McKenzie Selected to Lead OCH Regional Wound Healing & Hyperbaric Center

OCH Regional Wound Healing & Hyperbaric Center welcomes Brad McKenzie as the Center’s new program director.

In this position, McKenzie is responsible for overseeing the clinic’s day-to-day operations such as quality management, reimbursement, performance improvement, and community education

“I’m proud to be a part of a team of true professionals who treat our patients with love and kindness,” said McKenzie. “I’ve been able to visit other wound care centers throughout the state of Mississippi, and I can say unequivocally that our Wound Healing and Hyperbaric Center is the nicest facility in the state. As the only one of its kind in the Golden Triangle, the Center provides a unique service to those in need of this specialized care.”

McKenzie said he feels right at home at OCH. Not only was the Starkville native born at OCH, but he also spent much of his time at the Medical Center in his former position as a senior sales consultant with Johnson & Johnson. A 2001 graduate of Mississippi State University, McKenzie holds a bachelor of science in business and a minor in marketing. He and his wife, Nicole, have two sons, Luke, 10 and Landon, 6.

The Center, which is recognized as a Center of Distinction, is a member of the Healogics network with access to benchmarking data and proven experience treating approximately 2.5 million chronic wounds. Located inside OCH Regional Medical Center, the Center offers highly specialized wound care to patients suffering from diabetic ulcers, pressure ulcers, infections and other chronic wounds which have not healed in a reasonable amount of time. Some of the leading-edge treatments offered at the Center include negative pressure wound therapy, debridement, application of cellular-based tissue or skin substitutes to the wound, offloading or total contact casts and hyperbaric oxygen therapy.

Patients do not need a referral from a physician to make an appointment. For more information about the Center, click here.

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OCH Administrator/CEO Letter to the Editor

Dear Editor:

My purpose in writing this letter is to correct any misleading information, misstatements or implications of wrongdoing by OCH. The following documentation is in response to Supervisor Miller’s recent Letter to the Editor, as well as posts to her Supervisor Facebook page.

Related to Letter to Editor 9/24/17:

Not Fact: Supervisor Miller by referencing Singing River Hospital System appears to be implying that OCH’s retirement situation is like Singing River, casting public doubt on the stability of OCH’s retirement plan.

Fact: OCH has a “defined contribution plan” which is not the same as a “defined benefit or pension plan” with guaranteed retirement benefits. This means contributions, voluntary and employer, are transferred monthly to employees’ personal retirement accounts with VALIC for them to manage.

Not Fact: Supervisor Miller by referencing Singing River Hospital System appears to be implying that OCH has two sets of books, sweetheart contracts, and has not been transparent with its records.

Fact: OCH does not have two sets of books. OCH has never had and does not have any sweetheart contracts with family and friends of trustees and hospital administration. OCH has always complied with the public record access requirements.      

Not Fact: Supervisor Miller stated, “…I did notice very little money was spent on capital improvements”.

Fact: OCH annual capital expenditures:

  • $3.2 Million FY 2017 (11 Months)
  • $5.3 Million FY 2016
  • $2.6 Million FY 2015
  • $2.0 Million FY 2014
  • $2.7 Million FY 2013
  • $5.5 Million FY 2012

Supervisor Miller seems to think that $1,609,560 is a large amount money for annual debt service on the GO 2009 & 2010 bonds.  OCH annual capital expenditures since FY 2012 have been greater than the 2017-18 annual GO bond debt service payments.

Not Fact: Supervisor Miller stated that Ted Woodrell is now being contacted for help from many hospitals and counties in our state.

Fact: An email response from Mississippi Hospital Association on September 29, 2017, stated, “To date (September 29th) Surveys conducted by MHA have not identified other member hospitals utilizing the services of Mr. Woodrell.”

Not Fact: Supervisor Miller cited from the Stroudwater report, “In our market area, since 2011, OCH has seen a 7.5% decrease, Baptist a 5.7% increase, NMMC a 2.1% increase and all others a 4.5% increase.”

Fact: I could not find these percentages anywhere in the report. Stroudwater only had market data for 2013, 2014 & 2015, as data for 2011 & 2012 was not available. Therefore, I am uncertain how Supervisor Miller obtained these percentages.

Not Fact: Supervisor Miller stated, “…$21 million ‘reserve’ is not truly all ‘liquid assets’.  A large portion of those funds are already allocated or tied to guarantees on bonds, etc.”

Fact: OCH is not required to use the $21 million as a bond guarantee. OCH is only required to pledge its ongoing operational revenues toward bond service payments. The total funds at July 31, 2017, of $21 million are either liquid or can be unrestricted for liquidity purposes without penalty at any time.

Bricklee Miller Oktibbeha County District 4 Facebook Page:

Not Fact: 9/20/17 In reference to the due diligence requests for the hospital bidders, Supervisor Miller stated “201 items requested, 70 not answered or the information so redacted that it was unusable.”

Fact: As of September 14, OCH uploaded 214 (95.5%) of 224 items requested and released partial information of 4 (1.8%) items on the Due Diligence Checklist Summary.

OCH submitted information based upon direction and communication provided by both Butler Snow Attorneys and Ted Woodrell, which included modifying the extent of the line item requests.  They said additional information most likely would be requested if the submitted information was insufficient.

OCH redacted information that was mostly related to protected health information under HIPAA on patients and employees.

On August 29, OCH received a listing of 20 questions from the bidders for additional information.  Responses to these questions were submitted on August 31.  To this date OCH has not been formally notified of 70 items that were not answered.

