Lawrence Hospital struggles with changes

Published 5:00 am Monday, August 14, 2000

MONTICELLO — The loss of King’s Daughters Home Health serviceshas not caused a significant financial loss for Lawrence CountyHospital, but remains a blow to the struggling facility.

KDMC will end its affiliation with Lawrence County Hospital thatallowed KDMC Home Health to provide services to Lincoln Countypatients Sept. 7.

The agreement allowed KDMC to provide the services underLawrence County’s home health license. Lawrence County handled thebilling and collecting with Medicare and insurance companies.

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Deborah Roberts, Lawrence County Hospital administrator, saidshe expected the move after learning about changes mandated by thefederal government that will take effect Oct. 1. She said it wasthe best move KDMC could make facing the changes.

“We have always had a good working relationship with King’sDaughters and that will not change,” Roberts said. “They have beenvery good to us and we have a really strong working relationshipwith them. This only affects the home health service provided inLincoln County.”

Roberts said Lawrence County Hospital is going through some veryrough times, but she does not see it closing its doors in the nearfuture.

The administrator said the hospital’s shortfalls were caused bythe Balanced Budget Act of 1997 and Medicare reimbursement changes.The two federal mandates changed the way home health operated andcollected its reimbursements.

Home health operations will change again Oct. 1 when thePerspective Payment System goes into effect.

“The PPS is going to change the whole nature of the business,”she said.

The changes made in the 1997 BBA caused problems for thehospital at the time and have not improved over the years becauseof constant changes.

Lawrence County Hospital entered the home health service area inthe late 1970s or early 1980s, Roberts said. At the time,surrounding counties also wanted to provide the service to theirresidents but were unable to get the certificates of need necessaryto do so.

Home health branch offices were created in counties workingunder the Lawrence County license. Originally, KDMC, WalthallCounty General Hospital, Simpson General Hospital and SouthwestMississippi Regional Medical Center had branch offices.

The reimbursement changes made in 1997 caused Simpson andSouthwest to drop out of the program in 1998. Simpson was thesmallest and Southwest the largest of the branch offices.

“We didn’t want to get out two years ago because we stillthought it was beneficial,” said Phillip Grady, KDMC’s chiefexecutive officer.

Lawrence County Hospital survived the two hospitals’ earlierdropouts, but the future is now uncertain.

“When Simpson and Southwest dropped out, it really put us in abind,” Roberts said. “Fortunately, we had a reserve fund whichwe’ve been using since then.”

The reserve fund, however, is running short.

“We’ve held out for three years trying to work the changes,”Roberts said, “but there’s nothing in concrete about how this newsystem is going to work. Right now there’s a lot of guessing andspeculation.”

Roberts said she discussed the hospital situation with theLawrence County Board of Supervisors at their August meeting andthey put together a $100,000 reserve for the hospital to use untilthe next fiscal year.

Even with county help, however, the hospital must do everythingit can to cut costs, she said.

The hospital needs a staff of 130 people, she said, but thestaff is currently at 110 and they have no plans to hire any more.In fact, she said, the hospital is not replacing staff members whoretire.

“Our part-time people have been our salvation,” Roberts said,adding that the hospital has a large part-time field to draw fromand rotations have saved them a lot of money. “We’ve never beenoverstaffed. People here wear a lot of hats.”

Roberts, who has been with the hospital in various capacitiesfor 29 years, said she is still working on this year’s budget. Thisis the latest the budget has been worked on since she startedhere.

Roberts said the delay in the budget is caused by the balancingact she has to perform to meet expenses and keep the hospitaloperating. She expects to have to make more cuts in the future.

“We have discussed doing something with our ambulance andemergency room service,” she said, “but I don’t think we can domuch with them. Even though we’re losing money with them, I thinkthey’re necessary services.”

Roberts said the ambulance and emergency room services are theonly departments left at the hospital that are not directly tiedinto in-patient services, but they are too valuable and tooimportant to lose.

Every hospital needs emergency service, she said. Transfer timesfor critically-injured patients would be too long without them. Theloss of the emergency room would also be detrimental to in-patientservices, which get a lot of their patients from the emergencyroom.

Roberts said that although contracting out the ambulance servicewould save the hospital money, she doesn’t believe it is a viableoption.

“We keep three ambulances running here,” she said. “Mostambulance service contractors only keep one ambulance in a countywith others on reserve to assist if necessary. There are times whenall three of ours are responding to emergencies and I just can’tsee how it could be done while keeping the same emphasis on careand response time.”

The government has acknowledged that they cut too much in the1997 BBA, according to Roberts, and they are investigating how tocorrect the problem.

“That’s great,” she said, “but I don’t need help next year, Ineed it now. I’ve seen some bad stretches in health care, butnothing to this extent. It doesn’t paint a pretty picture, but Idon’t believe there is one. People may wonder why I would say allthis but I like getting everything out in the open. I don’t likesecrets.

“I think we’ve done very well with what we’ve had to contendwith,” Roberts said. “The quality of care here is undiminished.We’re endeavoring to persevere.”

Despite the setbacks, Roberts said she still has hopes for thehospital’s long-term success.

“Health care is a constantly-changing market,” she said. “Istill have hope and I pray a lot.”