, the St. Charles and PacificSource teams realized we could save patients and health care workers time and frustration by removing the pre-authorization barrier to proven, appropriate care.

The full impact of this effort is hard to quantify after only a few months, but I can tell you that in conversations with patients, family members and our staff of caregivers and physicians the emotional burden of waiting for treatment has been greatly reduced. The toll on physicians and caregivers tasked with spending time and energy on insurance approvals has lessened. And, ultimately, we believe that by getting patients into treatment earlier we will see an improvement in their long-term health.

I’d like to thank our colleagues at PacificSource for being willing to try something bold that challenges the status quo and looks at patient care in a logical, evidence-based way. I’m hopeful this model will serve to inspire creative thinking for others and that we can move toward building more programs like this that remove administrative burden and improve the health care experience for all.

When we work together with the best interest of our patients in mind — like Dr. Chang and her colleagues have done for 20 years — everyone wins.

Sincerely,
Steve 

The trauma team at St. Charles Redmond recently received a visit from a former patient that they had never forgotten. Arlo was just 15 months old when his mother carried him into the Emergency Department more than a year ago. The little boy was in need of life-saving intervention after an auto accident. The team activated quickly and worked for more than three hours, doing all they could to stabilize Arlo so he could be brought to a hospital in Portland.

Many that helped care for him didn’t think they would ever see Arlo again. But more than a year later, the little boy – now 3 – visited the team with his parents Emma and Jarib. The couple wanted to say thank you to the team who they credit with saving their child’s life.

In a card, Emma wrote: “Words cannot describe how truly grateful we are. I know Arlo is still here today because of the team that was on the day of the accident. We are blessed to have Arlo here with us today. Thank you for everything.”

Arlo spent 599 days in and out of the hospital in Portland, but is now back home in Central Oregon surrounded by family and friends. Emma says that he loves dinosaurs, animals and playing with his cousins – just like any 3-year-old. 

The visit from the family was tremendously meaningful to caregivers from Redmond who had helped care for Arlo that day.

“This means so much to us. We often don’t get the full story and we’ve definitely thought about you guys a lot,” said Danielle Taylor, a nurse who cared for Arlo, told the family. “I’m just so glad he’s OK and to see you guys smiling.”

The pilot who flew Arlo to Portland, Wesley Wilburn, and the Deschutes County Sheriff’s Deputy who helped comfort the family also came to visit.

“The hospital staff here knocked it out of the park. It was impressive to watch everyone circle the wagons. I believe part of the reason he’s here is the fast-acting staff,” said Deputy Kevin Riding.

Emma said that this visit to the team in Redmond “felt like a really important step to take in our healing.”

And no doubt, getting to see Arlo doing well with his family, was healing for the caregivers as well.

If you followed conversations during the recently concluded Oregon legislative session like I did, you might have noticed a common thread: People have wildly varied ideas about hospitals and clinics as organizations, what we do, how we function, and even why we exist.

Like many of you, those of us who work in health care organizations are deeply concerned about the stability, affordability and quality of health care and the wellbeing of caregivers. These concerns are not new, and big solutions seem as out of reach as ever. But two fresh concerns seeped into the state-wide discourse lately. First, what role should private equity investors play when it comes to essential services? And second, are out-of-state interests taking over Oregon health care and what should be done about it? These are complex questions, and the legislative session closed without much in the way of answers. But that doesn’t mean these questions are going away.

The interests of private equity investors and out-of-state corporations vary widely. Time will tell whether their increasing activity in Oregon leaves us better or worse off. Meanwhile, I want you to know where we stand.

St. Charles is a nonprofit, locally operated, community-oriented organization. We aspire to behave in such a way that society is happy we exist, and not unhappy. We strive to prosper for and along with Central Oregon, not to its detriment. We are not beholden to out-of-state interests or private equity investors. Money spent at any of our facilities goes back into the community through wages, benefits and educational opportunities for our more than 4,800 employees; through investments in equipment and facilities; and through direct dollars that we donate to support other community nonprofit organizations.