Not Fact: 9/28/17 Supervisor Miller posted Comparative Income Statements for 10 Months of operation at FY 2017, which is not accurate and generally accepted accounting principles (GAAP) were not followed.

10/04/17 “…this projected 6 million dollar loss.”

Fact: The correct loss was $5,066,421. The bottom line loss for FY 2017 10 Months was reported as $5,836,599 and is overstated by $770,178.

Not Fact: 9/24/17 “That is not true of the 21 million…money is allocated and cannot be used.  I will supply the breakdown soon for you.”

10/04/17 “Do you realize the 21 is not usable liquid cash? Much is tied to obligations.”

Fact: Of the total funds at July 31, 2017, $17 million of $21 million is usable upon discretion of the Board of Trustees at any time. These funds are either liquid or can be un-restricted for liquidity purposes without penalty. The $4 million is required for self-insuring professional and general liability claims.

Not Fact: 10/04/17 “Consistency is a basic tenant of accounting.  Mixing accrual and cash accounting is a confusing practice and should be avoided.”

Fact: OCH does not mix accrual and cash accounting.  Cash accounting would in no way accurately reflect the financial position of any hospital in the United States. Depreciation and amortization expenditures are not cash disbursements on our income statement.

Not Fact: 10/04/17 “Expenses to acquire or IMPROVE a business asset that will last longer than a year are not deductible as business expenses, useful life, expensing election, repairs, improvements.”

Fact: Capital acquisitions and capital leases with useful life longer than 1 year are depreciated over the useful life of the equipment or leases using straight-line depreciation as adopted by the Board of Trustees. This means depreciation and amortization are recognized each year as noncash disbursements.

Not Fact: 10/07/17 “I was contacted by numerous concerned employees that were made to attend meetings at OCH. This [picture of newspaper articles] is part of the information being distributed.”

Fact: I responded directly to her post stating these materials were not distributed to employees. Employees attended mandatory educational sessions about what can and cannot be done on the clock in regards to the referendum. The educational PowerPoint was presented to employees and to the Board of Trustees. The pictures of articles that she posted were the same articles that were NOT distributed to our employees but to our Board of Trustees.

Not Fact: 10/17/17 “…you the taxpayers hold the debt. You pay $24 million per week in taxes to support  . Absolutely, as your supervisor I have the facts and support protecting all the taxpayers in district 4.”

Fact: For FY 2017/2018 the Board of Supervisors has assessed $1,609,560 for bond payments, which is $30,953/week, not $24 million. The BOS has assessed $200,000 for EMS services, which is $3,846/week. This totals $34,799/week, NOT $24 million.

As documented above, whether intentionally or unintentionally, Supervisor Miller has misled the public on numerous issues on many occasions. I encourage the public to fact check all information.

Richard G. Hilton, FACHE

OCH Regional Medical Center

Administrator/CEO

OCH Response to GSDP Questions

  1. What is your plan for enhancing healthcare in Starkville going forward?

OCH:  OCH completed the 2016 Community Health Needs Assessment (CHNA) Report. This process involved targeting 81 key participants from the OCH service area and statewide for the community advisory committee. Of these, 54 participated in answering the survey questionnaire regarding community health needs. Committee members prioritized the community health issues that needed to be addressed. The primary health concerns were identified as follows:

  • Adult Obesity
  • Child and Adolescent Obesity
  • Hypertension
  • Physical Inactivity
  • Diabetes
  • Heart Disease
  • Stroke
  • Behavioral/Mental Health
  • Elder Care
  • Access to Affordable Insurance
  • Access to Primary Care Providers
  • Access to Preventive Care and Screenings

After completing the CHNA Report, the steering committee completed the 2016 CHNA Implementation Plan to address the above items. To review the Report and Implementation Plan, visit och.org.

OCH will use the CHNA Report and Implementation Plan process every three years to ensure that the most current community health needs are being identified. This is just one of many efforts the hospital is making to ensure healthcare services continue to grow to meet the community’s needs. Strategic planning is obviously the cornerstone of our efforts for the future. To address more of the community’s immediate concern, see question 7.

  1. When does a “Certificate of Need” come in to play and does it affect all hospital services or just selected areas?

OCH:  Health care providers are required to receive “certificate of need” before expanding services in selected areas.  According to the Mississippi State Board of Health Certificate of Need (CON) manual, “The intention of health planning and health regulatory activities is to prevent unnecessary duplication of health resources; provide cost containment, improve the health of Mississippi residents; and increase the accessibility, acceptability, continuity and quality of health services. The regulatory mechanism to achieve these results is the Certificate of Need (CON).”

“A CON must be obtained from the Department before undertaking any of the activities described in Section 41-7-191 (1) without obtaining a Certificate of Need (CON) from the Department. No final arrangement or commitment for financing such activity may be made by any person unless a CON for such arrangement or commitment has been issued by the Department. The Department will only issue a CON for new institutional health services and other proposals which are determined to be needed pursuant to statutory requirements. Only those proposals granted a CON may be developed or offered within the State of Mississippi.”

“No CON shall be issued unless the action proposed in the application for such Certificate has been reviewed for consistency with the specifications and criteria established by the Department and substantially complies with the projection of need as reported in the State Health Plan which is in effect at the time the application is received by the Department.”

