The consultants charged with assessing Clarksdale’s hospital have asked their questions and presented their report to Coahoma County Supervisors last week.
Trilogy Healthcare Solutions interviewed 21 healthcare providers, contractors and present owners of the hospital over three months and presented a 39 page document with their finding to the board Oct. 9.
“You are not alone in this endeavor,” said William Williams, representing Trilogy. “There are 64 rural hospitals in the state and many of them are in communities of less than 16,000 and regional facilities like you.”
Williams also reported there have been five hospital closings in the state since 2010 and 48-percent of Mississippi’s hospitals are in some type of financial crisis.
He spoke of a changing healthcare market at the national and local level, the local business model for delivering healthcare and also the demographics of Clarksdale and how they all intertwine to influence the business side of healthcare.
“You do have some positives, but you also have some issues that must be addressed quickly,” said Williams. “You also need to look to the future – 10, 15, 20 years – and plan accordingly.”
Trilogy has been charged by the county to assess the current facility, look at the books, study the regions current and future demographics, look at how a rural healthcare business model can be successful in Clarksdale and work with those interested in managing or owning the local hospital.
Williams pointed out Trilogy is working with other hospitals in the state to chart a similar course. Trilogy also manages hospitals.
Trilogy’s report said the current 181-bed hospital was built in 1952 and much of the infrastructure to the sprawling facility is in need of repair. The report also suggested the hospital footprint be reduced to about 50 beds.
One solution would be to build a newer, smaller hospital. The county has approximately $24 million in a special county healthcare fund that was set up when the hospital was sold and then leased years ago.
“We think there are three things you need to focus on,” said Williams. “Sustain and evaluate what you have, how are you going to grow access to quality healthcare and stabilize this market as it relates to your hospital.”
The hospital has seen a number of managers/operators over the past several years and Williams said the business and those working for the hospital need stability.
He said the hospital sees roughly 24,000 people annually through its emergency room and it acts as “the front door” for the hospital.
Trilogy SWOT Analysis
(Strengths, Weaknesses, Opportunities, Threats)
Strengths
• Density of volume in Patient Service Area and Surrounding Service Area to support a local hospital.
• Annual emergency room visits.
• Existing government subsidies relating to MHAP/DSH program to protect access to quality healthcare in the county. That number is currently about $31.4 million.
• Current medical staff makeup consisting of right mix of primary care and specialist.
• Patient satisfaction results with an overall rating 3 out of five stars.
• Tenured department leaders in the clinical departments.
Weaknesses
• Aging physical plant that will require significant capital infusion going forward.
• Aging major equipment in the areas of radiology, laboratory, surgery and pharmacy.
• Significant out-migration of commercially insured patients to competing facilities for basic primary care services.
• Significant portions of the Coahoma County population experience incomes below the poverty line.
Deterioration of the revenue cycle functions and processes after transition from to CHS to new owner – transition to a new EMR platform in FY 2018.
Opportunities
• Strategic recruitment and placement of primary care in PSA and SSA.
• Implementation of population health initiatives to capitalize on possibility of new revenue streams.
• Improve revenue cycle functions to fully optimize the value of the hospitals net patient operating revenues.
• Renegotiate existing physician employment agreements.
• Restructure and renegotiate existing hospital-based physician agreements (e.g. anesthesia, emergency room, other).
• Possible construction of a replacement hospital or a micro-hospital that will be uniquely positioned to deliver care in a more cost- and operationally-efficient manner.
Threats
• Continued out-migration of commercially insured patients from PSA and SSA.
• Consistent declines in overall service utilization.
• Aging physical plan and medical equipment.
• Possible reductions to existing government subsidies related to MHAP/DSH program.
• Difficulty in recruiting physicians to a medically under-served area.
NWMMC wrote off $15 million in unpaid medical bills several years ago, many of those who simply walked into the emergency room, were treated and then walked out.
NWMMC is currently a Level 4 Trauma Center meaning they can handle most emergencies and can perform surgery to stabilize patients before sending them to a Level 5 Trauma Center – the medical professions highest level of care.
NWMMC is also a primary stroke center and routinely offers a better outcome for patients who have had a stroke. The hospital is also an accredited chest pain center.
The hospital has a Labor and Delivery Suite, which includes two labor and delivery rooms, five regular labor rooms, two delivery Rooms and a 23-bassinet newborn and intensive care nursery. NWMMC saw over 700 births last year or about two a day.
Supervisors were told the hospital needs to focus on the things they do well and downsize the facility footprint. That plan is typical of rural hospitals suffering in the current healthcare market that is tailored to larger metropolitan hospitals.
Supervisors and their attorneys traveled to bankruptcy court in Nashville in May and worked out a deal where Curae, the company most recently running the hospital, stepped aside and allowed CHS, the previous manager of the hospital, to join with the county to find a buyer or new manager.
Coahoma County signed an agreement with Trilogy Healthcare Solutions a consultant specializing in attracting and retaining doctors and healthcare professionals in June. Trilogy, of Ridgeland, was brought into the mix to walk the county through new working agreement with CHS or to transition the county and CHS in going separate ways.
The county has been approached by several companies wanting to lease the hospital with one group having local ties.
The county had a fund of approximately $30 million from the sale of the facility several years ago and that fund has dropped to roughly $26 million. The county took $3 million to meet payroll while the hospital was in bankruptcy. Those funds are earmarked and must be spent in specific ways related to local healthcare.
Community Health Systems, Inc. is one of the nation’s leading operators of general acute care hospitals. The organization’s affiliates own, operate or lease 106 hospitals in 18 states with approximately 17,000 licensed beds.
The county is also looking at state and specifically federal funding sources to help jumpstart their work.
Curae declared bankruptcy in August with hospitals in Clarksdale, Amory and Batesville directly affected. The Amory hospital was sold to North Mississippi Medical Center in Tupelo and the Batesville hospital was sold to a group of local investors.
The Coahoma County Board of Supervisors issued a statement in November saying they planned “to continue operations at Northwest Mississippi Regional Medical Center with the ultimate goal of identifying a new buyer for the hospital.”