St. Charles is many things. As the largest employer in Central Oregon, we are a crucial economic driver for the region. We are an essential provider of “safety net” health care services. We are a place where many people experience some of the most joyful and most harrowing days of their lives. We are a collection of people – your friends, your family members, your neighbors – who have taken on the responsibility of caring for the communities we serve. And you’d better believe we take that responsibility seriously.

The decisions we make today about the care we provide are tied directly to our ability to ensure that you have access to safe, quality health care services for the long term. Because we serve a vast, rural, geographically isolated region, we also find ourselves increasingly partnering with other local organizations to lift each other up and help each other maintain services. These partnerships are exciting as they show that our community is willing to come together for the greater good.

Health care is a complicated business, but at the end of the day my hope is that you know St. Charles is made up of local people who care about doing what’s right for the beautiful and unique communities we are all lucky enough to call home.

Sincerely,
Steve

After being closed for almost a year, the St. Charles Madras gift store has reopened thanks to wonderful volunteers from the community. Two of those volunteers, Julia and Sunny, come from Opportunity Foundation of Central Oregon, a local nonprofit that provides job training and placement for adults with disabilities.

Julia and Sunny love volunteering at the St. Charles Madras gift store. The pair, pictured here with their volunteer mentor Melissa, volunteer at the store every Wednesday morning as part of the job training program. In addition to stocking the shelves, conducting inventory and ringing up sales, the pair also like getting to interact with caregivers.

“I love working here. I’m happy to be with my friends. It makes me happy being here because the people are my friends. It brings me a good mood to see my friends,” said Julia, 53, who has lived in Madras for 40 years.

Vicki Woods, manager of support services for St. Charles Madras, says Julia has gotten to know so many of the caregivers, who love stopping by to say hi during her shifts. She says Sunny is a great worker who loves giving back to the community by volunteering.

“It’s so much fun to have Julia and Sunny here,” said Woods.

Caregivers in Madras are especially appreciative because for many months the gift shop had been closed. Having this support from the Opportunity Foundation helped to reopen the gift store.

Lew England, business relations director for Opportunity Foundation, also praised the partnership between the two organizations and hopes to use the same model in other communities. “It's been outstanding. Staff there are great and it’s a wonderful partnership for us."

“I didn’t ever want to leave St. Charles,” said Michael Teeters, a newly hired relief nurse in the St. Charles Bend Emergency Department. Originally from the East Coast, Teeters spent six years working as a traveling nurse at nine different hospitals across the country, but when he came to St. Charles, something felt different. After spending the last six months as a traveling nurse in Bend, he applied to be hired on as a permanent caregiver crediting the supportive team, the competitive compensation and the culture.

“St. Charles feels like home, like where I’m meant to be. The people that work here are incredible,” said Teeters.

A year ago, St. Charles – like hospitals across the nation – was experiencing a high vacancy rate, exacerbated by workforce shortages related to the pandemic and a nationwide shortage of nurses. To meet patient care needs, St. Charles brought in many expensive temporary nurses to cover key positions and ensure it had the right staffing levels to provide care for the community.

Today, St. Charles’ labor shortage is all but erased and the vacancy rate for acute care nurses is down to 6% (from a high of more than 20% in early 2023). One key factor in this turnaround is traveling nurses, like Teeters, opting to apply for permanent positions with St. Charles.

“These are highly skilled nurses who could find a home anywhere. They are choosing St. Charles – that speaks to our strong culture and competitive rates of pay,” said Rebecca Berry, Chief Human Resources Officer for St. Charles.