The State Board of Health requires health care providers to receive a certificate of need to provide the following services:

  • Acute Hospital Beds*
  • Ambulatory Surgical Services*
  • Cardiac Catheterization Services
  • Comprehensive Inpatient Rehabilitation Services
  • Diagnostic Imaging Services of an Invasive Nature, i.e Invasive Digital Angiography
  • Home Health Services
  • Intermediate Care Facilities for Individuals with Disability
  • Licensed Chemical Dependency Services
  • Licensed Psychiatric Services
  • Long-Term Care Hospital Services
  • Magnetic Resonance Imaging (MRI) Services*
  • Mobile Medical Imaging
  • Nursing Home Beds/Long-Term Care Beds
  1. Skilled Nursing Facility
  2. Intermediate Care Facility
  3. Intermediate Care Facility for Mentally Retarded
  • Open-Heart Surgery Services
  • Positron Emission Tomography Services
  • Radiation Therapy Services
  • Renal Failure/Dialysis
  • Swing Bed Services*

*OCH has this service.

  1. What do you see as the future outlook for local healthcare in relation to national trends of merging healthcare entities?

OCH:  The destiny of all hospitals, no matter whether local or not, is directly impacted by federal and state policies.  The financial payor mix of hospitals can have a financial impact, especially those hospitals with high Medicare and Medicaid participation.  Some local hospitals may desire the opportunity to seek a merger with a larger system.  On the other side, larger systems may actually prefer to offer affiliation arrangements that do not involve a buyout or long term lease with option to buy.

Supervisor Miller made a reference to the summit she attended on April 11, 2016, hosted by Governor Phil Bryant, and stated, “The hand out materials were filled with a great deal of factual data, including a forecast that 90% of hospitals would merge in the next two years and why.”  OCH Administrator/CEO Richard Hilton agrees there have been some mergers since April 2016, but it looks like the consultant projections are not going to reach the 90% in the two year timeline projection.  Since the summit some of the major for-profit hospital systems have started divesting ownership of solo hospitals as listed below:

  • Hospital Corporation of America
  • Community Health System
  • Quorum
  • Tenet Healthcare

Another factor affecting hospital acquisitions/mergers are location of hospitals in Medicaid expansion vs non-expansion states.  Non-expansion states since the passage of Obama Care receive an average of 17.2% lower reimbursement.  Mississippi is one of the 19 non-expansion states.  With past and current efforts to repeal Obama Care, there have been no discussions of scaling back the 17.2% higher reimbursement for the Medicaid expansion states or raising by 17.2% reimbursement to the non-expansion states.  Larger systems will be looking critically at hospitals with a higher Medicaid payor mix in the non-expansion states before merger consideration.

History has shown that once a hospital is sold, there is a tendency for those hospitals to be sold time and time again. At least three hospitals within 100 miles of OCH have been sold more than one time.

  1. What are the advantages of keeping our hospital local?

 

OCH:  Final decisions for healthcare are made here in Oktibbeha County, and maintaining local ownership and control will assure that the needs of our community and the population served are being met. OCH’s culture is community-oriented while providing quality care. The Medical Staff will continue to have direct access to OCH Board of Trustees and Administration for input regarding patient care management and other areas of concern.

OCH is Oktibbeha County’s second largest employer. Keeping the hospital local will give employees comfort knowing that every effort will be made for keeping jobs. Historically, mergers have resulted in loss of jobs within 1 to 2 years, of a sale. Loss of jobs to corporate central locations usually result from economy of scale goals. Sometimes, layoffs are avoided by reducing employees’ hours or giving employees the option of relocating to one of their other hospitals.

Currently, OCH has an annual economic impact of $127 million, according to the Kaiser Foundation, and spends approximately $7 million locally each year on goods and services.  Over the past 10 years, OCH has had a progressive annual increase in its economic impact and can look forward to continuing this increase.

  1. When would it make sense to sell or partner with a larger hospital group?

 

OCH:  Selling implies one approach.  Partnering implies either a sell or perhaps another type of alignment strategy.

Selling should be done before an entity is in a bankruptcy position. If the Board of Trustees, Administration and Medical Staff felt that it was in the best interest of OCH to sell, then a joint recommendation would be forthcoming to the Board of Supervisors for following the statutory process.

Partnering can come by a sell or through a less abrupt way of giving up local control and management.  Affiliation is a partnering option for smaller hospitals to align with a larger hospital or system.  This approach could take place at any time when the Board of Trustees and Medical Staff feels that it would be advantageous. Affiliation can provide the benefits of sharing resources while avoiding the pitfalls of mergers.

H&HN Daily, April 15, 2014, reported, “The Future of the Merger Model.  The shift to network models may reflect a growing recognition that mergers often fail to deliver their promised benefits.  The rationales for mergers are frequently spurious and the obstacles understated.  Chief among the benefits touted is the promise of economies of scale.  Economies of scale derive from a fall in unit costs as volumes grow.  But such efficiencies are invariably proximity-based.  In other words, production, be it of a tangible product or an intangible service, must be concentrated in locations that are sufficiently proximate to one another for the economies to take effect.”  The closer the entities are makes it more possible for economy of scale to be beneficial.

Affiliation allows an opportunity for both the local community hospital and larger hospital/system to test the cooperative arrangement.  The advantage here will allow both entities to measure the short term results as a benchmark for projecting potentially the longer term results before making a final merger decision.   A final merger decision should be one where all major stakeholders are in agreement that a merger is the best decision to make.

  1. How does OCH plan on addressing the income shortfall of this past year and insure long-term financial stability?

OCH:  Supervisor Miller and Consultant Woodrell want the public to believe that OCH has not experienced revenue growth.

