rural hospitals – Rural and Progressive

A test of faith

Last Friday Governor Brian Kemp took the unprecedented step of declaring a statewide public health emergency as the number of Covid-19 (coronavirus) cases began to increase on national and state levels. The Georgia General Assembly suspended its calendar last Thursday and returned for on Monday for a special session called by the Governor to approve his actions. Yesterday the Georgia Department of Public Health (DPH) confirmed 197 cases of Covid-19 and three deaths. The number of reported cases are updated daily at noon.

Whether the changes we are adopting come from business, civic, or elected leaders, the chorus in this choir is to avoid being closer than six feet from other people. I prefer the phrase physical distancing instead of social distancing. We need our social connections now more than ever, just not the close physical ones.

Last weekend I was supposed to be with about 12 other Life Is A Verb Campers for a house party filled with making art, cooking Pi Day themed meals, walking, yoga, and sharing stories. Instead of being together physically, we gathered at 11:00 in the morning via Zoom for coffee and everyone’s choice of pie. I made a roasted mushroom and asparagus quiche. It wasn’t the same as being in a room together, but it was good to see much-loved faces and talk.

Having done that on Saturday, the next morning I did a quick FaceBook search of five large churches in rural Washington County to see how they were adapting to the six foot wingspan way of living now. All five opened their doors to congregation members. One of the five churches was St James Christian Fellowship. This congregation is led by Georgia State House Representative Mack Jackson. He did not reply to my email with questions about opening the church last week.

Last Thursday Jackson worked with other state representatives to suspend their work and return home out of an abundance of caution due to Covid-19. On Friday some members stood closer than six feet to Kemp while he announce the public health emergency. Despite the cautions taken by the state, Jackson and other faith leaders invited people to gather together, perhaps more than once, last Sunday.

Everyone in those churches knows that the local hospital, like those in other rural counties, is not equipped to handle a large number of Covid-19 patients. The capacity just isn’t there, no matter how caring and well=trained the health providers are. With all of the free and easy-to-use technology available for streaming a service, why any church leaders thought that unlocking the doors last Sunday was a good idea, is enough to test one’s faith.

One way the Republican health plan will impact my rural county

Last night I used this nifty tool released by the Kaiser Family Foundation to calculate how the proposed health care bill released by the Republicans Tuesday night will impact Washington County.

In Washington County, if you are 60 years old and making $40,000 a year (per capita income is under $38,000 in my county), the Affordable Care Act (Obamacare) health insurance tax credit in 2020 will be $7,800. The House plan would provide a credit of just $4,000 in 2020. That means the cost of buying health insurance for a 60-year-old making $40,000 per year will GO UP by $3,800 if the Republican plan is adopted.

Washington County health data comparing ACA and proposed plan from Republicans

Under the current plan, insurance companies are capped at charging three times the amount charged for coverage for younger people. Under the Republican plan the cap increases to five times the cost of rates charged to younger people.

There are also considerable cuts to Medicaid and Medicare.

All of these proposed changes will impose serious financial and health threats to people in my county who may not be able to afford insurance any longer, and these expenses will be added to the other cuts to funding in the proposed legislation. These factors, plus others in the proposed plan, do not bode well for our hospital or facilities in other rural communities.

Last May Washington County voters took on a bond to support our hospital, knowing that the bond could not solve all of the financial problems for our struggling facility. We still have work to do if we want to keep our hospital open.

The documents behind a $15.4M question

Washington County Regional Medical Center (WCRMC) has steep financial challenges. That doesn’t make the rural hospital in Middle Georgia unique.

The solution proposed by recently appointed Hospital Authority members led by Chair Jim Croome, and, the Washington County Board of Commissioners (WCBOC), is to ask the county to approve a $ 15.4Million dollar bond.

The debt that citizens can choose to take on in a May referendum will fund $9M for infrastructure, IT, and computers at WCRMC. Property owners will have to decide if their personal budgets can stretch to take on more in property taxes to also give the hospital $6.4M to pay down debt, address pension plans, and general operations.