These so-called conversions (from traveling nurse to permanent caregiver) used to be extremely rare, but not anymore. In 2022, St. Charles hired four traveling nurses (commonly referred to as travelers in the medical community) into permanent positions. In 2023, that ballooned to 58 travelers into permanent positions and so far this year 18 travelers have already been hired into permanent spots. Converting travelers to permanent staff also cuts costs. Berry says this trend, along with robust recruitment and retention efforts and other programs, has helped propel a significant turnaround in the health and stability of the St. Charles workforce.

“I am so proud of the work we have put into creating a culture where highly qualified clinical caregivers want to stay and make Central Oregon their home and St. Charles their long-term employer,” said Berry. “Our goal now is to maintain that success and build on it so we have a consistent workforce pipeline into the future.”

Chris Collins, a Client Relations Manager for FocusOne, which provides traveling nurse staffing for hospitals across the country, says that the percentage of travelers converting to be permanent nurses at St. Charles is notable.

“With many of our clients typically experiencing conversion rates of less than 5%, St. Charles definitely stood out with their impressive 12% conversion rate in 2023. There are several likely factors that helped contribute to that success. Notably, St. Charles offers attractive pay packages and is situated in a location known for its picturesque scenery. However, it's the culture St. Charles has created that sets them apart and makes them attractive to those looking for a permanent position. St. Charles prioritizes fostering a welcoming environment, which resonates with travelers, as evidenced by the glowing reviews they receive. Travelers rate St. Charles highest in the categories of Friendliness Towards Travelers, Orientation and Staff Support,” said Collins.

A reliance on traveling nurses is part of what led to St. Charles' financial struggles in 2022. St. Charles expects to hire some travelers every year, as part of a natural demand during busy summer months, but the day-to-day reliance has shifted. In January and February of 2024, St. Charles onboarded just five new travelers. During the same period in 2022 and 2023, St. Charles onboarded 196 and 56 travelers, respectively.

Ryan Huebscher, assistant nurse manager for the Bend Emergency Department, said that the transition away from reliance on travelers has been noticeable. As evidence – when the ER recently posted a new RN position, numerous travelers applied.

“That speaks dramatically to the culture we have,” said Huebscher. “Nurses like working here, they like the team environment and ultimately want to make it their home base. It makes me really proud that so many travelers want to transition to permanent staff and call St. Charles their home.”

Suzi Bean, nurse manager for the ER in Madras, said that there were times in 2022 when some night shifts, there was only one St. Charles caregiver – the rest were travelers.

“Our crew is so happy to have a team they can build on,” said Bean. “The purpose our caregivers bring to the work they do and the investment they want to make in their community is huge. You can tell they live here, they want their loved ones, their neighbors and their friends to have good care.”

For Teeters, the decision to become a permanent St. Charles caregiver feels like a great fit. “The flow, the morale, the core staff – everything feels really good right now. I enjoy coming to work and I feel appreciated here.”

St. Charles has relocated its high-risk breast cancer clinic into the St. Charles Cancer Center, a move caregivers believe will help them identify more people at increased risk for developing cancer and give those people the tools they need to reduce their risk.

The clinic – a partnership between St. Charles and Central Oregon Radiology Associates (CORA) since 2015 – was previously located in CORA’s facility on the east side of Bend. Last year, when the CORA-employed provider who staffed the clinic retired, the decision was made to move the clinic into the Cancer Center and staff it with a St. Charles-employed provider.

That provider, Stephanie Henderson, started working in January and the clinic is now seeing patients.

“Because we were already collaborating closely with CORA, it made sense for us to bring it in-house,” said Dr. Linyee Chang, senior medical director of Cancer Services for St. Charles. “It’s important for our cancer program to provide this service as it allows our comprehensive breast program to encompass the full spectrum of breast care.”

On the surface, the move simply means that patients of the clinic will go to a different location for their appointments – crossing Neff Road from CORA to the Cancer Center. But bringing the clinic into the Cancer Center and under health system administration will also improve the care provided, both now and in the future, Chang said.