Fiscal Year Audited (Million)             Unaudited

2011    2012    2013    2014    2015    2016        2017

IP Revenue      48.8    49.3    47.2    44.8    52.0    48.8         46.7

OP Revenue     103.6   114.8     124.8    136.1    144.5    145.7        157.6

Total Pat Rev  152.4   164.1     172.0   180.9     196.5    194.5        204.2

Deductions         94.1    103.9     110.9   116.6     125.6    125.5        137.5

Net Pat Rev      58.3      60.2       61.1     64.3       70.9      69.0          66.7

OCH has experienced annual increase in Total Patient Revenues.  Insurance payors have continued shifting coverage to outpatient care while reducing insurance payments which has caused an increase in deductions, impacting the bottom line.  Hospitals throughout the state and the country are currently experiencing what OCH has with variable impact on their bottom line.

OCH has already initiated efforts with department managers and supervisors to:

  • Look at ways to reduce service line costs through better inventory control.
  • Evaluate new services that could be added that would positively impact our bottom line.
  • Review reimbursement for highest volume procedures.
  • Complete a cost versus reimbursement analysis for highest volume/highest cost procedures.
  • Evaluate particular services that can be accomplished with less resources through attrition.

Cost reductions have already been implemented in the new fiscal year related to the following areas:

  • Contracted services such as billing and waste disposal
  • Reprocessed sterile supplies
  • Travel related to continuing education

These are short term initiatives with longer term results to come through the question below on OCH’s plan to expand healthcare in Oktibbeha County.

  1. What plans exist for OCH to expand healthcare in Oktibbeha County?

OCH:  The key to the future success is physician recruitment and retention.  The first step is to get past the November 7th referendum and show potential physician recruits that sale/lease of OCH is no longer an issue.  For the past three years recruiters have indicated that potential physicians who expressed concern about OCH selling were either reluctant to give consideration or just said not interested because of ongoing talks about a possible sale.

The physician specialties below are needed in the community and can have the opportunity for establishing full-time sustainable practices:

  • 1 ER Physician
  • 2 Family Medicine Physicians
  • 1 Gastroenterologist
  • 3 Hospitalists
  • 2 Internal Medicine Physicians
  • 1 Neurologist
  • 1 OB/GYN
  • 1 Otolaryngologist

OCH has recently been engaged with the potential recruitment of 2 part-time (1 day a week) plastic surgeons to supplement follow-up services needed after initial breast disease surgery.  The plastic surgeons are willing to provide services in the areas of breast reconstruction, surgery related to hand conditions needing soft tissue coverage, and liposuction, services that do not require routine overnight stay in the hospital.

OCH has already secured physicians in the fields of family medicine with practice commencement in August 2018, and urology with practice commencement in August 2021.

 Another current strategy includes a successful affiliation with a health system that allows OCH to continue providing community oriented services. Affiliation is much different than a merger in that it allows for more local input. An affiliation to be considered will allow OCH to remain under local control while expanding its services derived through mutually beneficial arrangements.

Partnering by affiliation could potentially bring bulk purchasing power, shared IT resources & support, and other shared services.  OCH can have an opportunity by economies of connection through system affiliation.

During the summer and fall of 2016, before the Board of Supervisors hired Ted Woodrell and Stroudwater, OCH Administrator/CEO Richard Hilton was contacted by a CEO of a system regarding partnering through an affiliation process.  Hilton informed this CEO that more information would be needed for OCH Trustees and Administration on how the affiliation process would work and be mutually beneficial. Also, another system CEO reached out to Hilton and expressed interest in a possible affiliation arrangement. These discussions did not go any further with either CEO, nor was any formal presentation made to the Board of Trustees and Medical Staff as a result of three Supervisors hiring Woodrell and Stroudwater. From that point on, Hilton and staff were engulfed in production of data and information for the assessment. Once the three Supervisors approved the resolution and RFP for the sale/lease of OCH, the idea of affiliation was forced to be put on hold.

Almost a year later, a third CEO of another hospital system met with Hilton and informed him that his system is watching what happens with the November 7th referendum on OCH.  This CEO stated that his system has an interest in extending an affiliation arrangement, as well.  Hilton indicated that with consideration from the Board of Trustees and input from the Medical Staff, there could be discussion of an affiliation opportunity. One specific interest discussed was making available “super specialty physicians” on a part-time basis.  These are physicians who cannot have sustainable practices in Starkville, but can provide routine specialty related services not requiring an overnight hospital stay.

With three system CEOs expressing direct interest in affiliating with OCH, this brings a unique opportunity worth exploring that can help meet OCH’s needs for expanding its physician specialty services, that are not currently available, in order to help market share retention.

Affiliation probably begs the question from the public on what is the mutual benefit.  OCH could have a partner willing to help expand its services while the system affiliate receives referrals for services not immediately available at OCH.

 BY AFFILIATING WITH A HEALTH SYSTEM WHILE REMAINING UNDER LOCAL CONTROL, THE COMMUNITY CAN BE ASSURED THAT THE BEST HEALTHCARE POSSIBLE IS BEING MADE AVAILABLE TO THEM IN THE FUTURE.  OCH, THROUGH ITS TRUSTEES, MEDICAL STAFF AND EMPLOYEES, CAN WORK TOGETHER TO COME UP WITH THE BEST AFFILIATION SOLUTION—ONE THAT HAS THE MOST POSITIVE IMPACT ON OUR PATIENTS, MEDICAL STAFF, EMPLOYEES AND COMMUNITY.

