Mississippi Today

Mississippi has more rural emergency hospitals than any other state. Can the ‘lifeline’ program save rural health care?

Published

3 months ago

August 7, 2024

Staff Editor

mississippitoday.org – Gwen Dilworth – 2024-08-07 06:00:00

Mississippi has more rural emergency hospitals than any other state – and there could be two more on the way soon.

Some have hailed the federal designation, created in 2023, as a lifeline for struggling rural hospitals at risk of closure. Others say it forces hospitals between a rock and a hard place.

Rural emergency hospitals provide 24-hour emergency and observation services, and can also opt to provide additional outpatient services. But the program comes with a catch.

Hospitals must close their inpatient units and transfer patients requiring stays over 24 hours to a nearby facility. In return, hospitals receive $3.3 million from the federal government each year.

Rural emergency hospitals in Mississippi currently include Jefferson County Hospital in Fayette, Progressive Health of Batesville, Perry County General Hospital in Richton, Sharkey Issaquena Community Hospital in Rolling Fork and George County Hospital in Leakesville.

Progressive Health of Houston and Smith County Rural Emergency Hospital in Raleigh, a new department of Covington County Hospital established in collaboration with South Central Regional Medical Center, also intend to apply for the status.

Patient’s Choice Medical Center of Smith County in Raleigh has sat empty after voluntarily terminating its Medicare certification on July 3, 2023. Credit: Pam Dankins/Mississippi Today

Nationwide, 29 hospitals have received the designation, according to Centers for Medicare & Medicaid Services enrollment data. Over half of them are located in the Southeast.

State Health Officer Dr. Daniel Edney last year likened conversion to a rural emergency hospital to a closure because of the corresponding loss of medical services.

Quentin Whitwell, the founder and CEO of Progressive Health Group, said that in his experience, the designation has provided increased sustainability and financial viability for hospitals that have adopted it.

Progressive Health Group owns and manages six hospitals in Mississippi, Georgia and Arkansas, over half of which are rural emergency hospitals or plan to seek the designation. The organization previously served as a consultant for Jefferson County Hospital.

“A lot of people saw it as a place where hospitals would go to die. We, on the other hand, saw an opportunity for expanding ancillary and outpatient services and utilizing the federal subsidy to grow those hospitals,” he said.

He said the model has strengthened access in some areas to outpatient services like general surgery, gastrointestinal and primary care and specialty doctors.

Inpatient services are “the drag on small rural hospitals,” he said.

In Mississippi, 37% of hospitals are facing immediate risk of closure, according to a recent report. 52% face some risk of closure and 64% have experienced losses on services.

Nearly 200 hospitals have closed nationwide since 2005. Many of these hospitals had low patient volumes and revenues that were insufficient to cover their costs, said George Pink, deputy director of the Rural Health Research Program at the University of North Carolina.

The rural emergency hospital was designed to offset the financial challenges of running an inpatient unit, which is costly because it requires 24-hour-a-day nursing care, along with administrative and dietary departments, regardless of patient volume, he said.

“They’re not a model of health care for every rural community, they’re not a panacea for rural communities. They really are targeted at very small communities that are at risk of losing their inpatient hospitals,” he said.

Sharkey Issaquena Community Hospital converted to a rural emergency hospital after a tornado destroyed the hospital in March 2023. Board Attorney Charles Weissinger said the program made sense given the hospital’s circumstances, but noted that “it’s not the salvation for rural medicine.”

Pink said that among communities that have experienced hospital closures, emergency services are considered one of the most significant losses.

Quentin Whitwell Credit: Submitted/Quentin Whitwell

Progressive Health of Houston intends to apply for rural emergency hospital status to meet that need. The hospital reopened its emergency department in May after a decade without emergency services in Chickasaw County. Whitwell said that last December and January alone, the county saw 10 cardiac deaths out of a population of 17,000.

Without the ability to provide inpatient services, hospitals may have to give up valuable services, like an intensive care unit or obstetric services.

Though rural hospitals are allowed to provide obstetric services, “it’s not realistic for the reimbursement model,” said Whitwell.

Irwin County Hospital in Ocilla, Georgia, a Progressive Health Group facility, continued providing obstetric services after becoming a rural emergency hospital, but was forced to close the unit after just four months.

David Culpepper, spokesperson for Smith County Rural Emergency Hospital, said the new facility will provide emergency care to the area for the first time in two decades. This is possible by eliminating the cost of inpatient care, he said.