In addition to enjoying streamlined policies and procedures, the provider will have more options in terms of ordering MRI scans or ultrasounds than they would at CORA because of rules against self-referral, Chang said. Also, the move will bring the clinic into closer alignment with St. Charles’ existing menu of high-risk assessment and risk-reduction strategies.

Women identified to have greater than a 20% lifetime risk for developing breast cancer are considered at high risk. If they visit the clinic, they’ll receive general education about breast cancer, learn how to reduce their risk, discuss potential treatments, develop a personalized plan for surveillance and complete a familial risk questionnaire to identify whether they may benefit from a comprehensive genetic assessment.

The Cancer Center’s genetic counselor, Brigitte Cronier, said she expects to see an uptick in patients who come to her from the high-risk breast clinic now that it’s at St. Charles.

“Genetic counseling is a big part of risk assessment, and many of the people we meet are going to be candidates for it,” she said. “At the same time, there will be plenty of people we follow for high risk because of some other factor and not because of a genetic test result. Ultimately, we just want to capture as many high-risk people as possible and make sure they know what they can do to try to stay healthy.”

Jessica Keegan is the prevention and high-risk coordinator for the Cancer Center. She said the comprehensive screening process is designed to guide people into the program that’s right for them.

“When people come to me, I’m going through and building out pedigrees with them to really look and see where they are going to be best served,” she said. “That may be genetic counseling or it may be a more frequent screening regimen. We’re looking to make sure we are giving them the best possible resources.”

Last but certainly not least, Chang and her team see the breast cancer clinic as a next step on the path to a more robust high-risk cancer program at St. Charles.

“This is just the start. We want to have high-risk lung care, high-risk prostate care, high-risk colorectal care – we’ll be identifying those and rolling out comparable programs to this one,” Chang said.

“This clinic will serve as a sort of model for how we take care of people who are at higher risk for cancer and empower them to take control of their risk and their health,” she continued. “We’re here not just to take care of people who have cancer, but to help them never develop cancer at all.”

For more information or to schedule a consultation with the high-risk breast cancer clinic, call Jessica Keegan at 541-706-6729.

Above: St. Charles caregiver Jake Fries stands in front of his new home in Bend.

In March 2023, Jake Fries was reading the news when he spotted an advertisement for a new housing community in Bend called Rooted at Poplar. The concept: Seven 1,300-square-foot homes on the south end of town, with four of them prioritized for local workers thanks to partnerships between a developer, Rooted Homes, and local employers and organizations.

A year later, nearly half of the Rooted at Poplar’s residents are St. Charles caregivers, including Fries, a 29-year-old surgical tech in the Bend operating room.

“I can finally afford to live in my own place,” Fries says. “It’s changed everything.”

Like many local workers, Fries had trouble finding affordable housing in Bend, where the median price of a single-family home reached $800,000 last summer. It’s an issue that has contributed to workforce shortages at St. Charles, which is why the health system partnered last year with Rooted Homes, a nonprofit whose mission is to make buying a home more affordable.

“At St. Charles, we not only care about our people, we also depend on them to care for the communities we serve. We need great people to be able to live and work in Central Oregon,” said Rebecca Berry, vice president and chief Human Resources officer for St. Charles. “We knew we had to find creative ways to help attract and retain great caregivers.”

Rooted Homes works with a consortium of partners to build high-quality, affordable housing and pay part of the cost for homebuyers. To fund its Poplar project, Rooted Homes tapped a number of local and state organizations, banks, charitable foundations, the City of Bend and the Bend Chamber of Commerce, which secured financial support from some of its members. St. Charles Foundation provided $7,500 to cover closing costs for the three caregivers now living in the community.

“It really was a team effort,” said Berry. “Everyone knows how important it is that Central Oregon remains a place where people can afford to live, and we appreciate the partnership of the Bend Chamber, Rooted Homes and all the other entities involved in making this happen.”

