By Guest Blogger, Sheila Crowley, Murray County News Staffwriter
A large contingency of people were on hand Wednesday evening at the Silverberg building to share thoughts regarding Murray County Medical Center’s management alliance. The facility held the meeting to share information regarding MCMC and get feelers as to if the general public has a preference between Sanford or Avera for the facility’s management agreement. Dr. Snow welcomed the audience to the community forum. He introduced the hospital board and shared an opening statement.
State of the Union
Interim CEO Michael Ladevich took the microphone and helped to ‘set the stage’ as to why the meeting was being held. Ladevich commented on his first impressions of the MCMC facility as being a beautiful operation and felt MCMC offers excellent providers and staff members. “Surprisingly,” he said, “MCMC is very high tech.” Ladevich shared with his extensive opportunity to see different facilities, he feels MCMC has a very high tech nature. “There’s a lot of modern, up-to-date equipment. You are as equipped as any suburban hospital.” Ladevich continued stating he feels MCMC can do 95% of what the big city hospitals in Sioux Falls and the Twin Cities can do….”and we can do it better.”
Murray County Medical Center was recently recognized as being in the top 6% of the hospitals in the nation. This recognition was based, in part, on the in-patient scores received from CAQH. “This means we do a good job,” shared Ladevich. “What are you going to get out of going to Sioux Falls, Twin Cities, or Mayo Clinic? Not a whole lot more – unless you are really ill.”
Ladevich feels MCMC’s future is bright as long as all the community gets behind the facility. He explained, however, currently the community is divided. Ladevich talked about the falling out the hospital had with three of it’s previous providers and eluded to the fact it was, indeed, the facility’s fault. This drew applause from several in attendance. “We need to take accountability and responsibility for that. However, we can’t take back, or turn the clock of time backwards.” Ladevich continued, “This meeting isn’t about whether we were right or wrong and I’ll just acknowledge we were wrong. It’s about the future.”
Statistics of MCMC were shared which showed in 2010 the facility sent approximately 33% of their business to Sioux Falls. That number has now risen to 50%. “We’ve lost a lot of business to Sioux Falls,” said Ladevich.
He went on to explain why the facility needs a management agreement and stated both Avera and Sanford are top notch which each having their strengths and weaknesses. Ladevich admitted both organizations would like to see that 50% grow to 70% or 75%. “When 70% of our business goes to Sioux Falls… we’re out of business. Because this is all about patients and volume.” He used the nursing home as a reference stating this is why Slayton no longer has a nursing home. “They didn’t have enough volume.”
Ladevich explained CLA (Clifton Larson Alan) has led the hospital board through some strategic planning over the last nine months. He explained the status quo, however, isn’t an option. The options with regard to management, according to Ladevich, are about change, disruption, and risk regardless of whether the facility stays with Sanford or goes to Avera for the their management agreement. “This is about what your opinions are regarding these two companies,” explained Ladevich when explaining the purpose the community meeting. “They are both excellent companies in one regard and we have to protect ourselves against these companies in the other regard.” He continued, “The board’s job is to sort through these opinions and facts. Bring that all together and try to make the best decision for this community.” Ladevich emphasized MCMC will remain independent. “What we contemplating is a management contract and whether we re-up with Sanford or move over to Avera.” He made reference to area facilities who are owned by the above mentioned companies.
Ladevich explained MCMC is 100% financed by patient revenues. “The more patients we see, the more revenue we receive.” He commented on the wave of the future involving more and more patient responsibility for their services versus insurance companies paying the bill. Ladevich also commented on the fact the funds for the facility are not a result of dollars received from Murray County taxpayers. “This is another misconception,” he said. He again related the facility’s poor finances on the lack of volume. The statistics show the patient volume in 2018 is approximately half of what it was in 2012. Six years ago was the last time MCMC was profitable according to the statistics.
No patients…no revenue…no community hospital.” Ladevich said, “The $64,000 question is what it will take for you to support this hospital again? Because we need your business.”
Consequences if Volume & Finances Don’t Improve
Ladevich shared the consequences of not getting the volume back in place for MCMC. “All you have to do is look at the nursing home closure in Slayton…you can look at Avera Tyler, Sanford Westbrook, Sanford Tracy, Mayo Springfield, and Mayo Madelia… these are all in the papers. And most recently Granite Falls has signed a letter of intent to go with Avera.” These are all ownership situations, according to Ladevich, not management. However, if the finances don’t improve at MCMC eventually the facility would have to sell out to either Avera or Sanford. “Services would be stripped from the community and jobs would be lost,” shared Ladevich. “and we’d become a band-aid and shipping station.”
He expanded his conversation into the financial picture of the hospital stating the July number was $9,300,000 – which is better than the facility was doing in 2018, however, Ladevich said the facility is $230,000 below the budget number. Currently the net income is -$788,000 which is $200,000 below the budgeted amount MCMC had hoped to take in.
In 2012 the visits in the clinic tallied 13,400, whereas in 2018 they were at 7,000. Currently they are projected at 7,500 for 2019 but the goal is set at 8,000. On the in-patient side of the equation, 2012’s number was 1100, 2018-650, and 2019 looks to be between 650-700.
The net income showed MCMC clearing one million dollars, however, in 2018 the facility lost $1.5 million. He said the run rate for 2019 thru July is a negative $1.3 million. The goal is to get back to zero. “Our challenge,” explained Ladevich, “is to bottom out those statistics and start heading back up the curve.”