  1. Does OCH plan for any layoffs of current physicians or staff?

OCH:  OCH has not developed an immediate plan for any layoffs of current physicians or staff.  Recruited physicians seeking a full-time practice opportunity after residency training routinely want to be employed.  Employing physicians will have to be an option provided.  Recruiting full-time physicians, employed or not employed, often requires subsidizing those clinic practices until established.

OCH is monitoring what other hospitals are doing.  Some larger systems and/or hospitals are reducing employees to 72 hours per pay period, as well cutting back or eliminating services provided. OCH is prepared to make similar changes—but only if absolutely necessary.

  1. How might ambulance service be affected with the sale of the hospital?

OCH:  The new system owner may operate the ambulance service for the County for a period of time. Later, the system owner may ask for annual subsidy support or take action to reduce the number of ambulances available with staffed personnel.  The system owner may, at some time in the future, put the Supervisors on notice that they no longer want to run the ambulance service.  Since EMS is a County responsibility, the Supervisors will have no choice but to seek another firm for ambulance operation. In any of these scenarios involving subsidy request, the amount requested could easily exceed the current .55 mil allotment.

 

 

OCH Administrator/CEO Weighs in on Supervisors’ Press Release on Hospital Bids

The press release regarding the bids for OCH, to me, does not give enough information to meet the expectations of Oktibbeha County citizens. It appears Supervisor Miller has misled the county by stating the bidders “will be announced at a special meeting of the BOS Tuesday, September 26, at 3 p.m.” The board refuses to even state the number of bidders due to confidentiality reasons; however, I do not see where the number of bidders breaches the confidentiality matter.

The bids announced include net proceeds of at least $25 million above the $35 million hospital related bonds. The hospital currently has land, buildings and equipment with a total cost value of $132 million. Without reviewing the bids, it appears that this announced bid falls very short of what the replacement value is for the facility.

The bids also include paying approximately $35 million in hospital related bond principal with OCH and the county.  I’ve been asked how that would work. In the past year, I’ve spoken with the director of the Mississippi Development Bank regarding the hospital’s approximately $11.8 million left on the principal portion of these bonds. As annual debt payments come due, you have to pay the principal plus interest on those bonds. I was told that if the hospital sells, bonds may not be able to be paid off until the 10 year call date has been met. That 10 year call date for OCH bonds will be met in 2023 and 2024. Until the call date, the remaining bond principal and required interest would have to be set aside in an escrow account. In addition, there could be a premium assessment on those bonds to be escrowed, as well. The county has approximately $23 million in bonds that would have to be treated the same way. Do the bidders understand they may be required to put up much more than $35 million for paying off the bonds upon the call date?  And how much would that be? Is this something that the board of supervisors understand? Has this been discussed by the bond attorneys as to what has to take place if those bonds cannot be called until the 10 year call date is up? I think this is something the public needs to thoroughly understand before they vote.

One of the objectives listed calls for ending the tax levy of approximately $1.9 million per year. To my knowledge this is the first time the board of supervisors has made a public statement about what will happen with the tax levy. By doing this, are the supervisors making a commitment to lower the taxes?

The expanded services listed on the bids includes cardiology. It’s been said over and over again by Supervisor Trainer that a new owner will be able to bring open heart and cardiovascular surgery to OCH. I have repeatedly stressed that OCH cannot get a certificate of need (CON) for open heart surgery unless the hospital can demonstrate performing 150 open heart and 450 heart catheterizations a year. In addition, before OCH can show meeting this requirement, the competing hospitals in the planning area must demonstrate that they are doing at least 150 heart surgeries and 450 heart catheterizations a year. Baptist Memorial Hospital Golden Triangle, based upon recent communication, is performing approximately 100 heart surgeries per year. This information indicates there is no way that the Mississippi State Board of Health will issue a CON until the numbers with Baptist Memorial have risen and is consistently showing at least 150 cases per year. Also, the hospital’s service area must have a population base of approximately 100,000, and at the present time, the primary and secondary service area of OCH is around 85,000. Assuming at least two of the bidders are the hospital’s current competition of North Mississippi Medical Center and Baptist Memorial, I cannot see why they would be willing to invest the amount of money required for setting up open heart surgery and heart catheterization units when that same service is being provided 23 miles to the east and 60 miles to the north. The essential equipment needed and the staffing requirements to support these services are very costly.

The supervisors have indicated that the bidder is a not-for-profit company. It’s important to note, a not-for-profit would not pay ad valorem taxes to the county on the buildings and equipment. The county will be able to receive ad valorem taxes if a new owner continues to lease physician office buildings to non-hospital employed physicians and providers just as those taxes are currently being paid by those providers not employed by OCH.

 

OCH CEO Explains Why a Loss for the Hospital Is Not a Tax Increase for You

After the release on Tuesday of OCH Regional Medical Center’s interim financial report for fiscal year 2017, the question was asked by an Oktibbeha County citizen, “Will my taxes increase to cover the hospital’s loss?” The answer is no. OCH has never asked the Oktibbeha County Board of Supervisors to cover any hospital operational losses and will not in this situation either. The funds for the hospital’s day-to-day operational expenses comes from orders of physicians and providers for providing medical/surgical care such as nursing, intensive care, inpatient/outpatient surgery, labor and delivery, nursery, IV infusion, laboratory, blood bank, imaging (radiology, CT, MRI, nuclear medicine and ultrasound), respiratory therapy, physical therapy, speech pathology, occupational therapy, anesthesiology, emergency medicine, cardiac rehabilitation and ambulance services for our patients.