The hospital will offer “strictly emergency services with a full-on suite of imaging … and radiological services along with a fully functioning lab,” said Culpepper.

It will be located at the former Patient’s Choice Medical Center of Smith County, which closed in 2023.

Pink, who studies health care finance and rural hospitals at the University of North Carolina, said because the rural emergency hospital program is just over a year old, it’s too soon to say whether the designation helps hospitals surmount their financial challenges.

Several changes to the law could make the program more appealing to struggling hospitals, he said, like allowing facilities to participate in the 340B Drug Pricing Program, which requires pharmaceutical companies to provide outpatient drugs to certain hospitals at reduced prices.

Whitwell said he would like to see the program allow hospitals to operate inpatient psychiatric units and to shore up its definition of “rural.”

Republican Rep. John Lancaster of Houston proposed a bill this year to allow rural emergency hospitals to license psychiatric inpatient beds as a separate entity as a workaround to the federal regulations. The legislation did not make it out of committee.

Less than a year after Alliance HealthCare System in Holly Springs received rural emergency hospital status, the Centers for Medicare and Medicaid Services rescinded the designation, arguing that the hospital is too close to Memphis to be deemed rural.

As a result, the hospital closed its emergency room in April and began the process of becoming relicensed as an acute care hospital.

Harold Miller, the director of the Center for Healthcare Quality and Payment Reform, said the rural emergency hospital program poses a “problematic choice” for hospitals by forcing them to eliminate inpatient services in order to receive subsidies from the federal government.

“There is this narrow, narrow window in which a hospital actually could benefit, and then an even smaller window of the hospitals that could benefit that are willing to do what is necessary in terms of closing services to be able to qualify,” he said.

He said his research shows that hospital closures would be better prevented by ensuring that insurers pay hospitals adequately for their services. Because rural hospitals often have limited administrative resources, they are often not able to combat claims that are contested by insurance companies, he said.

“We need to be fixing that,” he said. “…We are letting the private insurers off the hook.”

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

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Mississippi Today

New health care coalition forms, including hospitals that left state hospital association

Published

6 hours ago

November 5, 2024

Staff Editor

mississippitoday.org – Gwen Dilworth – 2024-11-05 12:46:00

A new health care alliance will unite several of Mississippi’s largest hospital systems – all of which left the state hospital association following controversy over Medicaid expansion – under the umbrella of one of the state‘s largest and most influential lobbying firms.

The new group will be helmed by former Mississippi Medicaid Director Drew Snyder, who served under two Republican governors who thwarted Medicaid expansion and the flow of billions of federal dollars to provide health insurance to low-income Mississippians for over a decade.

The new collaborative will focus on “providing sustainable solutions to challenges facing access to care,” said a press release. It will include representatives from the state’s leading acute and trauma care hospitals, rural hospitals, mental health providers and primary care providers.

Critics, along with the Mississippi Hospital Association, say the new group’s formation is motivated by partisan politics.

A slew of hospitals left the hospital association after the organization’s political action committee made its largest-ever contribution to Democratic gubernatorial candidate Brandon Presley, a strong supporter of Medicaid expansion, in 2023. All but one have joined the new collaborative.

This means lawmakers in 2025 will hear from two separate groups of hospitals and health care organizations, raising questions about whether their overall impact will be diluted without a unified voice.

Gov. Tate Reeves announces his plans for a series of Medicaid reimbursement reforms during a press conference at the Walter Sillers Building in Jackson, Miss., on Thursday, Sept. 21, 2023. Credit: Eric Shelton/Mississippi Today

Snyder, who declined repeated requests for comment for this story, will lead the Mississippi Healthcare Collaborative under the umbrella of multi-state, Jackson-based lobbying firm Capitol Resources and its new health policy consulting division, Health Resources.

Capitol Resources is a strong supporter of Republican Gov. Tate Reeves. The firm’s political action committee has contributed nearly $75,000 to Reeves since 2018.

Five of Capitol Resources’ scores of Mississippi clients hold multi-million dollar contracts with the Division of Medicaid.

A query to the Mississippi Ethics Commission published just days before Snyder announced his resignation from the Division of Medicaid sought an opinion on how a former head of an agency could work for a lobbying firm with clients in the same field as his or her public service without violating state law. Requests for opinions are anonymous.