The process starts with an application that places potential buyers in a lottery system, where essential workers and employees of partner organizations (such as St. Charles) are given additional weight made possible through private funds raised by the Bend Chamber. From a pool of around 300 applicants, Fries ended up fifth on the waitlist for a home, eventually landing a spot after another applicant dropped out. From there, the process was similar to buying any other house: loans, escrow, keys, furniture shopping. Fries moved into his new home in February.

“Now I feel like I’m able to build myself and my future family a better future,” he said.

The typical monthly mortgage for the Poplar homes is around $1,650, about 40% lower than average rent prices in the area. And it’s not just the mortgage that’s low — monthly utilities hover around $12. Rooted Homes communities are built with sustainability in mind, featuring solar panels and a net-zero design, said Jackie Keogh, vice president of the company. Residents also receive a free electric bike.

“The goal was that these folks become more long-term residents and, therefore, longer-term employees because they are not impacted by the cost of housing,” Keogh said.

Thanks to continued community support, more homes are on the horizon, including 40 new houses on Bend’s west side.

“It's been a great partnership,” Keogh said, “and we hope to continue it with St. Charles.”

You may have seen recently that St. Charles has been positively recognized by S&P Global Ratings and Moody’s Investors Service, two large and influential credit rating agencies, for the health system’s operating performance turnaround.

As a nonprofit health care organization, we issue bonds to reinvest in our facilities and infrastructure to continue providing high quality, critical care to Central Oregon communities. The affirmed ratings and improved outlooks from the two agencies strengthen the health system’s capacity to borrow additional capital dollars in the future. And it’s nice that others have recognized the improvements we’ve made over the past 18 months, stabilizing our workforce and our finances.

I want to tell you about another sign of stabilization at St. Charles – one that will be more visible to our patients, visitors and caregivers than a credit rating.

Late last year, the St. Charles Board of Directors approved a $74 million plan to fund deferred maintenance, facility improvements, equipment upgrades, growth initiatives and other projects. The total includes $30 million in bond funds for development of the Redmond Cancer Center and $44 million from last year’s earnings for existing needs.

This is another really strong signal that the organization is stabilizing financially. It comes after three years of limited spending on this kind of work across the health system, at first as a cautionary move near the beginning of the COVID-19 pandemic, and then because we simply didn’t have the financial strength to fund a lot of projects.

Now, with an improved financial outlook, the 2024 plan covers a number of facility projects that will be noticeable to patients and the visiting public, as well as equipment and infrastructure upgrades that will make a positive day-to-day impact on St. Charles caregivers. All projects in the plan were prioritized and selected by operational leaders across the system as part of an in-depth planning process.

This is great news, not only for our bottom line and the caregivers who work in our facilities every day, but for the health of the organization as a whole and our ability to continue to provide Central Oregon with excellent care, far into the future.

As always, thanks for reading,
Steve

St. Charles’ Board of Directors has a new chairperson: Ann Rhoads, a 10-year resident of Bend.

Rhoads joined the Board in 2021 and spent the past year as Vice Chair, shadowing outgoing chairperson Jamie Orlikoff to better understand the role and its responsibilities. (Orlikoff will remain on the Board.)

Previously, Rhoads served on two St. Charles committees, one focused on investment and another on audit and compliance. She was a natural fit for those after her 33-year career as an audit professional with PricewaterhouseCoopers, she said.

“My background is in finance and accounting,” Rhoads said. “Serving on this Board appealed to me because of my interest in health care in and of itself, and how it’s being delivered.”

A former member of the local Volunteers in Medicine Board and a current member of the Tower Theatre Foundation Board, Rhoads also joined the St. Charles Board because of her commitment to giving back to the community she has called home for a decade.

“I have a very strong affinity for the fact that we have an excellent health system in Central Oregon that serves the community and is interested in making the community healthier,” she said. “When you live here and you see that every day, you want to be a part of it and help make sure it’s going to be around for a long time.”