The loss reported in the interim financial report includes $4.4 million of depreciation and amortization which are non-cash expenditures.  This means that the hospital used $606,587 of its current cash & investment assets which was over $21 million at July 31, 2017.

The hospital’s local investments are collateralized as required by state law. Financial institutions holding deposits of public funds must pledge securities as collateral. As of our latest audit on September 30, 2016, all hospital funds eligible to be included in the state’s collateral pool program were properly included and were fully collateralized. OCH’s fund placed with the MHA Investment Pool are not required to be collateralized; however, these funds are placed with permitted investment through section 27-105-365 Mississippi Code Annotated (1972).

What OCH is experiencing is not unique. Hospitals throughout the state are experiencing the same results that we are with increased gross revenues, increased deductions from revenues and reduced reimbursement from insurance companies and other third party payers that impacts the hospitals’ bottom line.  As the OCH Board of Trustees, medical staff, administration and employees work together as a team, we will be able to endure what is impacting the hospital industry nationally and statewide.

OCH Interim Financial Statement Shows Loss; Hospital Plans for New Fiscal Year

The most recent interim financial statements for OCH Regional Medical Center from October 2016 to July 2017, that were presented to the OCH Board of Trustees on August 22 and recently requested by the Oktibbeha County Board of Supervisors, show a cumulative operational loss for the current 10 month period.

Although the hospital has experienced a gross patient revenue increase of $6.9 million (4.4%) from the prior FY 2016 period, deductions from revenue have increased by $9.1 million (8.7%). This increase in deductions has directly impacted OCH’s adjusted gross revenues, putting them at $57 million compared to the prior year’s $59.3 million. Factors affecting increased deductions include significant third party payor reduction of covered services. These reduction in payments have contributed to an increase in this year’s operating loss, as well as an increase in operating expenses of $2.3 million (3.8%). This results in a bottom line loss of $5.1 million. Of this bottom line loss, $4.4 million is for depreciation and amortization, which are non-cash expenses.

“The decrease in bottom line is an experience that many other hospitals are seeing throughout the state,” said OCH Administrator/CEO Richard Hilton. “Hospitals are being impacted at different levels. Several hospital CEOs have shared their financial performance with me, and the same story of gross revenues and deductions from revenue increasing while insurance reimbursement is decreasing is always the common theme.”

Insurance companies are shifting the financial burden to their policy holders and their dependents in the form of increased high deductibles of $5,000 to $7,500. These types of deductibles obviously often translate to increased bad debt and increase accounts receivable with longer payment terms.

“Some hospitals have already started to downsize their operations by eliminating non-profitable services, as well as reducing staffing positions as a way to reduce expenses immediately,” said Hilton. “As we finish out the last two months of this fiscal year, our staff will work together to look at ways to decrease cost. These actions will be discussed with the OCH Board of Trustees and the department directors of the hospital. When the bottom line is an issue at OCH, as it has been only a few times in our entire history, we work together to come up with the best solution—one that has the least impact on our patients, employees and community.”

OCH Receives Award from American Heart Association for Quality Stroke Care

OCH Regional Medical Center has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Silver Quality Achievement Award. The award recognizes the hospital’s commitment and success ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

These quality measures are designed to help hospital teams provide the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. They focus on appropriate use of guideline-based care for stroke patients, including aggressive use of medications such as clot-busting and anti-clotting drugs, blood thinners and cholesterol-reducing drugs, preventive action for deep vein thrombosis and smoking cessation counseling.

“A stroke patient loses 1.9 million neurons each minute stroke treatment is delayed. This recognition further demonstrates our commitment to delivering advanced stroke treatments to patients quickly and safely,” said Eddie Coats, OCH Critical Care Manager. “OCH continues to strive for excellence in the acute treatment of stroke patients. The recognition from the American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke further reinforces our team’s hard work.”

OCH Regional Medical Center has also met specific scientific guidelines for a Level 3 Stroke Center designation, featuring a comprehensive system for rapid diagnosis and treatment of stroke patients admitted to the emergency department.

“The American Heart Association and American Stroke Association recognize OCH Regional Medical Center for its commitment to stroke care,” said Paul Heidenreich, M.D., M.S., national chairman of the Get With The Guidelines Steering Committee and Professor of Medicine at Stanford University. “Research has shown there are benefits to patients who are treated at hospitals that have adopted the Get With The Guidelines program.”

Donna Canady said she’s one of those patients who has benefited and continues to benefit from being treated at OCH. In August 2014, Canady was talking to a neighbor when she said her words weren’t making sense. That neighbor brought Canady to the OCH Emergency Room where she received immediate care for a stroke.

“Everyone was so kind and patient with me. They were emotionally supportive. Lori [OCH Speech Language Pathologist Lori Windle] came to my room to help me learn how to swallow so that I could eat again,” explained Canady.

After being discharged, Canady received outpatient physical therapy and occupational therapy at OCH Rehab Services to re-gain strength in her arms and legs to help her return to activities of daily living.

In addition to the inpatient care and outpatient rehabilitation, Canady has continued to participate in the OCH Stroke Support Group. Led by OCH Rehab Services Licensed Speech-Language Pathologists Lori Windle and Laurel Jones, the support group helps patients who have experienced communicative, cognitive or swallowing difficulties as a result of stroke.

“It’s hard for others to understand what you’re going through, but the support group meetings help because everyone who is there has been in that boat before either as a patient or a caregiver,” said Canady adding that she couldn’t have made it through the rehabilitation process without her husband, James.