Last year the Washington County Tax Commissioner included a neon green insert with 2015 property tax bills stating that one mil of their taxes was being used for the hospital.

Last year county leaders could have chosen a course of action that might have made last week’s 2.5+ hours county commission meeting a lot shorter.

In late April 2015, county and hospital leaders had an option to improve operations and secure $5Million in capital improvements through an offer from University Hospital in Augusta. A management agreement already in effect between the two hospitals had already secured a $1Million line of credit for WCRMC.

University’s offer included a 20 year lease with an option for Washington County to sell the hospital if it decided that was the best course of action (University held first right of refusal. After that Washington County could pursue another buyer: page 3, University_proposal_to_WCRMC_April_29_2015). University guaranteed 24/7 Emergency Department operations, surgical and inpatient nursing services, and diagnostic and imaging services.

The lease proposal also stated that University, “will not seek any support from Washington County for the operation of WCRMC” during the first five years of the lease agreement (page 3, University Hospital offer to WCRMC April 2015).

University has already proven it can right-size a small hospital; just ask McDuffie County residents and patients at University McDuffie County Hospital.

Instead of saying “No thanks” to the offer, the Washington County Commissioners took a different tack, one that broke the management agreement with University and a retraction of their April offer.

County Attorney Tom_Rawlings hand-delivered letters on June 8th to local doctors inviting them to a private meeting with Navicent Health representatives from Macon to “structure a partnership with a larger hospital system.’ The meeting wasn’t planned for county offices or Rawlings’ office , both located on the high visibility Courthouse Square.

Instead, the June 8th meeting to discuss a possible relationship with Navicent was planned at Daniels Heating, Air, and Electrical just north of Sandersville, where cars travel pass at 55 MPH. The Chair of the Washington County Board of Commissioners is Horace Daniels.

While Navicent Health was planning a meeting with Washington County leaders and physicians, their 11 month old management arrangement with neighboring Oconee Regional Medical Center was spiraling towards a fatal crash.

The meeting Rawlings convened where the WCBOC Chair works violated the Management Agreement between University and WCRMC according to a letter dated June 12 from University’s CEO Jim Davis.

Davis closed his letter with, “We wish you and the Commissioners the best of luck in preserving a hospital in Washington County.”

Washington County leaders signed an agreement with University that secured a $1Million line of credit for our hospital. The organization that right-sized McDuffie County’s hospital proposed a 20 year lease agreement with $5Million of improvements to our struggling hospital. It did not include a request for $15.4Million in bond debt funded by Washington County property owners. It did include a restriction on future requests for taxpayer dollars.

Washington County needs a good hospital. Voters should have an opportunity to read the documents that brought us to a $15.4Million bond referendum in May. As I work through more documents I’ll post them here.

Rep Sharon Cooper attempts a 180

I hope Rep Sharon Cooper didn’t hurt herself while attempting that 180 on her statement last week about rural hospitals when she said, “There are some of those rural hospitals that need to close.”

Yesterday Cooper attempted to dial back her comments by telling the Atlanta Journal Constitution that closing rural hospitals “would have serious consequences on the affected community, hurting it economically and limiting access to acute care for Georgians.”

Cooper went on to say, as reported by Jim Galloway today,“If we don’t act to make real, substantive changes, we very well could be faced with the hard reality of hospital closures in rural parts of this state, no matter how many short gap measures we take, leaving many communities without the economic engine and access to care people depend on.”

Nurse Cooper and many of the urban based legislators under the Gold Dome suffer from a chronic disease that rural residents can identify in just seconds. I don’t know what the Latin derivation is, but it translates to, “I’m from Atlanta and I know what is best for ‘you people’ who don’t use GA 400 every day.”

Cooper and others in her camp have refused Medicaid Expansion dollars, and in doing so have made it harder for rural hospitals to cover their costs, let alone recruit providers or make even modest capital improvements to aging facilities. No one is advocating for perpetual “short gap” measures as solutions for rural hospitals.