The Ethics Commission ruled that the public official could not work for compensation on matters “which he or she was directly or personally involved while working for the government,” but would not be forbidden from working for a company that does.

A national ethics expert told Mississippi Today that when public officials transition to private sector work, particularly in the same field as their public service, it can raise ethical issues.

The knowledge and information public officials hold can be used as a “leg up,” which leads to unfairness in private companies’ and lobbying organizations’ business dealings with government entities, said professor John Pelissero, the director of Government Ethics at the Markkula Center for Applied Ethics at Santa Clara University.

Capitol Resources has for years represented Centene, a company that currently holds $5.2 billion worth of contracts for managing Medicaid beneficiaries care through its subsidiary Magnolia Health. The company has paid the lobbying firm $3.9 million over the last decade, according to the Secretary of State’s website.

Tim Moore, the former head of the Mississippi Hospital Association, said he has concerns about the conflict posed by a lobbying firm representing two health care organizations with competing interests.

“How do you represent a managed care company and a bunch of hospitals at the same time?” he said.

Moore was ousted by the Mississippi Hospital Association’s Board of Governors following hospitals’ withdrawal from the organization.

Clare Hester, the founder and managing partner of Capitol Resources, did not respond to a request for comment by press time.

The evolution of the Mississippi Hospital Association

The Mississippi Hospital Association was for many years one of the most powerful lobbies at the Capitol. But that began to change with the passage of the federal Affordable Care Act, which created a partisan rift over whether or not the state should expand Medicaid.

The trade association splintered in May 2023, starting with the departure of the state’s largest hospital system, University of Mississippi Medical Center, in May. Four additional hospitals, all led by Gregg Gibbes, left the association in 2024.

Hospital leaders at the time declined to say what precipitated their decision to leave, other than to cite concerns about the hospital association’s leadership. But the exodus was widely interpreted as a rebuke of the association’s support for Presley and, specifically, Medicaid expansion.

Research has shown that Medicaid expansion would provide millions of dollars to Mississippi’s struggling hospital system.

As Reeves faced an uphill reelection bid, due in part to his opponent’s support of Medicaid expansion and his adamant opposition, he worked with Snyder to create a new program to provide supplemental payments to hospitals to offset low Medicaid payments. While the program did not directly support low-income Mississippians, it was estimated to generate $700 million for the state’s largest hospitals.

Republican House leaders pushing for Medicaid expansion in the last legislative session said the program prevented some large hospitals from being strong advocates for expansion, in part due to fear that Gov. Reeves would punish such a move by doing away with the expanded payments.

The Mississippi Hospital Association has 76 current hospital members, according to its online directory. Some are members of hospital systems.

Richard Roberson, CEO of the Mississippi Hospital Association. Credit: Jerry Mitchell/MCIR

“The Mississippi Hospital Association will continue to be the trusted voice in health care and to offer education and quality advocacy solutions based on sound health care policy – and not politics – as we have successfully done for almost 100 years,” president and CEO Richard Roberson told Mississippi Today. Roberson is the former head of TrueCare, a provider-led, nonprofit managed care organization that contracts with Medicaid.

Kent Nicaud, one of Reeves’ top campaign donors and the president and CEO of Memorial Hospital, will serve as chair of the collaborative’s board. Memorial Health System left the hospital association in 2023, and is a current client of Capitol Resources.

Moore said having two major health care trade associations in the state will “create division among the industry, which is not good.”

“…The best thing for all hospitals is to be united in one voice, because they have similar issues, whether they’re a small hospital or a large hospital,” he said.

Along with hospitals that left the association, Mississippi Healthcare Collaborative incorporates several existing Capitol Resources clients, including the state’s 21 Federally Qualified Community Health Centers, and Universal Health Services, a company with five behavioral health centers in Mississippi.

“For too long, too many health providers have been siloed in our advocacy. It’s time to sit down at the same table and work together,” said Terrence Shirley, CEO of the Community Health Center Association of Mississippi, which represents the Federally Qualified Community Health Centers, in a press release.

Other members of the new group include Methodist Rehabilitation Center and Northwest Regional Medical Center in Clarksdale.

The group’s members are based in 78 of Mississippi’s 82 counties.

Ochsner Medical Center, which left the Mississippi Hospital Association last year and is a client of Capitol Resources, is not listed as a member of the new collaborative. Ochsner did not respond to Mississippi Today by the time of publication.

Geoff Pender contributed reporting.