According to the American Heart Association/American Stroke Association, stroke is the No. 5 cause of death and a leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds, someone dies of a stroke every four minutes, and nearly 800,000 people suffer a new or recurrent stroke each year.

Important Hormones for Your Health

OK, today I want to talk about hormones – which ones are important and why. Hormones have just as much impact on your health as the three other big pieces of the puzzle – physical health, mental health and nutrition. Don’t believe me? Well, you will by the end of this, so keep reading! This will be a very broad overview and I haven’t included all hormones, just what I call the big hitters. In later columns, we’ll dive deeper into individual hormones.

Vitamin D
Vitamin D is technically a pro-hormone that we get mainly from being out in the sun. Other sources include cod liver oil, calcium-rich foods, egg yolk and supplementation. Almost everyone is deficient in Vitamin D. I take a Vitamin D. The biggest areas of benefit include significantly decreasing risk of cancer (by blocking progression of pre-cancerous cells) and lowering heart disease rates. It can also improve testosterone levels, calcium absorption, bone health, blood pressure control and lower autoimmune disease rates. It’s one of the first areas I recommend for a quick improved health intervention in most of my patients.

Thyroid
Your thyroid is important, and low levels of thyroid hormones can significantly impact health. Your thyroid regulates metabolism, energy and body temperature. When it’s healthy, it increases protein synthesis, lowers cholesterol, increases fat breakdown and improves cognition. When it’s low, there are over 200 symptoms you could have. The most significant include fatigue, depression, weight gain, dry skin, brittle nails, thin hair, brain ‘fog’, constipation and high cholesterol. Women, especially those ages 40-60, are more prone to low thyroid levels compared to men although we do see it in men as well.

Adrenal
Another common area impacting health is your adrenals (you have two of them – they rest just above your kidneys). When you are startled and have that ‘body shock’ feeling, that’s the adrenals releasing adrenaline. When there is longer term stress, the adrenals release cortisol. When stress continues and cortisol gets depleted, you move towards what we call adrenal fatigue. Unfortunately, due to our inherent culture of go-go-go, adrenal fatigue syndrome is very common. Also, it usually takes a long time (4-12 months) to resolve once addressed. Stress management is a key to reducing your risk for adrenal fatigue and improving your health. We’ll discuss stress management techniques in a later column.

Sex Hormones
Testosterone, estrogen, and progesterone are all considered sex hormones. The name is misleading as these hormones are definitely not just about sex. That’s not even how the word sex is meant here. Anyway, I could go on for many moons on this subject as I’m passionate about it but we’ll hit some highlights here. In general, women need estrogen, progesterone and testosterone. Men need testosterone and estrogen. People usually think of testosterone as only for men and estrogen as only for women but that’s not the case. Men and women need estrogen and testosterone to benefit their health but the levels needed are different. As an aside, sex hormone optimization is complex and you need a healthcare provider who specializes in this to address and manage it properly as there are risks to mismanagement. Testosterone helps your body with sex drive, erections (in men), muscle strength, mood, energy, bone strength, as well as decreasing heart disease, cholesterol and diabetes risks to name a few benefits. Estrogen and progesterone can affect mood, sex drive, breast growth (particularly in women), urinary tract infection risk, cholesterol, bone strength, cognition, Alzheimer’s risk, skin health and sleep…again, to name just a few areas. Progesterone, in particular, is good at helping with sleep.

For women, these sex hormones can be deficient before menopause, but definitely deficient after. Ten to fifteen years ago, there was concern for hormone replacement after menopause and several post-menopausal women abruptly stopped hormone replacement. We now know that likely put them in a higher health risk category than if they’d stayed on them. Also, since then, we’ve learned more and really see where there’s a benefit in maintaining these hormone levels with appropriate surveillance by a qualified healthcare provider.

For men, testosterone in particular got a bad rap 4-8 years ago with a concern for worsening heart disease risk, and historically there has been a concern for prostate cancer risk. We will address these individually at length in upcoming columns but the short of it is this: there does not appear to be an increased risk for prostate cancer with normal compared to low testosterone levels (the data actually shows an increase incidence in the low testosterone groups) and, in most patients, there’s an improvement in heart health and lowering of heart disease risk with normal testosterone levels compared to low (similar to above, the data points towards increased heart disease risk at low testosterone levels compared to normal).

I know I threw a lot at you here, but that’s a super-high bird’s eye look at the impact of hormones on health. Keeping hormone levels optimized naturally, or if needed through supplementation, improves your chance for more functional years and an improved quality of life!

Dr. Thomas is a board-certified physician who operates Complete Health Integrative Wellness Clinic and Thomas Urology Clinic in Starkville, Mississippi.

This column is for informational purposes only and is, under no circumstances, intended to constitute medical advice or to create or continue a physician-patient relationship. If you have a medical emergency, you should immediately seek care from your nearest emergency room, and if you have specific health questions, you should consult your own physician.

 

Four Big Areas That Affect Your Health

My dad had a triple bypass when I was a first-year medical student, or M1 as we call it.  I remember the months leading up to the day.  My father was (and still is) a big hunter and I remember us walking through the woods and he’d have to stop, as he said, ‘to catch his breath’.  Sometimes he’d even stop and act like there was something he wanted to look at or listen to there in the woods but we both knew he just couldn’t breathe and he had to stop.  He’s like me and every other Mississippi man – when it comes to our health, we’re going to rationalize away and be in denial eventually to the point of crisis.  As his shortness of breath got worse, he visited his family doc and a chest x-ray revealed fluid on his lungs which led to a visit to the cardiologist.  Turns out it was his heart.

