Clarksdale Press Register
Senator Hyde-Smith Addresses At-Risk Rural Hospitals
By THE PRESS REGISTER
Wed,11/23/22-12:00PM, 247 Reads
At a hearing in the build-up to writing the nation’s agriculture production law, U.S. Senator Cindy Hyde-Smith used the dire outlook of rural hospitals in Mississippi to show why the 2023 Farm Bill should strengthen federal rural development programs to help rural health care facilities stay afloat.
Hyde-Smith serves on the Senate Agriculture Committee that conducted a hearing titled, “Farm Bill 2023: Rural Development and Energy Programs” on in mid-November. It was the latest in a series of hearings leading up to the development of a new five-year farm bill to authorize U.S. Department of Agriculture (USDA) agricultural, rural development, and nutrition programs.
“Thousands of constituents of mine from Clarksdale, Mississippi, and Greenville, Mississippi, and other rural hospitals throughout the state are living with the fear of uncertainty of their hospital closing,” said Hyde-Smith. “It is a reality.”
“Six months from now, if their husband has a heart attack, or their wife goes into labor, or if there’s some type of medical emergency, they’re trying to decide if they’re going to be able to drive five minutes to their local hospital or 100 miles to Memphis or Jackson,” she explained.
Hyde-Smith identified a “Five/Five Review” requirement as an impediment for at-risk hospitals accessing USDA Rural Development Direct and Guaranteed Loans. The Five/Five review handicaps applicants that have existed less than five years or that haven’t operated on a financially successful basis for the past five years.
“I think we can all agree that there needs to be a level of confidence that loans made will be repaid,” said Hyde-Smith. “But that said, USDA is often referred to as the lender of last resort. Hospitals with impeccable balance sheets don’t need our financing; and if they do need something, they get it somewhere else. They don’t get it from USDA.”
“The bottom line is there are rural hospitals in Mississippi and across the country that need financing to remain operational, but they just can’t get it,” the Senator explained. “USDA or Congress alone cannot eliminate all of the health care challenges facing rural America, but I really think that we can do better.”
Xochitl Torres-Small, Under Secretary for Rural Development, acknowledged the problem and cited the closure of 135 rural hospitals with another 450 at risk of closing. She also committed to working with Hyde-Smith and the committee to address the problem in the 2023 Farm Bill.
“I think you’re absolutely right,” said Torres-Small. “We have got to walk that cautious line of making sure we’re making wise investments but also being there for communities when they need it.”
At the hearing, Hyde-Smith also introduced Kenneth F. Herring, general manager of the Adams County Water Association, Inc. in Washington, Miss., whose testimony focused on changes to make USDA funding programs better at ensuring affordable and sustainable water and wastewater services in rural populations, especially economically-disadvantaged communities.
Delta Health System of Greenville, the parent company of Delta Health System of Clarksdale, announced in September it was having cash flow problems and Clarksdale’s hospital was part of that problem.
Coahoma County Supervisors met with leaders of Delta Health System in a special called meeting Aug. 30, to discuss concerns at the Greenville hospital, and county leaders then hired a consultant to gather data on the local hospital and offer solutions to revamping services at the local facility.
An hour-long executive session saw supervisors vote to approve a letter of engagement with Stroudwater, a healthcare advisory group with offices in Portland, Maine, Nashville and Atlanta, to look at the financial situation at the Clarksdale hospital.
Also in that August meeting Interim DHS CEO Iris Stacker and attorney Scott Phillips talked about issues that have the Greenville hospital an estimated $25 million in the red and Clarksdale’s hospital responsible for about $8 million of that.
The board also approved a letter of engagement with the legal firm of Wise Carter of Jackson in August and gave the nod to the chamber’s committee to “develop a strategy to deal with current challenges and report back to the board within two weeks.”
The committee is working under the auspices of the Economic Development Authority of Coahoma County (EDA). Supervisors also met with Chamber Executive Jon Levingston, Bowen Flowers and attorney Edward “Ted” Connell in August seeking a non-disclosure agreement as they will be presented sensitive data at some point, will develop a strategy for Clarksdale’s healthcare and possibly seek others to manage the local hospital.
The situation with DHS became public in early July with news reports in the Press Register about the resignation of then CEO Scott Christensen. DHS’ CFO Scott Goodin left his post in late July.
Stacker has attributed the significant losses to COVID and the surging wage demand for nurses, in large parts — two factors that have resulted in the medical center having to “right-size” its nursing staff and operate with only one medical floor.