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

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Mississippi Today

On this day in 1926

Published

13 hours ago

November 5, 2024

Staff Editor

mississippitoday.org – Debbie Skipper – 2024-11-05 07:00:00

Nov. 5, 1926

Victoria Gray Adams, Freedom Summer, 1964, Herbert Randall Freedom Summer Photographs. Credit: University of Southern Mississippi

Victoria Gray Adams, one of the founding members of the Mississippi Freedom Democratic Party, was born near Hattiesburg, Mississippi.

“(There are) those who are in the Movement and those who have the Movement in them,” she said. “The Movement is in me, and I know it always will be.”

In 1961, this door-to-door cosmetics saleswoman convinced her preacher to open their church to the Student Nonviolent Coordinating Committee, which began pushing for voter registration. A year later, she became a field secretary for SNCC and led a boycott of businesses in Hattiesburg, later helping found the umbrella group, the Council of Federated Organization, for all the civil rights groups working in Mississippi.

In 1964, she and other civil rights leaders fought the Jim Crow laws and practices that kept Black Mississippians from voting, marching to the courthouse in the chilly rain to protest. By the end of the day, nearly 150 had made their way to register to vote.

Adams became the first known woman in Mississippi to run for the U.S. Senate, unsuccessfully challenging longtime Sen. John Stennis. She also helped found the Mississippi Freedom Democratic Party. It was time, she said, to pay attention to Black Mississippians, “who had not even had the leavings from the American political table.”

In August 1964, she joined party members in challenging Mississippi’s all-white delegation to the Democratic National Convention.

“We really were the true Democratic Party,” she recalled in a 2004 interview. “We accomplished the removal of the wall, the curtain of fear in Mississippi for African-Americans demanding their rights.”

Four years later, the party that once barred her now welcomed her.

She continued her activism and later talked of that success: “We eliminated the isolation of the African-Americans from the political process. I believe that Mississippi now has the highest number of African-American elected officials in the nation. We laid the groundwork for that.”

In 2006, she died of cancer.

“When I met … that community of youthful civil rights activists, I realized that this was exactly what I’d been looking for all of my conscious existence,” she said. “It was like coming home.”

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Vote today: Mississippi voters head to the polls. Here’s what you need to know

Published

14 hours ago

November 5, 2024

Staff Editor

mississippitoday.org – Geoff Pender – 2024-11-05 03:00:00

Polls in Mississippi will be open from 7 a.m. to 7 p.m. today as voters make their picks for presidential, congressional, state judicial and some local races.

Voters are reminded to bring a photo identification. This can include a valid Mississippi driver’s license, an identification or employee identification card issued by any government entity of the U.S. or state of Mississippi, a U.S. passport, a military photo ID card, a current student ID card issued by an accredited college or university or a Mississippi voter ID card. For more information on voter ID rules, check here.

Those who do not have a valid ID can vote affidavit, but must return and present a photo ID within five days for their ballot to count. Voters waiting in line as polls close at 7 p.m. will still be allowed to vote. If you vote absentee or affidavit, you can track the status of your ballot here.

POLLING PLACE LOCATOR: Use the secretary of state’s online locator to find where you vote

Stay tuned to Mississippi Today for live results, starting after polls close.

LISTEN: Podcast: Mississippi’s top election official discusses Tuesday’s election

The Mississippi secretary of state’s office offers an online resource, My Election Day, where voters can locate or confirm their polling place, view sample ballots and view current office holders. Those with doubts or questions about their precinct locations are urged to contact their local election officials. Contact info for local election officials is also provided on the My Election Day site.

The secretary of state’s office, U.S. attorney’s office and the state Democratic and Republican parties will have observers across the state monitoring elections and responding to complaints.

The secretary of state’s elections division can be contacted at 1-800-829-6786 or ElectionsAnswers@sos.ms.gov.

The U.S. attorney’s office investigates election fraud, intimidation or voting rights issues and can be contacted at 601-973-2826 or 601-973-2855, or complaints can be filed directly with the Department of Justice Civil Rights division at civilrights.justice.gov. Local law enforcement holds primary jurisdiction and serves as a first responder for alleged crimes or emergencies at voting precincts.

The secretary of state’s office also provides some Election Day law reminders:

It is unlawful to campaign for any candidate within 150 feet from any entrance to a polling place, unless on private property.

The polling places should be clear of people for 30 feet from every entrance except for election officials, voters waiting to vote or authorized poll watchers.