After focusing on workforce and financial rebuilding in 2023, St. Charles is well-positioned, Rhoads said, to pursue initiatives within the Board’s three priority areas for 2024:

Sustainability: “We got our financial house in order last year,” she said. “Going forward, we can now really reinvest in the organization. We can make sure we’re providing the right services and the right number of beds for the communities we serve. And we’re prepared to do some fairly big things, like the Redmond Cancer Center. That’s an exciting place to be.”

People and culture: “At one point, we had more people leaving the organization than staying with us. But we’ve stabilized that. We’re on a positive upswing and we’re building the nursing staff back to where it needs to be,” Rhoads said. “We want people to be proud to work at St. Charles and to be happy in their jobs. We want to be a place with an irresistible culture, where people feel respected and valued for not just their skills but simply who they are.”

Safety and quality: “Obviously, safety is Job One for a hospital. We closely monitor the safety and quality of the care we provide and we’re working hard to develop new ways to improve,” she said. “We’re well on our way to where we need to be, but of course this is the kind of thing that needs constant attention, and it’s intertwined with having the right people in place and giving them the tools they need to do their jobs.”

Overall, Rhoads is looking forward to serving as Board Chair because she believes St. Charles’ future is as bright as ever.

“There have been bumps in the road, obviously,” she said, “but I feel like we’re on the right track.”

A major investment in training Madras and Prineville nurses over the past three months means more patients in Jefferson and Crook counties can get the care they need closer to home rather than transferring to Bend, Redmond or beyond.

St. Charles spent nearly $500,000 to train nurses at the two hospitals, giving them the additional breadth of knowledge they need to provide the same level of care patients receive at Intermediate Care Units (IMCU) in Bend and Redmond. IMCUs serve as an essential link in the health system, taking care of people who don’t need the long-term critical care of an Intensive Care Unit, but who need a higher level of care than is typically available in a Medical Services unit.

To provide IMCU care, nurses need to have a robust understanding of things like administering heart medications and advanced life support techniques.

“The skill set has always been there,” says Dr. Maggie King, chief medical officer at St. Charles Prineville. “We just expanded it.”

As an example, a patient with Type 1 diabetes who is experiencing diabetic ketoacidosis – a serious condition caused by lack of insulin – requires an insulin drip and, often, an overnight stay. That’s a treatment typically provided in IMCUs.

Before the new training, patients with diabetic ketoacidosis in the Madras and Prineville areas had to be taken to Bend or Redmond. Now, those patients can stay at their local hospital to get the treatment they need, saving them a trip across Central Oregon and keeping them closer to friends, families and other resources.

And to be clear, it’s not just diabetics who benefit. Any patient who needs hospital care, but not ICU-level care, can stay closer to home.

“It’s been a wonderful thing for our community,” says Kassidy Apperson, a registered nurse at St. Charles Prineville who was in the first cohort of IMCU trainees last summer.

The training took place in Bend over the course of three months, beginning with classroom instruction and then hands-on learning in patient-care units, said Todd Shields, vice president and hospital administrator for Madras and Prineville. Another cohort is scheduled to start in February.

IMCU-level care started in Madras and Prineville in August. Since then, more than 40 patients who would’ve previously transferred have been treated in the two hospitals, Shields said. This not only saves the patients and their families the hassle of moving hospitals, he said, it also frees up ambulances and emergency workers, as each transfer removes them from service for about three hours. Finally, keeping these patients close to home reduces patient load for caregivers in Bend and Redmond, opening space for people local to those towns.

Nurses in Madras and Prineville have greatly benefited from the training, too. “(We’ve) really seen from the staff this level of pride,” King said. “There is a stronger sense of capability in keeping patients here and a push to care for them locally.”

For caregivers who are wholly dedicated to doing what’s best for their patients, that’s a great feeling, said Apperson.

“Being able to keep (them) in the community … has been so good for our patients,” she said. “It’s just awesome.”