Arizona Tribune - A Rural Hospital Defies the Odds and Turns Around - in 24 Months

If the hospital didn't make it, it would not be alone. Since 2020, 36 rural hospitals in the U.S. have closed^[i]-a statistic that's more than alarming. Yet, it doesn't even come close to revealing what may yet lie ahead for rural hospitals.

A February 2024 Chartis report found 418 other rural hospitals are at risk of closure and that 50% of these vulnerable facilities are currently operating in the red-that's the highest percentage of rural hospitals losing money in the past decade.^[ii]

What's going on? The bottom line is rural hospitals simply cannot continue to care for patients while simultaneously shouldering the enormous and ever-increasing regulatory burdens and reimbursement cuts related to operations and hospital management. However, the importance of rural hospitals to their communities and for local access to care, cannot be overstated.

The issues are complex and come from all angles, and while all hospitals face similar challenges, they are unique in how the problems impact them. Workforce shortages. Inability to offer competitive salaries. Decreases in Medicaid and Medicare reimbursements, as well as 3^rd party insurance payments. The inability to invest in needed equipment and technology. Or to afford required upgrades to their facilities.

Then there are the issues happening behind the scenes, like low staff morale or a tarnished hospital reputation, which factor into financial losses. A host of other factors play into the mix related to rules and regulations, too. Case in point: Rural hospitals staff their emergency rooms 24/7. However, hospitals only get paid if patients come in.

WCRMC Brings In Aletheia Health Partners

WCRMC faced many of these same challenges, including the fact the hospital's ER had earned a reputation with some as a "band-aid station" and town residents avoided going there for care. It had also been difficult recruiting/retaining staff and investing in needed resources.

In August of 2022, WCRMC asked strategic advisory and management group, Aletheia Health Partners (AHP), to help them stop their monthly bleed and set them on a course for sustainability. As a result, Aletheia started consulting with WCRMC and AHP's Chief Administrative Officer, Kerry Trapnell, and he took the helm as interim CEO in January of 2023. Aletheia stepped in as the new management team in May of 2023.

Trapnell and the Aletheia team placed priority on listening to the community and to hospital staff to understand the complexities and nuances that were contributing to the financial loss. This process revealed the most critical areas where bleed was happening, allowing Aletheia to offer recommendations to WCRMC, which WCRMC asked them to swiftly put into motion. This included eliminating nearly all high-cost contract clinical positions which included agency staffing and emergency room providers. Of those that needed to remain, the hospital went from managing over 30 individual contracts, to just a handful.

This freed up funds that were used to increase salaries for nurses-who hadn't seen pay raises in years. Other staff eventually received pay increases, too. Another step taken included identifying areas of staff overlap and cost cutting to reduce these redundancies. Other savings allowed for new services and resources to be added into WCRMC, such as growing specialist surgeons in the community, a new nuclear medicine program, and a new CT scanner.

Pamela Stewart Becomes CEO

Each win allowed the hospital to regain more sure footing, and in December 2023, WCRMC named its new CEO, Pamela Stewart. Stewart had a significant 20-year history with WCRMC, working as a nurse and in compliance-related roles. Prior to accepting the CEO position, she served as interim Chief Nursing Officer. Her background also included working for The Joint Commission, where she gained additional insights into hospital and care quality, safety, and performance. As a bonus, Sandersville is Stewart's hometown.

Stewart credits Aletheia with their expertise in rural hospital operations as key to the turnaround. But she is quick to point out that, because they are rooted in and deeply understand rural communities, Aletheia was able to do what others who came before them could not.

Notably, the process included listening to concerns from community leaders, attending meetings, getting to know the community leaders, and eventually regaining their trust. Combining this with a "show, don't tell" approach, community leaders could see that tangible, significant and swift financial gains were actually happening at WCRMC. This newly forged relationship and demonstrated successes went a long way in securing a $15.5 million bond in 2024 from the Washington County Commissioners for hospital projects. The funds will be applied to new equipment, a new emergency department, remodeled inpatient rooms, remodeled nursing home, and other infrastructure and facility improvements.

"When Aletheia started working with Washington, the hospital had over $4 million in accounts payable and almost no cash. So we had to deal with old debt, while also paying current expenses. While we have done a lot, where we are going next would not be possible without the help of the county," stated Trapnell. "By the county trusting our demonstrated commitment to the hospital and the community, we have the benefit of their financial support via the bond. Ultimately, the staff, the hospital facility, and the community will be beneficiaries of the county working as a partner with us, allowing our team to forge ahead in our quest to be a shining example of rural healthcare."

From Surviving to Thriving

Within 24 months, the hospital went from losing millions of dollars each year to generating a profit. Today they are thriving and are poised to break ground on a new Emergency Department in early 2025, using a portion of county-generated funding. And, a new MRI, one of only two available in the state of Georgia that includes the capability to test for post-COVID cardiac issues, was obtained through a grant Aletheia helped WCRMC achieve and will be installed in the WCRMC radiology department in the fall of 2024. Aletheia also pursued and was awarded other grants totaling over $2 million to assist with adding new services.

"Part of our commitment to the county includes our team pursing every grant opportunity we can, in an effort to do our part obtaining funding. And, with Aletheia's help, we have done just that," said Stewart. "As a Sandersville native and CEO of the hospital, I'm truly excited about our partnership with Aletheia. Admittedly, I was hesitant at first to use another management company, but in the last two years, their team has proven over and over they are fully invested in our hospital and our community. The changes we have made and the improvements on the way ensure that people in our area have access to outstanding care, right here at home."

Today, hospital services and capabilities include the following with more improvements on the way:

• Comprehensive inpatient and outpatient surgery services

• 24-hour physician staffed emergency room

• Imaging Center, Rehabilitation Services (Occupational Therapy, Physical Therapy, Speech Therapy), Wound Care, Respiratory Therapy, Cardiac Rehabilitation, Swing-Bed, Inpatient and Outpatient Surgery, ICU, Telemedicine, Lab and Ambulance Services

• Pediatric Clinic, Sleep Center, and a Specialty Clinic offering Cardiac and Orthopedic Services

Into the Future

The groundwork has been laid and the future is bright not only for WCRMC as a hospital, but for local health care for the citizens of Sandersville and surrounding areas. The financial turnaround of the hospital goes against the grain of what is happening across the state and the country, but it also means it can be done. One key viewpoint Aletheia brings to the table is helping their rural hospital clients to stop looking outward at "what is being done wrong to them" with respect to payors, insurance, and regulations but rather focus inward to make sure the elements that are in their control are maximized and executed to the best of their ability, for the betterment of their hospital. Aletheia is of the firm belief when there is leadership, a framework, funding, and importantly, local support, rural hospitals can not only be stabilized, but they can also thrive and regain their place as a healthcare partner in their communities.

About Aletheia Health Partners

Aletheia Health Partners helps rural hospitals become solid and strong so they can focus on what matters most: patient care. As a community-focused hospital management company, Aletheia Health Partners provides management and operations service modules including human resources, revenue cycle management, and pharmacy services - all with the goal of creating a path for rural hospitals to remain sustainable for the communities they serve. To learn more, visit https://aletheiahp.com.

CONTACT:
[email protected]
706-389-9500
https://aletheiahp.com

[i] Becker's Hospital Review: https://www.beckershospitalreview.com/finance/36-rural-hospitals-have-closed-since-2020.html

[ii] Report: Unrelenting Pressure Pushes Rural Safety Net Crisis into Uncharted Territory, Feb. 2024, Chartis.

SOURCE: Aletheia

View the original press release on ACCESS Newswire

R.Lee--AT