The problems of improving the health status of rural communities are complex. What won’t begin to solve them is a lot of pontificating by metro legislators who think their zip code makes them experts on all things rural.

Rural Georgia needs to suck it up

Health professionals know minutes, 60 to be exact, matter following a stroke. For someone struggling to breathe during an asthma attack, or stopping the bleeding after an accident, or consumed by a mental health crisis, seconds matter. Minutes are too long. State Representative Sharon Cooper, R-Marietta, should know this. She’s a registered nurse.

She also has the luxury of living in a metro county with a wealth of hospitals, four to be exact, according to the Cobb County Chamber of Commerce.

Cooper opposes the Affordable Care Act and the expansion of Medicaid funding, a critical financial piece for rural hospitals. Walking lockstep with Gov Deal and fellow state legislator Rep Jason Spencer, Nurse Cooper told WABE in Atlanta, “There are some of those rural hospitals that need to close.”

I guess we’re just spoiled out here in rural Georgia, expecting to have access to an emergency room without driving 20+ miles to get care. All 1 Million of us rural Georgians who were cared for in small rural hospitals last year just need to suck it up, buckle up, and floor it.

Who cares how far away the hospital is? It’s only time and miles.

Crack addicts aren’t running my rural hospital

State Representative Jason Spencer thinks Georgia’s hospitals are like crack addicts because they support Medicaid expansion funding. Spencer, a Republican who represents citizens in the Woodbine area, said in a Face Book post, “By the way, many hospitals are addicted to the current reimbursement structure in Medicine (the main problem with the healthcare). They are like addicts on crack.”

I’ve been lucky enough to know every person serving on the Hospital Authority Board of Washington County Regional Medical Center (WCRMC). Chaired by retired Elder Middle School Principal Bern Anderson, the Board includes former County Commissioner Carl Forrester, retired state employee Bobby Anderson, Head Start Director Susie Wilcher, retired teacher Adam Adolphus, and Thiele Kaolin employees Marc Sack and Rob Mathis. When the hospital’s CEO, Jimmy Childre, Jr. began working there, he did so initially as a volunteer, taking no salary.

These people know that having a good hospital does more than save lives; it creates jobs (375 full-time employees at WCRMC, according to the hospital), keeps money in the local economy, helps attract businesses to our county, and improves health outcomes. The Authority Board also wants to cover the costs of running a good hospital.

That doesn’t make them crack addicts.

Hospitals, including WCRMC, get just 93 cents on the dollar for Medicaid patients. Every time they do what hospitals are supposed to do, like save a life or safely deliver a baby, someone has to find a way to collect the unreimbursed expenses (which holds for private insurance, Medicare, and Medicaid patients). The Sandersville Progress has reported on new ways WCRMC is improving collection of payments for services, but, like many other rural hospitals, we will always have some patients who simply cannot pay their bills.

Governor Deal could still take action in the legislative session that begins today to increase the flow of Medicaid funding to our state’s hospitals while the Federal government carries the full cost for three years. Deal chose to pass on that, sending the money to other states who did the math on protecting rural hospitals (even the conservative Georgia Hospital Association said we need those dollars in Georgia).

According to Hometown Health CEO Jimmy Lewis , one million rural Georgians are treated in small community hospitals every year, in addition to those traveling through rural areas who may need emergency care. Governor Deal’s decision has already hurt the communities of Folkston, Arington, and Richland in the southwest part of our state, who saw their hospitals shuttered last year. Rep Spencer said (boasted maybe) that as many as 20 more small hospital closures could happen in our state in the next two years.

Our elected legislators will be hell-bent for leather to finish the session that opens today so they can raise campaign money and get on with the work of being re-elected in the November elections.

Elected power, just like crack, can be addicting. Maybe Georgia’s voters will consider electoral interventions when they go to the voting booth in 2014.

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