Small and rural hospitals

1. Small and rural hospitals Challenges and Opportunities O. J. Booker Monroe County Hospital

3. Forsyth, Georgia

4. Our Volunteers

8. Monroe County Hospital • Forsyth, GA – 25 miles north of Macon • 4,500 folks in town, 23,000 in county • Monroe County Hospital – 25 beds • No OB, no nursing home • Surgery and inpatient care • 6 active medical staff • 4 visiting surgeons

9. Monroe County Hospital • 140 employees • $15 million gross revenue • $9 million net revenue • 100 discharges per month • 900 ER visits per month • 50 surgeries per month • 10,000 x-rays per year

10. Loving care

11. What’s a small rural hospital? • A *Small Rural Hospital is defined as a general acute hospital with an average daily census of 75 or less in a county with a population of 75,000 or less. (*as defined by the Georgia Hospital Association Center for Rural Health) • There are approximately 70 hospitals in Georgia that meet this definition (35 CAH & 35 PPS).

12. Small Rural Hospitals: • make up 41% of the total number of hospitals in the state (approx. 70 of 170) • provide 17,000 jobs • treat over 108,000 inpatient stays • provide $2.6 million in uncompensated care • have an estimated community economic impact of $1.5 billion

13. Small Rural Hospitals: • Approximately 80% are non-profit 501(c)3 organizations. • Small rural hospitals are geographically distributed equally throughout the state – all of which operate emergency departments 24/7.

14. Rural/small characteristics • Hospital impacts much more per capita • Frequently is the largest employer • Economic impact is great • Multi-tasking (wear lots of hats) • Equivalent responsibility vis-à-vis regulation, law, etc. • Have to be simple, not complex

15. Rural/small characteristics • Deliver babies • Only cafeteria in town • Local resource and advice • human resources • insurance • disaster • flu shots

16. Rural/small characteristics • Depository of brain power • Doctors, management, other professionals • Prestige • Love/hate relationship with the public • Have to market without money

17. Rural problems and issues • Volume • Can change up or down dramatically • Depends on smaller group of physicians • Community responds to adverse events • Economy of scale • Cannot get same high discounts on products and services

18. Size of hospital Economy of scale bell curve

19. Rural problems and issues • Staffing • High and low census challenges flex • Qualified senior management • Pool of candidates can be slim • Salaries don’t compete with large cities • Diverse services • Volume not enough to add more complexity • Leak to urban centers • “Bigger is better” syndrome

20. Rural problems and issues • Demographics • Rural typically higher Medicaid and indigent • Financial • Overhead a larger part of expenses • Harder to flex labor in lean times • Capital harder to obtain

21. Revenue enhancement

22. Cash flow control method

23. **The figures above exclude other operating revenue and non-operating revenue and exclude any ICTF payments.

24. It’s not all bad! Hospital weenie roast

25. Good things • Strong sense of place and family • No anonymity • Grow your own • You can see everybody • customer service and quality • CEO and senior management visible

26. Good things • Agency personnel use not as prevalent • Staff are crosstrained and are good at many things • Action to change and correct is quicker and more direct, takes less time. Not as many “moving parts”

27. Is there hope? • Yes, you can be successful in all areas • Management is everything. • Don’t make promises. • Do what you say you are going to do. • Drive for excellent customer service. • Do the next right thing. • Politicians and naysayers get a grain of salt.

28. When Bush loses Congress

29. Is there hope? • Have, preach and live a core value set. • Talk about something at least twice before you formally introduce the idea. • Make sure everyone that is relevant is involved in at least the brainstorming. • Study the experience and success of other small hospitals. • Thanks and praise on the tip of the brain.

30. Always be sincere, even when you have to kiss a pig!

31. Is there hope? • Opportunity to control expenses • Review and renegotiate all contracts. • Expenses don’t have to be expensive. • Rurals don’t expect glitter, and most eschew it. • Love the patient. The patient is the source of everything. • Tell the Board all you can.

32. NOTE TO O.J.: Hurry up. These folks want a break.

33. Is there hope? • Give credit to others. • Pay attention to physician needs. Try to surprise them. • Do what makes sense. • Do not operate in a vacuum. Communicate.

34. Is there hope? • Be in the public. • festivals, plays, BAH • county commission, city council • hang out • Bite your lip. • Have fun, laugh, make light. • Ask God to shower His blessings on the hospital.

35. Greetings from the Vatican! All my best, Bishop Hefner

36. How can you help? • Be aware. • Read newsletters, get on mailing list • Strike up conversations with employees, CEO • Participate. • Attend the parties, open houses, etc. • Talk to your legislators. • Tell them how you feel about your hospital • Tell them stories about what the hospital does

37. How do I learn more? • Georgia Hospital Association. • www.gha.org • Center for Rural Health • National Rural Health Association • www.nrharural.org • Rural Policy Research Institute • www.rupri.org

38. For a copy of this presentation – • www.monroehospital.org (News) • O. J. Booker • Monroe County Hospital • 88 Martin Luther King, Jr. Drive • Forsyth, GA 31029 • 478-992-9746 Have a good conference!