Your heart is the pump for your body, bringing blood in and pushing blood out.  Ironically, my father worked as an electrician on pumps at a local paper mill!  Anyway, his pump wasn’t working and fluid was backing up.  I was in Jackson in medical school and getting most of these updates from my mom.  When she said he would need open heart surgery, I rushed over to Meridian to see him.  He was justifiably nervous and, interestingly, in that life crisis moment, as much as he loves hunting, he made me promise to sell all his guns to make sure my mother could pay the bills if he didn’t make it through surgery.

As they whisked him down the long, sterile hall towards the operating room, I settled into an uncomfortable chair, pulled out a highlighter and tried my darnedest to read Guyton and Hall’s Textbook of Medical Physiology and not think about my dad.  The surgery and recovery yielded a couple of hiccups but ultimately he rebounded and has done reasonably well since that scare in 2003 although his heart is still not in great shape and he takes a potpourri of medications now to adjust for that.  I look back and reflect on this life crisis for him.  He loves hunting just about as much as the rhinestone cowboy loved rhinestones (another family story for another day)!  In that moment, though, he was willing to give it all up to ensure the long term safety of his family.  It got me thinking.  Why does it take a crisis for us to flesh out and act on our highest priorities?  This question is difficult to answer so, just ponder it for your own life – are you stuck in the everyday or are you looking at and prioritizing for the big picture?

As it turns out, that crisis was a turning point for me as well.  It planted the seed of thinking what I could do for my family, present and future, to make sure I stay healthy to be there and provide for them.  The answer is one word: prevention.  My grandfather (my dad’s dad) died of a massive heart attack in his early 50’s.  My father had open heart surgery at age 53.  I knew the statistics.  Genetically, I was at increased risk simply from the cards I was dealt.  This, as we call it in the South, come to Jesus moment for my father turned out to have the same effect on me.  I was starting to learn more about medicine and I picked up on other factors – like that my dad was diagnosed with diabetes eight years prior.  How he then acquired what we call metabolic syndrome.  How all of this was a predictable unfolding revelation leading up to his open heart surgery.  I realize now that while sitting in that hospital with my yellow highlighter, waiting (and praying) for him to get out of surgery, I made a vow to myself to learn more about prevention.  I didn’t want to get to the point my father or grandfather was in their 50’s.

Through years of study, I’ve found four big areas that impact your health and wellness.  Let me say this as an aside – it’s not just one thing.  Yes, diet is important but it’s not the only thing.  Yes, sleep is important but it’s not this only thing.  And exercise and supplements and so on.  Your body is beautifully complicated and anyone selling a one-size-fits-all or do-this-one-thing approach to health and wellness is someone to stay away from.  The four key areas of importance are physical, mental, nutritional and hormonal health.  Each area has several subcategories.  To name a few, physical health includes exercise and sleep.  Mental health includes areas like stress management, time management, self-confidence, and mind-body medicine.  Healthy eating and supplements fall under nutrition.  And there are several hormones that make a big difference in your health.

I started my own journey with consistent exercise.  I was able to maintain it over time because it flat out made me feel better and I had more energy.  What was your starting point to better health and wellness?  What will it be starting this week?  This weekly column will address key topics within those four health and wellness categories to move you towards a better lifestyle.  It is not a door.  It’s a road.  I’m passionate about the journey!  Will you walk the road with me?!

Dr. Thomas is a board-certified physician who operates Complete Health Integrative Wellness Clinic and Thomas Urology Clinic in Starkville, Mississippi.

This newspaper column is for informational purposes only and is, under no circumstances, intended to constitute medical advice or to create or continue a physician-patient relationship.  If you have a medical emergency, you should immediately seek care from your nearest emergency room, and if you have specific health questions, you should consult your own physician.

MHA Names OCH Administrator to Board of Governors

The Mississippi Hospital Association recently named Richard G. Hilton, Administrator/Chief Executive Officer of OCH Regional Medical Center, to serve on the Board of Governors as the Prairie Council Representative through June 2020.  This is Hilton’s second time to be appointed to the Board.

Hilton has a long tenure with OCH, serving as the Chief Financial Officer/Associate Administrator from March 1983 to February 2012, when he was named CEO/Administrator by the OCH Board of Trustees.

An active member of MHA, Hilton currently serves on several MHA committees including retirement oversite, political action, and Medicaid advisory committees.

Hilton has also been involved in the Prairie Hospital Council, MHA Quarter Century Executive Forum, and currently serves on the Board for the North Mississippi Trauma System as the treasurer and for Vizient Gulf States Region. In 2010, Governor Haley Barbour appointed Hilton to the Mississippi Hospital and Equipment Facility Authority (MHEFA) Board of Directors, representing the 3rd Supreme Court District.  Hilton is also a Fellow of the American College of Healthcare Executives (FACHE) and has been a member of the Hospital Financial Management Association and the American Hospital Association since 1983.

Serving on the board of directors of the Greater Starkville Partnership Development and as a member of the Starkville Rotary Club, Hilton is very active in his community.  His philanthropic efforts also extend beyond the United States. He and his wife, LaRue, are the founders of Family Life Missions Inc., a benevolent ministry operating children’s homes in Catacamas, Honduras, where he served as president/CEO and board chairman from 1992-2005.

Hilton holds a B.S. in business administration from Harding University in Searcy, Arkansas, and an M.S. in hospital and health administration from the University of Alabama in Birmingham. He and his wife have seven children and 13 grandchildren.

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