The financially imperiled Greenwood Leflore Hospital is now onto Plan B to stay open, and the outlines of the strategy are starting to take shape.
The new short-term goal, said Gary Marchand, the hospital’s interim CEO, is to stay viable until April on the hopes that the Mississippi Legislature — and possibly Congress — will take steps in early 2023 to sustain for the long term not just Greenwood’s hospital but other endangered rural hospitals as well.
“To get to the long term, you’ve got to get through the short term,” Marchand said Monday.
The Greenwood hospital, which is jointly owned by the city of Greenwood and Leflore County, is scrambling to rebound from Friday’s surprise announcement from the University of Mississippi Medical Center that, after months of talks, it was no longer interested in taking over the 208- bed hospital.
Since May, the Greenwood hospital has been cutting services and staff in an effort to hang on until the anticipated lease could be finalized. Initially, the target date was early December. When negotiations with UMMC hit a snag last month, the target date was extended until early February. Now, the hospital is looking at trying to make ends meet for at least an additional two months, even while its available reserves have been exhausted.
One development that could help stave off insolvency is the federal Medicare program’s approval of the hospital’s request for a hardship extension on the payback of a loan. Installments on the loan, which had an outstanding balance of $5.6 million at the end of September, had been averaging almost $900,000 a month since April. The hospital learned late last week that it has been granted a five-year repayment schedule of $103,000 a month. Over the course of the next year, that will reduce the hospital’s cash drain by an estimated $4.4 million.
Marchand said that although no additional cutbacks in medical services are currently contemplated, neither will discontinued services, such as labor and delivery or intensive care, be reinstituted anytime soon. Those services have been shifted to other hospitals, primarily UMMC’s facility in Grenada.
The maternity ward at the Greenwood hospital had become untenable, according to Marchand, because of the nursing shortage and the hospital’s decision to stop trying to fill its staffing gaps with premium-priced contract nurses. “We couldn’t staff the care safely. We couldn’t hire enough staff to provide consistent care 24 hours a day for consistent days. University can in Grenada, and we couldn’t.”
He said the hospital’s focus will be on maintaining its emergency room, outpatient diagnostic services, surgery and a limited number of inpatient beds.
He also said he did not anticipate rolling back any of the recent layoffs. On Friday, hours before UMMC revealed it was pulling out of lease negotiations, the Greenwood hospital announced it was cutting around 80 full-or part-time employees, the third round of job cuts since May.
“The only way we would start bringing staff back is if we saw an uptick in patient volumes,” Marchand said.
The hospital will also begin this week working with its physicians to extend their contracts into 2023. In early September, the hospital, assuming the lease with UMMC would go through, sent 90-day cancellation notices, effective Dec. 1, to 34 physicians who either were employees of the hospital or were in private practice but had contracts to serve as medical directors of hospital programs.
“Obviously we want to keep them,” Marchand said.
One of the affected physicians, Dr. John F. Lucas III, said he plans to continue to work for the hospital.
“As long as they have an operating room here and I can do what I’ve been doing for the last 30 years, I want to stay here,” said the nationally recognized vascular surgeon.
Lucas said he had not talked with other physicians as to what their intention might be other than the hospital’s newest surgeon, Dr. Dezarae Leto. According to Lucas, she also intends to stay on board.
Lucas said his reaction to UMMC’s decision mirrored that of hospital and local government officials.
“We were sort of shell-shocked,” said Lucas, who had been advocating for years the affiliation of the Greenwood hospital with a larger medical institution. “I wish they would tell us what we failed to do to meet their requirements for a lease going forward. We’re at a loss as to where we didn’t do what they had asked us to do to make a lease feasible.”
The only explanation UMMC has given so far is a vaguely worded statement, released Friday, that the proposed takeover was “not possible due to several factors, the most significant being the current realities of health-care economics that all health systems are facing in this challenging environment.”
Lucas said he understood the necessity of curtailing or even dropping some medical services at the Greenwood hospital. He said historically, the hospital has provided far more services to the community than it could financially justify. “That’s been for the benefit of the community but for the detriment of the hospital’s finances,” he said.
Lucas lamented the state Legislature’s refusal to expand Medicaid to cover the so-called “working poor” — workers who aren’t provided health insurance by their employers and don’t earn enough to purchase coverage themselves. Mississippi is one of 12 states, all dominated by Republicans, that have not expanded Medicaid.
The failure to expand Medicaid, according to Lucas, is particularly hard on hospitals in the Delta, which serve a high percentage of uninsured patients. “We provide a lot of care that’s not funded because of where we live. It’s what we need to do, but it puts us at very much of a financial disadvantage compared to those more affluent areas of the state and those areas that have another hospital that they can send the indigent patients to and not take them, such as Jackson .”
Dozens of rural hospitals in Mississippi are endangered, according to the Center for Healthcare Quality and Payment Reform, a national policy center that advocates for changes in how hospitals are compensated. It has estimated that 38 of Mississippi’s 70 rural hospitals are at risk of closing in the near future and that 24 of these — the highest number in the nation — are at immediate risk of having to shut down.
In addition to expanding Medicaid, Marchand said, the Legislature could help rural hospitals by changing other aspects of the insurance program that is funded mostly by the federal government but operated by the state. Those reforms, he said, could include eliminating the state tax that hospitals pay on their Medicaid revenue and increasing the supplemental payments hospitals receive beyond the reimbursement for services.
Without help from the Legislature or Congress, Marchand said, the Greenwood hospital will not survive.
Lt. Gov. Delbert Hosemann, in a statement to Mississippi Today Friday, did not promise any rescue plan targeted specifically to the Greenwood hospital but indicated the Senate would be looking at how to address the growing crisis in rural health care in Mississippi.
“The financial issues facing health care are becoming universal in our state. We need a universal plan to address them,” he said.
The Greenwood hospital’s board is planning to meet by the end of this week with city and Leflore County officials to discuss their options. The county, acting separately, has asked an Indianapolis health-care consultant to come up with a plan to keep the hospital open.
Marchand said that the county’s initiative could be helpful if it enables US Rep. Bennie Thompson, in whose district the hospital is located, and others to secure new federal dollars for the hospital.
On Monday, Thompson said although he has had conversations with Leflore County supervisors about Greenwood Leflore Hospital’s troubles, he was still waiting to hear directly from the hospital administration on what it is seeking from him or Congress.
“We rely on hospital leadership. This helps us determine how helpful we can be,” the Democratic congressman said in an email.
“We are ready to be supportive during this time. It is obvious from reading the articles and chatting about different conversations that they need assistance, but like any other business, they need to meet with the federal delegations and discuss a plan to move forward.”
He noted that Congress has been out of session for a month in advance of Tuesday’s midterm elections and that he has traveled to Greenwood several times during the break — apparently suggesting that a meeting with him could have been set up by now.
“When other hospitals in the district reach out for assistance, we have extended the resources,” he said.