Small outpatient hospitals are not the wave of the future, they already exist.
One of America’s top medical experts told those gathered at the Delta Council’s annual meeting last week that large multi-service hospitals with a variety of specialties are in rapid decline and will soon be in metropolitan areas. He said he would never be seen again.
Nashville attorney Richard Cowart, who specializes in rural health care, has been hired by the Greenwood group of companies to help Greenwood hospitals move toward federal designation and, if approved, a long-term Survival will be guaranteed. The new board of directors of Clarksdale Hospital is seeking similar designation.
“We can’t afford to provide specialty care in every community in Delta,” Cowart told an audience at the Delta Council. “Not enough people.”
The 2020 Census reports that population decline is a factor across the delta, with Coahoma County losing 18 percent of its population. The county’s population is currently 20,197, declining by about 300 each year.
Cowart was also hired to help Delta develop a regional approach that not only keeps local medical facilities alive, but also finds ways to improve the care local hospitals bring to towns. rice field.
He reiterated that Delta needs a new approach to healthcare. He talks about small hospitals with 10-20 beds, emergency rooms, small intensive care units, basic services and diagnostic equipment, telemedicine, and doctors who visit the facility weekly instead of daily. bottom.
He said small hospitals in these areas also serve surrounding counties. Cowart cited Alabama and Tennessee as two states that developed successful regional models decades ago.
“The best way to survive when you’re small and at risk is to play as a team,” he said.
Cowart also said Delta’s medical providers need to think carefully and plan wisely in what has been called a nationwide rural health crisis.
“You can’t make long-term decisions in a crisis,” says Cowart. “We have to stabilize the patient. I’m trying to take a long-term view of
He noted that nearly 30 percent of all rural hospitals in the country are at risk of closing, according to the latest estimates by the Center for Healthcare Quality and Payment Reform. The problem is particularly acute in the Delta, he said, where all five acute care hospitals, including hospitals in Clarksdale Cleveland, Greenville, Greenwood and Rolling Fork, are either operating at a loss or have at least no cash. It is said that there is a shortage.
Cowart noted that a small hospital in Crittenden County, Arkansas, is bucking that trend, with increased emergency room traffic, which leads to follow-up visits to local doctors and clinics. The hospital, affiliated with Baptist Health Care, is about 65,000 square feet, has 11 beds and cost about $40 million to build.
Most rural hospitals were built when inpatient care was more common and were designed with physical space to accommodate inpatient care, he said. However, hospitalizations have fallen dramatically, a trend accelerated by COVID-19. About 60 percent of medical care is now done on an outpatient basis, according to Cowart, which he predicts will increase to 80 percent. As a result, rural hospitals, also affected by depopulation, are operating at less than 15% of capacity.
Cowart said he hopes Greenwood LeFlore will be granted an exemption from distance rules that would normally disqualify an application for critical access status. But even if the effort succeeds and restores the hospital’s financial stability along with a few short-term infusions, it won’t be “the end of the job,” he said. “It’s a preparation to start thinking about what we do in a long-term and more sustainable way.”
Clarksdale is also seeking changes to distance rules that affect its status.
Cowart said communities in the Delta region need to start working together in developing a regional approach to health care, similar to the Delta Council’s concept of driving agriculture, economic development and flood control efforts. The outline might be to identify critical services that all counties should receive (such as emergency care and obstetric care), but it might be more strategic about where specialized care is provided. said he.
Cowart only touched on it briefly in his first presentation and didn’t mention it at all in his second presentation. The topic has generated considerable debate in Mississippi, extending Medicaid, which is provided under the Federal Affordable Care Act, primarily to the working poor. The expansion is backed by the Delta Council and the Mississippi Hospital Association, but has not been voted on by the Republican-majority legislature. Governor Tate Reeves and outgoing House Speaker Philip Gunn, who joined other state officials at the major rally on Friday, have staunchly opposed the expansion. Mississippi is one of only ten non-expansion states.
Cowart has been hired by Delta Council’s BF Smith Foundation in late 2022 to help communities navigate an increasingly complex world of rural healthcare.
Cowart is a recognized authority advising senior management on policy, regulatory and business issues related to healthcare. He serves as a strategic advisor to healthcare companies (both for-profit and non-profit), with a focus on business transactions, advising healthcare providers on business, policy and governance issues.
hospital history
On May 1, Greenville’s Delta Health System (DHS) formally handed over control of Clarksdale Hospital to a five-member local board of trustees.
The documents signed on May 1 include the so-called “sales bill” under which the hospital’s equipment will be turned over to Coahoma County, accounts receivable and payable, an intangible asset contract under which contracts and insurance will be handed over, and a lease agreement for DHS Clarksdale. was included. Agree to return the facility to the county and release DHS from the lease once all termination conditions have been met.
Attorney for the hospital board of trustees, Ted Connell, said the board and the interim leadership team, led by Stroudwater consultants, were busy at the time and were meeting regularly to prepare for the transition. He noted that the transition process will take 60 to 90 days, but Coahoma County now manages the area’s hospitals.
The regulator signed a resolution in mid-April cutting ties with Greenville’s Delta Health System, establishing a local board of trustees, and developing a plan to move the local hospital forward.
The supervisors also invested in the county’s $30 million hospital to help run the fledgling board, create budgets, purchase supplies, change physical factories, and run payroll when needed. It also agreed to contribute up to $15 million from the Reserve Fund.
The new hospital’s board is currently asking for $10.6 million.
With this line of credit, trustees and Stroudwater will be able to plan improvements for the hospital. Items discussed with supervisors include new computers and software, immediate repairs, vendor payments, hiring doctors and nurses, and payroll.
The hospital’s new board of trustees consists of the following members: Donnell Harrell, Vice President. Trip Hayes, Commissioner. Lera Keyes. and Alan Byrd.
The hospital has applied for “Critical Access” designation, which is under review by the Mississippi Department of Health, which must approve the application before it can be submitted to federal regulators. Clarksdale Hospital is eligible for higher annual Medicare reimbursements as a critical access hospital.
A major stumbling block to this application is regulations disqualifying Clarksdale Hospital because it is located within 55 miles of other hospitals, particularly West Helena and Marks.
Mr. Connell and Mr. Flowers traveled to Washington, D.C., where they met with Senators Roger Wicker, Cindy Hyde Smith, and Rep. Benny Thompson to brief them on the situation at the hospital and ask for help at the federal level.
DHS Greenville announced in August that it was having cash-flow problems, and Clarksdale’s hospital was part of the problem. Greenwood Lefleur Hospital has cut services and is also looking for ways to increase revenue.
Coahoma County supervisors met with Delta health system leaders at a special meeting on August 30 to discuss concerns at Greenville Hospital. The board then hired Stroudwater to collect data on local hospitals and provide solutions to modernize services at local facilities.
Although the county employs Stroudwater as a consultant, Stroudwater will actually work for and with the trustee. In Mississippi, hospital directors are governed by state law.
Health care is a major industry in Coahoma County and a key driver of industry and employment in the area. It is an important factor for the quality of life of the community.
Rural hospitals have been hit hard by the COVID-19 pandemic, rising costs from inflation and a shortage of nurses and doctors to staff them. Poverty care without payment guarantees is also a problem, even in the emergency rooms needed to treat patients.
The complexity of the problem means there is no quick fix, and Mr. Stroudwater has been working with the county for at least 18 months to see if there are solutions and ways to make Clarksdale Hospital profitable. will be confirmed.
The supervisors asked the hospital board to submit reports through Connell every 30 days for at least the next three months. Hospital administrators meet regularly and are open to the public, as are county supervisor meetings.
