CLEVELAND — A leading national expert on health care law says resolving the financial crisis facing Greenwood Leflore Hospital and other endangered hospitals in the Delta should only be the first step.
The long-term strategy, according to Dick Cowart, has to be developing a regional approach that would not only allow the region’s medical facilities to survive but also to improve the health status of the people they serve.
“You can’t make long-term decisions in a crisis. You’ve got to stabilize the patient,” he told a gathering of hundreds at the annual meeting of Delta Council Friday. “We’re going to try and stabilize the patient, and then we’re trying to take the long view as to how you take a different view and a fresh view and a regional view to health care.”
Dick Cowart, a Nashville attorney who specializes in health care law, left, and Gov. Tate Reeves talk after Cowart’s presentation on the problems and opportunities facing hospitals in the Delta. (By Tim Kalich)
Cowart, a Nashville attorney who is originally from Mississippi, has been hired by a group of Greenwood businesses to help the Greenwood hospital pursue a federal designation that, if granted, could ensure its long-term viability. At the same time, he is working for Delta Council on a more encompassing regional approach.
Cowart was called on to perform double-duty on Friday. He addressed a smaller gathering of Delta leaders, then followed that up by filling in as the keynote speaker when the original keynoter, U.S. Sen. John Boozman of Arkansas, was delayed in Washington to vote on the debt ceiling and budget deal.
Cowart said the problems that have been plaguing the Greenwood hospital are common for rural hospitals around the country. He noted the latest estimate by the Center for Healthcare Quality and Payment Reform that nearly 30% of all rural hospitals in the country are at risk of closing. In the Delta, the problem has gotten especially severe, he said, with all five of its acute care hospitals, including Greenwood’s, operating at a loss and running low on cash.
He described the Greenwood hospital as a case study of what “can and probably will happen in other parts of the Delta.”
He said most rural hospitals were built at a time when inpatient care was more common, and they were designed with the physical space to accommodate it. Inpatient volumes, though, have dropped dramatically, a trend that was accelerated by COVID-19. Today, about 60% of health care is performed on an outpatient basis, and that is projected to grow to 80%, according to Cowart. That has left hospitals in rural areas, which were also impacted by population declines, operating at 15% capacity or less.
Greenwood Leflore Hospital, which had been licensed for 208 beds, has indefinitely mothballed three-fourths of those. It is now licensed for 25 acute care beds and 10 rehabilitation beds, which are within the maximum threshold for the designation it is seeking as a “critical access hospital.” Its application has been approved by the state, and if granted by federal authorities, it would produce an estimated $11 million to $14 million more in Medicare reimbursements a year — enough to get the hospital to at least break even, according to its administration.
Cowart was highly complimentary of Gary Marchand, the Greenwood hospital’s interim CEO who was in attendance. The two had worked together during Hurricane Katrina in 2005, when Marchand was running Memorial Hospital of Gulfport.
“You’ve got the right man in Gary Marchand in the right place at the right time,” the attorney said.
Cowart is hopeful that Greenwood Leflore will be granted a waiver on the distance rule that would normally disqualify its application for critical access status. But even if that endeavor is successful and, together with several short-term cash infusions, restores the hospital to financial stability, that won’t be “the end of the job,” he said. “That is just to get you in a position to start thinking about what do you do that is longer term and more sustainable.”
Cowart said that communities in the Delta need to start collaborating — similar to the ethos that drives Delta Council’s agriculture, economic development and flood-control efforts — in developing a regional approach to health care. The broad outlines for that, he said, might be identifying those essential services — such as emergency and obstetrical care — that every county should have, but to be more strategic on where specialized treatment is provided.
“You cannot afford specialty care in every community in the Delta,” he said. “There is not enough population.”
He cited Alabama and Tennessee as two states that decades ago developed successful regional models.
“The best way to survive when you are small and at risk is to play as a team,” he said.
Cowart only mentioned briefly in his first presentation — and not at all in his second — a topic that has been of considerable debate in Mississippi: expanding Medicaid to cover mostly the working poor, as provided under the federal Affordable Care Act. Expansion has been endorsed by Delta Council as well as the Mississippi Hospital Association, but it has gotten nowhere in the Republican-dominated state Legislature. Gov. Tate Reeves and outgoing House Speaker Philip Gunn, both of whom were on stage with a host of other state officials for Friday’s main gathering, have been unflinchingly opposed to expansion. Mississippi is one of only 10 non-expansion states.
Reeves’ main challenger this year, Democrat Brandon Presley, has made Medicaid expansion a central theme of this election. He has pledged to push it through if he can upset the Republican incumbent.
Reeves said he is not budging.
“Though some would want you to believe that Medicaid is a panacea, it’s not,” he said.
He said his research has shown that about a third of those in the South who have been added to the Medicaid rolls through expansion came off of private insurance.
“For that particular third, it’s actually not good for the providers because the reimbursement rates when they were on private insurance actually are higher than when they moved to Medicaid,” Reeves said.
Wade Litton, who finished his one-year term as Delta Council’s president Friday, said the organization is not backing away from its endorsement of Medicaid expansion but is not harping on it, given the current political climate.
“It’s been noted that Medicaid expansion from the governor is not on the table, and so our best approach is to try to come up with the best solution with the hands that we are working with,” Litton said.
- Contact Tim Kalich at 662-581-7243 or tkalich@gwcommonwealth.com