Challenges at MCMC
He went on to talk about the challenges MCMC is facing with the number item identified, by both the community and staff, as provider turnover. This is felt to be one of the big hindrances from improving the volume at MCMC. Ladevich feels they have been able to calm some of those waters in placing very qualified providers such as Dr. Snow, Dr. Mishra, adding Paige Freeman as well as Tracy Hansen. He feels improvements need to be made on patient registration, the revenue cycle, and general surgery. Ladevich said MCMC is currently looking at working with Dr. Harms of Pipestone as surgeon. He spoke of the fact sleep studies have been incorporated – both home and in-hospital. Infusion therapy along with Western Mental Health have been added to the lineup of services available at MCMC. As part of the mental health, the facility will be offering services utilizing a TMS (Trans-cranial Magnetic Stimulation) machine which will help those suffering from depression. Ladevich feels MCMC does approximately one-fourth the colonoscopies that they could be doing. In addition he hopes to double or triple ophthalmology as well as do a better job with getting more patients to utilize orthopedics. He also wants to include dermatology and urogynecology. “It’s amazing how many people, who have been in this community, don’t realize all the things we can do. I hear nearly every week I didn’t know MCMC could do that,” commented Ladevich. “Maybe we just need to do a better job of communication.”
According to him, “Life is better. We’ve increased about 7% but we need to be at 14% to 15% in order to get back to zero.” He did speak on the fact that if people have their care provider outside of MCMC, they can still utilize the services of the facility whether it be for a colonoscopy or other lab work, etc.
Ladevich then introduced Kris Jacobson who served as the moderator for the evening. Jacobson shared she also came from a small community who was passionate about their hospital and keeping healthcare local. She said the agreements from Avera and Sanford aren’t apples to apples which is why it makes the partnering decision so much more difficult.
Each has their own strengths and weaknesses.
• Management contract costs
• EMR (Electronic Medical Records system). The facility will need to evaluate which is the better system and most user friendly for MCMC and for patient.
• Community support.
• Leadership style of each of those organizations.
• Clinical services. It’s critical that the partner is the right fit for MCMC in offering some of the services the facility is looking for.
• Additional market share opportunities. What move patients to come to MCMC.
Question and answer cards were provided to those in attendance. They could fill them out and be contacted via email or phone call with an answer to their specific question as the evening was not set up to be a question and answer type event.
Two letters were read – one from Amy Rucker in support of a Sanford agreement. The other was from Jerry Kellen who was a former board member at Worthington Regional Hospital. He felt Sanford has the interest of the community in its best interest and community involvement whereas Avera is about what’s best for their organization. He did emphasize the key is to decide what is best for the community long term.
Several individuals spoke of support of the providers who left six years ago as a result of MCMC’s CEO at the time. Some say they continue to use the services at MCMC if possible.
Lorna Bader shared her concern regarding hospice. She had heard that if Avera comes into a community, they want to use their hospice and she expressed her concern losing Hospice of Murray County as a result of that partnership.
Jerry McCord spoke stating the current partnership is Sanford hired the past CEO. He felt the past administration’s allegiance was to Sanford – not Murray County. He also added he feels Sanford hasn’t lived up to their contract. According to the document McCord said each year Sanford is suppose to review the financials of MCMC. “I believe that Sanford managed us with the idea of bankrupting the hospital so they could buy it. I know if we switch to Avera there’s guarantees we will get any of our providers back, but I believe Sanford’s past action has proven they shouldn’t be awarded the agreement.”
Judy LaBoda shared a question to the board asking if the three providers who had left come back, yet still work for Avera, how does it benefit the community. Where do the funds get benefitted to? Does it come back to Slayton? She added, the new providers Paige and Tracey live in the area and aren’t going anywhere. “They are very good and I appreciate them being here.”
Curt DeVries commented he had moved from Worthington to Lake Wilson. DeVries said he watched the situation with Worthington Regional Hospital unfold and felt the CEO, at that time, was wined and dined. In his opinion Sanford was a ‘snake in the grass’ in taking over ownership of the facility and the quality of care declined as a result. He was happy to hear the board intends to keep MCMC independent and feels this decision is in their best interest. He cautioned those going out of the community for their healthcare needs…”When you really need this facility will it be here? I suggest you support your local hospital the best that you can.”
Another in attendance commented on the prompt, courteous, professional, and well informed care she has received from MCMC.
Stacey Posthuma commented stating she feels the board needs to look at what is best for the community. “It’s a great thing that we got together to discuss things because there’s obviously hurt feelings. I’ve consistently heard, I left because our provider left and we’ll come back if he/she comes back. There’s no guarantee, from what I’ve heard tonight, that your provider will come back. What is the best course of action for our community hospital if they don’t come back? I think it’s important to look at what’s best for the community. I also hope the board has talked to, and listened, to the employees and ask what is best for their job situations.” She spoke on the new program implemented at USD in Vermillion which is encouraging local youth entering the medical field to commit to providing healthcare to the rural area. “We need to step away from our hurt feelings. What’s really important to this community is to keep MCMC a community hospital…. not a Sanford or Avera hospital.”
Tom Whitehead shared his concern with the loss of current providers when choosing the partnership agreement. “They are top notch. It’s not just them but the entire staff and I don’t want to loose any them.”
Judy Horn spoke on she and her husband’s decision to not follow their provider when they left despite really liking them. “It comes down to whether you want to support your provider or your hometown.”
The MCMC board will be filtering through information and make their decision whether they will partner with Sanford or Avera some time over the next couple of months.