The rapidly changing health care environment has caused much consternation across our nation and especially here in the Natchez area.

I have to spend more time than I should just trying to keep up with what I will call the business side of health care.

The art and science of my profession remain a pleasurable challenge, but the business side, which now includes politics, frankly stinks. The next few years will see radical changes, though precise details are not readily predictable. Recently, a medical business pundit estimated that by 2020 one-third of all U.S. hospitals will close. Small group medical practices will all but disappear, being swallowed up by large groups controlled by hospital organizations or similar entities. We have to be ready to face these challenges.

Despite much unpredictability, there are a few things that I have learned lately that I feel are accurate assessments of recent and near term events.

First, our county hospital must be sold. There is zero doubt in my mind. Anyone who knows anything about hospital business today knows that small standalone full service acute care hospitals cannot make it any more (refer to the pundit’s 2020 prediction above).

The nearby hospitals that are often referenced as doing well and even building new facilities are “critical access hospitals,” which are reimbursed totally differently from our local hospitals. Could different management decisions have reduced the urgency of our current situation or delayed this sale to little later time? Perhaps.

But the end result would have been the same. So let’s go on with it. No more delays, appeals, hearings or, heaven forbid, petitions.

Should a county wide vote be called, as this newspaper has not so subtly suggested, cash flow issues might eventually force closure before the sale could be finalized, and then I understand the Adams County taxpayers would likely be on the hook for the bond payoffs as CHS might not find it a worthy asset given the regulatory hurdles to getting the facility reopened once it is closed.

Secondly, I have learned there are plenty of “experts” in health care. Experts are of course defined one of two ways: A person from out of town with a nice briefcase, or a person who knows more and more about less and less until he/she knows everything about nothing (the latter is the kind you typically get when you call the help desk at my IT company or Medicare). They are expensive.

Unfortunately, we have needed many experts to try to help us deal with local issues.

That is because health care business has gotten so complex that a solo administrator and his/her loyal assistant with a director of nurses (now properly called a chief nursing officer) by themselves can no longer run the business.

This is why an organization like CHS is a great fit for this community. CHS bought the entire HMA system in a multimillion-dollar deal earlier this year and has agreed to buy Natchez Regional Medical Center.

This is a strong organization with the business know-how to run a great hospital, and I am excited about the future of our hospital services with CHS on the scene. Clearly they see great potential here. They will be a great asset to our community as they become a vital part of the infrastructure that any community, which expects to remain attractive needs.

Thirdly, the Board of Trustees at NRMC are citizens of our community and have had no desire to see the hospital fail. They were appointed by the county supervisors as stipulated by the state legislature. They get no significant pay for their efforts, which have been monumental this past year. If anyone could do a better job, please step forward. I’ve heard a lot of complaining, but no offers to take their places.

Luckily, those that thought the trustees should have cut nurses’ pay 10 percent to 20 percent a year ago weren’t on the board. That could would have led to such nursing shortages that more “agency nurses” that rotate through from out of town would have been required costing much more and leading to even quicker financial distress. The current dedicated staff understands the expected short-term reduction will help this entire community weather the storm until the sale is complete. Further delays may change their benevolent attitudes.

And lastly, to clarify some apparent misunderstandings, NRMC does not own any part of the office building next door. I, along with four other doctors, own the vast majority with our building developer and manager owning a small percentage.

We lease space to the other groups including NRMC for some of their employed physicians. We are also an unsecured creditor. We pay county property taxes yearly of about $100,000.

Ask me if I’m happy about all of this, and I can assure you that only the arrival of CHS and my chance to serve as a physician keeps me excited about our future in health care.

 

Kenneth W. Stubbs, M.D.

Natchez resident