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Marshall County’s only ER to close this month after mix-up with federal government

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As an internal medicine doctor, Dr. Kenneth Williams knows the importance of continuity of care. That’s one of several reasons why the impending closure of the Holly Springs hospital’s emergency room – and its precarious financial position as a whole – pains him so.

After receiving special designation from the Centers for Medicare and Medicaid Services to operate the hospital as an emergency room-only and close its inpatient services, the federal government pulled the status less than a year later. Now, the hospital must close its ER and face the expensive and daunting process of reopening and becoming relicensed as an acute care hospital.

“At the end of the day, who suffers” from the emergency room’s closure and reduced services at the hospital? “My patients,” said Williams, who is co-owner and chief executive officer of Alliance Healthcare System in Holly Springs, a town of just under 7,000 residents about 50 miles from Memphis.

The news of the ER’s closure comes less than three months after state lawmakers approved a $350 million deal to bring a battery plant to Marshall County that’s expected to create over 2,000 jobs over the next few years. But the county’s only hospital is struggling mightily to stay open, placing continuity of care out of reach for some people in the community.

Spokespeople from PACCAR and Daimler Truck, two of the companies involved in the battery plant, declined to comment for the story. Representatives from Cummins did not respond to Mississippi Today’s request for comment.

The emergency room entrance is seen at Holly Springs Alliance Hospital in Holly Springs, Miss., on Tuesday, April 9, 2024. The federal government has rescinded the hospital’s rural emergency status. Credit: Eric J. Shelton/Mississippi Today

Recently, one of Williams’ patients he sees at the clinic had an emergency and was taken to an ER outside Marshall County. Williams knew the woman had a severe UTI and was allergic to an antibiotic called cephalosporin.

But the other ER didn’t have her history, and she was given the drug, he said.

“She had a severe reaction and had to go to rehab. She almost died,” he said. “Something that simple means something. If she had come to our facility, it’s already in our records that she can’t take cephalosporin.”

Rural hospitals in Mississippi are struggling to stay afloat. One report puts 29% of the state’s rural hospitals at immediate risk of closure, and 62% are losing money on patient services.

Research has found that Medicaid expansion has a positive impact on hospitals, including via a reduction in uncompensated care. And while expansion is not a silver bullet, median operating margins in rural hospitals were higher in expansion states than non-expansion states, according to KFF.

Williams said Alliance incurs between $800,000 to $1 million a year in uncompensated care, or care the hospital provides for which no payment was received – often as a result of patients who are uninsured.

Williams said he’s “amazed” lawmakers are finally discussing the possibility, but damage has already been done to his hospital and the state as a whole.

“This state could be in so much better shape health care wise,” he said, noting the decision not to expand has been a “disservice” to communities like his.

Tim Moore, the former longtime head of the Mississippi Hospital Association, said expanding Medicaid would put significantly more money towards hospitals’ bottom line through a reduction in uncompensated care, and there’s “not a legitimate argument” against full expansion.

“Even if your concern is not for that individual that needs health care, you should have some concern for your local hospital that’s trying to take care of folks,” said Moore.

READ MORE: Negotiations begin: Where do House, Senate, governor stand on Medicaid expansion? Is there room for compromise?

Without the boost from Medicaid expansion, the hospital applied for a new federal designation that aims to keep rural hospitals open – though it requires the discontinuation of inpatient services.

Last year, the financially struggling Alliance received rural emergency hospital status, which allowed it to operate as an emergency room-only facility and receive monthly payments and increased reimbursements from Medicare. But on April 1, after Alliance HealthCare System had already laid off staff and shut down its inpatient services to comply with the requirements of the new designation, the Centers for Medicare and Medicaid Services rescinded the designation.

An empty emergency room in Holly Springs Alliance Hospital in Holly Springs, Miss., on Tuesday, April 9, 2024. The federal government has rescinded the hospital’s rural emergency status. Credit: Eric J. Shelton/Mississippi Today

Hospitals must either be a critical access hospital or a hospital with 50 or fewer beds in a rural county as of Dec. 27, 2020, to be considered for rural emergency status. The Centers for Medicare and Medicaid Services eventually determined Alliance is too close to Memphis, Williams and State Health Officer Dan Edney said.

The federal agency first inadvertently granted the designation, according to a letter it sent Williams, then claimed the hospital failed to reapply for rural status by the deadline given.

But Williams and the hospital’s counsel Quentin Whitwell said there was no formal reapplication process that they could determine despite back-and-forth communications with agency officials over four months.

READ MORE: Under a new program, rural hospitals could get more money – but they have to end inpatient care

Williams said the federal government’s actions, in combination with the state’s refusal to expand Medicaid, has done “irreparable harm” to the hospital.

Now, after closing two of its floors, the hospital has to start the long process of again becoming licensed as an acute care hospital, which includes major building repairs.

“We’re spending a ton of money that we don’t have … just to get our old designation back,” Williams said.

And it notified the state Department of Health it will close its emergency department – which Williams says costs around $1 million a year just to staff with one around-the-clock physician – beginning April 15.

Mississippi Today’s Eric Shelton contributed to this story.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Podcast: Ray Higgins: PERS needs both extra cash and benefit changes for future employees

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mississippitoday.org – Bobby Harrison – 2024-12-23 06:30:00

Mississippi Today’s Bobby Harrison talks with Ray Higgins, executive director of the Mississippi Public Employees Retirement System, about proposed changes in pension benefits for future employees and what is needed to protect the system for current employees and retirees. Higgins also stresses the importance of the massive system to the Mississippi economy.

