Mississippi’s state health officer says the Delta, with its declining population and slumping patient numbers, can no longer justify 20 hospitals, and the federal government has adopted insurance payment policies designed to pare them down.
“The federal government is no longer interested in paying 20 hospitals in the Delta to do what 10 hospitals could do,” says Dr. Daniel Edney.
“They’re not saying who we need and who we don’t need. They’re just making the reimbursement model such that not all 20 hospitals can possibly survive.”
On Tuesday, Edney joined the regular monthly meeting of the Greenwood Leflore Hospital Board to share his observations on the state’s hospital crisis. Also on hand were several Greenwood and Leflore County officials as they continue to work with the hospital board to try to avert the publicly owned hospital’s closing.
Edney, who became the state health officer in August, said he is focused on improving Mississippi’s grim health indicators, many of which are the worst in the nation.
A critical piece of that mission, he said, begins in the Delta, which is considered one of the state’s unhealthiest regions.
“Unless we’re able to start moving the needle in the Delta, we won’t move the needle much anywhere else,” said Edney, who grew up in Greenville and practiced internal medicine in Vicksburg for three decades before joining the state Department of Health.
The reduction of services at cash-strapped hospitals in the region, not to mention their potential closure, has the Department of Health looking at restarting services that it has not had to provide in 20 years, Edney said.
Among those would be prenatal and postnatal care for mothers, as well as the diagnosis and treatment of diabetes, which is rampant in the Delta.
“Half the diabetics in the Delta don’t know they have diabetes,” he said.
Officials at Greenwood Leflore Hospital, which is currently living on borrowed money, has said that it will not be able to stay open much longer without major changes in how rural hospitals are compensated for providing care to Medicare and Medicaid patients. Seventy-five percent of the patients at the Greenwood hospital are covered by one of these two government insurance programs.
Edney said he has been in talks with state leaders, in advance of the legislative session that begins in January, to discuss ways the state could address a crisis that has more than half of the rural hospitals in Mississippi in imminent danger of closing or downgrading services. He said so far no clear plan has been identified.
“I’ve heard what we’re not going to do. I’ve not heard what we’re going to do yet,” he said.
Gov. Tate Reeves and several other Republican leaders have not relented in their opposition to expanding Medicaid to cover those who make too much to qualify for existing Medicaid but too little to be able to afford private insurance. Although Edney remains a proponent of Medicaid expansion, he said that alone would not solve the hospital crisis, nor would it be of immediate help, since it might take a couple of years to get the expansion in place and the additional federal dollars, estimated at about $1 billion annually, flowing in.
Edney met in open session with the hospital board and then stayed for an hourlong closed-door session in which the hospital board met with county and city officials to further discuss the viability plan they have been putting together.
After that meeting ended, county officials said they were satisfied with the information provided by the hospital administration to go forward with their plan of providing $2.25 million to help offset the hospital’s ongoing losses. The city of Greenwood has pledged a matching amount. The county is planning to get its portion from its allocation of federal American Rescue Plan Act funds, while the city is tapping other sources.
In November, the hospital lost another nearly $2.2 million, as expense cuts were not able to fully offset revenue declines. Since May, the hospital has been cutting costs through layoffs and the curtailing of several services, but those changes have also further depressed patient volumes. Last month, total revenues were down about
$3.4 million, or 43%, from 2021, while expenses were down $2.6 million, or 26%. Unlike last year, however, the hospital did not have any COVID-related funding from the federal government to help offset its red ink.
Despite the negative profit margin, the hospital’s cash balance, which had been steadily falling, increased modestly in November to about $5.6 million. That’s because all of the state’s hospitals received their December and January Medicaid supplements in advance. The Greenwood hospital’s share came to about $1.5 million.
Edney said it is commonly misunderstood that COVID-19, given the hundreds of billons of dollars in assistance Washington sent to hospitals during the first two years of the pandemic, was good for those medical institutions. The opposite is the case, he said.
COVID-19 lowered patient numbers that have yet to recover while tremendously driving up costs, he said. Edney does not expect those higher costs to come down anytime soon.
That’s why a number of smaller hospitals in the state, according to Edney, are looking at seeking a new federal designation as a “rural emergency hospital,” which would entitle them to higher government reimbursements for the emergency and outpatient care they provide but get them out of the inpatient business.
Greenwood Leflore Hospital is pursuing a different designation as a “critical access hospital,” which would bring higher Medicare reimbursements but still allow it to staff a limited number of inpatient beds. The hospital is currently licensed for 208 beds, although it has not needed anywhere near that capacity in some time.
The hospital board on Tuesday voted to reduce its bed count to 25 for acute care and 10 for rehabilitation. These numbers fall within the maximums allowed for a critical access hospital, said Gary Marchand, the hospital’s interim CEO.
“We will have the ability to reopen beds if the need is ever justified in the future,” he said.
The Greenwood hospital would not be able to get that designation, however, without a waiver to the federal rule that says a critical access hospital cannot be within 35 miles of another hospital. There are at least three hospitals located less than 35 miles from Greenwood’s.
U.S. Rep. Bennie Thompson, whose district includes the Greenwood hospital, has said he would try to help it get that waiver. Edney said he has seen the federal government unwilling to relax the distance limit for a new hospital but he is hopeful it would for one, such as Greenwood’s, which has been in existence for more than a century.
“Greenwood Leflore should be a grandfathered facility,” Edney said. “You all shouldn’t be penalized because this is where you are.”
Leflore County District 2 Supervisor Reginald Moore said the current strategy is to ask the state Legislature to provide both short-term and long-term relief for the Greenwood hospital. He said the $4.5 million bailout provided by the city and county should keep the hospital solvent to June, and the Legislature will be asked to provide stop-gap funding to help it stay open through next October. By that point, it is hoped, changes at the state level on Medicaid funding could kick in as well as the “critical access” designation obtained at the federal level, which combined could help ensure the long-term viability of the hospital.
Moore said it will take a concerted, broadly based lobbying effort to make it all happen.
“We’re calling all hands on deck, because in January we will be making a trip to the Capitol to express our concerns, and we need everybody with us.”
- Contact Tim Kalich at 662-581-7243 or tkalich@gwcommonwealth.com.