To further alleviate the financial hemorrhaging, DHS closed its Neo-natal intensive care unit and cardiac rehabilitation department which were listed as “non-revenue producing venture.”
DHS operates hospitals in Clarksdale, Greenville and Senatobia.
Healthcare is a major industry in Coahoma County and a factor in attracting industry and jobs to a community. It is a key component to a community’s Quality of Life.
And Clarksdale is not the only hospital with concerns. Greenwood, Senatobia and most rural hospitals in the state are struggling. It has been estimated that almost half of the state’s 64 rural hospitals are at risk of closing or at least not profitable.
The complexity of the issue means there are no quick fixes. The Greenville hospital is undergoing a massive audit and has not said anything firm about its financial situation or what led to the hemorrhage of cash on the balance sheet.
At this point no one has said publicly the Clarksdale hospital is in danger of closing, but the county and local leaders are looking at options.
Coahoma County owns the local hospital and has leased it to various entities over the past three decades who managed the facility. That lease is one of the binding agreements that have both Greenville and Coahoma County working to keep the hospital open.
DHS told the Clarksdale Press Register in February 2021 that it was taking over management of the former Clarksdale hospital which became Northwest Mississippi Regional Hospital. It was DHS’s first hospital expansion under the newly named Delta Health System.
At that time DHS said its goal was to establish and strengthen physician relationships, enhance emergency room services, provide additional primary care with select specialties and increase awareness to the county and surrounding areas concerning care and services offered at the new hospital.
Janet Benzing was named the new administrator at Delta Health Northwest Regional in March 2021.
Delta Health System had been working with the Coahoma County Board of Supervisors about taking over management of the hospital facility from Community Health Services for some time.
CHS took over management of Northwest Mississippi Regional Medical Center from Curae in May 2019. Curae declared bankruptcy in August 2018 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 2018 saying they planned “to continue operations at Northwest Mississippi Regional Medical Center with the ultimate goal of identifying a new buyer for the hospital.”
Coahoma County signed a deal to transfer Northwest Regional Medical Center from Community Health System to Delta Health System, in mid-January.
Supervisors signed a letter of intent to shift its lease from Community Health System (CHS) to Delta Health Systems (DHS) out of Greenville, modify tax payments and get assurances on physical plant changes to the hospital.
The deal saw the remaining 14-years on the lease with CHS honored, taxes that would be paid by the hospital over those 14-years guaranteed and maintenance and approximately $2.3 million in improvements needed at the hospital satisfied.
Dollar amounts for the three key points of concern to the county are: a lease that generates approximately $500,000 a year; $900,000 in county, city and school taxes paid annually by CHS; and what are more than $2 million in renovation, improvements or demolition needed at NMRMC.
DHS has said it has invested $1.9 million in the local hospital.
Lease payments to the county by DHS are deposited into a Hospital Trust Fund designated for emergencies related to providing healthcare in the community. The fund currently has about $25 million in the account. The county can borrow from that fund and took $2 million from that account in 2020 to leverage work on the Jonestown bypass, county fire station and complete the new Justice Center and Coahoma County Jail.
DHS is a not-for-profit corporation owned by Washington County and as such does not pay property taxes. Coahoma County’s concern with no local representation on the DHS Board of Directors has also been discussed.
Supervisors hired Trilogy Healthcare Solution of Flowood as a consultant in 2019 to help them assess needs at the Clarksdale hospital and to study possible solutions to problems faced by the hospital.
Trilogy’s report to supervisors in October 2019 said the current 181-bed hospital in Clarksdale was built in 1952 and much of the infrastructure at the sprawling facility is in need of repair. The report also suggested the hospital footprint be reduced to about 50 beds.
The report said the hospital sees roughly 24,000 people annually through its emergency room, which acts as “the front door” for the hospital.
Northwest Regional was a Level 4 Trauma Center in 2019, meaning they could handle most emergencies and could perform surgery to stabilize patients before sending them to a Level 5 Trauma Center – the medical professions highest level of emergency care.
Northwest Regional was also touted as a primary stroke center and routinely offered a better outcome for patients who have had a stroke. The hospital was also listed as an accredited chest pain center.
The hospital has a Labor and Delivery Suite, which includes two labor/delivery rooms, five regular labor rooms, two delivery rooms and a 23-bassinet newborn and intensive care nursery. Northwest Regional saw over 700 births in 2020 or about two a day.
One of the main concerns in negotiations had been staffing and employee numbers at the Clarksdale hospital.