READ MORE: As lawmakers look to cut taxes, Mississippi mayors and county leaders outline infrastructure needs

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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‘Bringing mental health into the spaces where moms already are’: UMMC program takes off

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mississippitoday.org – Sophia Paffenroth – 2024-12-23 06:00:00

A program aimed at increasing access to mental health services for mothers has taken off at the University of Mississippi Medical Center. 

The program, called CHAMP4Moms, is an extension of an existing program called CHAMP – which stands for Child Access to Mental Health and Psychiatry. The goal is to make it easier for moms to reach mental health resources during a phase when some may need it the most and have the least time. 

CHAMP4Moms offers a direct phone line that health providers can call if they are caring for a pregnant woman or new mother they believe may have unaddressed mental health issues. On the line, health providers can speak directly to a reproductive psychiatrist who can guide them on how to screen, diagnose and treat mothers. That means that moms don’t have to go out of their way to find a psychiatrist, and health care providers who don’t have extensive training in psychiatry can still help these women. 

“Basically, we’re trying to bring mental health into the spaces where moms already are,” explained Calandrea Taylor, the program manager. “Because of the low workforce that we have in the state, it’s a lot to try to fill the state with mental health providers. But what we do is bring the mental health practice to you and where mothers are. And we’re hoping that that reduces stigma.”

Launched in 2023, the program has had a slow lift off, Taylor said. But the phone line is up and running, as the team continues to make additions to the program – including a website with resources that Taylor expects will go live next year. 

To fill the role of medical director, UMMC brought in a California-based reproductive psychiatrist, Dr. Emily Dossett. Dossett, who grew up in Mississippi and still has family in the state, says it has been rewarding to come full circle and serve her home state – which suffers a dearth of mental health providers and has no reproductive psychiatrists

“I love it. It’s really satisfying to take the experience I’ve been able to pull together over the past 20 years practicing medicine and then apply it to a place I love,” Dossett said. “I feel like I understand the people I work with, I relate to them, I like hearing where they’re from and being able to picture it … That piece of it has really been very much a joy.”

As medical director, Dossett is able to educate maternal health providers on mental health issues. But she’s also an affiliate professor at UMMC, which she says allows her to train up the next generation of psychiatrists on the importance of maternal and reproductive psychiatry – an often-overlooked aspect in the field. 

If people think of reproductive mental health at all, they likely think of postpartum depression, Dossett said. But reproductive psychiatry is far more encompassing than just the postpartum time period – and includes many more conditions than just depression. 

“Most reproductive psychiatrists work with pregnant and postpartum people, but there’s also work to be done around people who have issues connected to their menstrual cycle or perimenopause,” she explained. “… There’s depression, certainly. But we actually see more anxiety, which comes in lots of different forms – it can be panic disorder, general anxiety, OCD.”

Tackling mental health in this population doesn’t just improve people’s quality of life. It can be lifesaving – and has the potential to mitigate some of the state’s worst health metrics.

Mental health disorders are the leading cause of pregnancy-related death, which is defined by the Centers for Disease Control as any death up to a year postpartum that is caused by or worsened by pregnancy. 

In Mississippi, 80% of pregnancy-related deaths between 2016 and 2020 were deemed preventable, according to the latest Mississippi Maternal Mortality Report.

Mississippi is not alone in this, Dossett said. Historically, mental health has not been taken seriously in the western world, for a number of reasons – including stigma and a somewhat arbitrary division between mind and body, Dossett explained.

“You see commercials on TV of happy pregnant ladies. You see magazines of celebrities and their baby bumps, and everybody is super happy. And so, if you don’t feel that way, there’s this tremendous amount of shame … But another part of it is medicine and the way that our health system is set up, it’s just classically divided between physical and mental health.”

Dossett encourages women to tell their doctor about any challenges they’re facing – even if they seem normal.

“There are a lot of people who have significant symptoms, but they think it’s normal,” Dossett said. “They don’t know that there’s a difference between the sort of normal adjustment that people have after having a baby – and it is a huge adjustment – and symptoms that get in the way of their ability to connect or bond with the baby, or their ability to eat or sleep, or take care of their other children or eventually go to work.”

She also encourages health care providers to develop a basic understanding of mental health issues and to ask patients questions about their mood, thoughts and feelings. 

CHAMP4Moms is a resource Dossett hopes providers will take advantage of – but she also hopes they will shape and inform the program in its inaugural year. 

“We’re available, we’re open for calls, we’re open for feedback and suggestions, we’re open for collaboration,” she said. “We want this to be something that can hopefully really move the needle on perinatal mental health and substance use in the state – and I think it can.”

Providers can call the CHAMP main line at 601-984-2080 for resources and referral options throughout the state. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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On this day in 1997

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mississippitoday.org – Jerry Mitchell – 2024-12-22 07:00:00

Dec. 22, 1997

Myrlie Evers and Reena Evers-Everette cheer the jury verdict of Feb. 5, 1994, when Byron De La Beckwith was found guilty of the 1963 murder of Mississippi NAACP leader Medgar Evers. Credit: AP/Rogelio Solis

The Mississippi Supreme Court upheld the conviction of white supremacist Byron De La Beckwith for the 1963 murder of Medgar Evers. 

In the court’s 4–2 decision, Justice Mike Mills praised efforts “to squeeze justice out of the harm caused by a furtive explosion which erupted from dark bushes on a June night in Jackson, Mississippi.” 

He wrote that Beckwith’s constitutional right to a speedy trial had not been denied. His “complicity with the Sovereignty Commission’s involvement in the prior trials contributed to the delay.” 

The decision did more than ensure that Beckwith would stay behind bars. The conviction helped clear the way for other prosecutions of unpunished killings from the Civil Rights Era.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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