Arkansas Hospitals, Summer 2021 by Arkansas Hospital Association

ARKANSAS

HOSPITALS Summer 2021

WHAT COVID-19 IS TEACHING US FULL CIRCLE: FIRST CONFIRMED CASE TO COVID-19 VACCINATIONS

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ARKANSAS HOSPITALS | SUMMER 2021 1 Independently Owned and Operated/Member of the Cushman & Wakefield Alliance

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W W W. P O W E R S - H VA C . C O M

COVID-19

PERSPECTIVES LESSONS FROM THE PANDEMIC

12 Learning from COVID-19 16 From First Confirmed Case to Vaccinations 43 A Tale of Two Pandemics 47 Pandemics Change the Workplace 54 One Year Changes Everything

SPECIAL SECTIONS

23 The Annual Statistics Edition 16 Quick-Reference Guide to the 2021 Legislative Session

IN EVERY ISSUE

5 President’s Message 7 Editor’s Letter 9 Hospital Newsmakers 10 Event Calendar, Learning Opportunities 51 Leader Profile: Terry Amstutz 58 Coach’s Playbook 64 Where We Stand: Get Vaccinated!

ARKANSAS

HOSPITALS Arkansas Hospitals is published by The Arkansas Hospital Association

419 Natural Resources Drive | Little Rock, AR 72205 To advertise, please contact Brooke Wallace magazine@arkhospitals.org Elisa M. White, Editor in Chief Nancy Robertson, Senior Editor & Contributing Writer Ashley Warren, Associate Editor Katie Hassell, Graphic Designer Roland R. Gladden, Advertising Traffic Manager

BOARD OF DIRECTORS

Chris B. Barber, Jonesboro / Chairman Ron Peterson, Mountain Home / Chairman-Elect Peggy Abbott, Camden / Treasurer Darren Caldwell, Jonesboro / Past-Chairman Ryan Gehrig, Fort Smith / Director, At-Large Greg Crain, Little Rock Barry Davis, Paragould David Deaton, Clinton Marcy Doderer, Little Rock Kathy Gammill, Searcy Phil Gilmore, Crossett Vince Leist, Harrison James Magee, Piggott Mike McCoy, Danville Johnny McJunkins, Nashville Gary Paxson, Batesville Larry Shackelford, Fayetteville Brian Thomas, Pine Bluff Debra Wright, Nashville

EXECUTIVE TEAM

Robert “Bo” Ryall / President and CEO Jodiane Tritt / Executive Vice President Tina Creel / President of AHA Services, Inc. Elisa M. White / Vice President and General Counsel Pam Brown / Vice President of Quality and Patient Safety Lyndsey Dumas / Vice President of Education Debbie Love / CFO Melanie Thomasson / Vice President of Financial Policy and Data Analytics

Summer 2021 Lindsay Gilbert and Angela Comet working with bacteria in the biological safety cabinet. (See story, page 48)

DISTRIBUTION: Arkansas Hospitals is distributed quarterly to hospital executives, managers and trustees throughout the United States; to physicians, state legislators, the congressional delegation, and other friends of the hospitals of Arkansas. Arkansas Hospitals is produced quarterly by Central Arkansas Media. Periodicals postage paid at Little Rock, AR and additional mailing offices. The contents of Arkansas Hospitals are copyrighted, and material contained herein may not be copied or reproduced in any manner without the written permission of the Arkansas Hospital Association. Articles in Arkansas Hospitals should not be considered specific advice, as individual circumstances vary. Products and services advertised in the magazine are not necessarily endorsed by the Arkansas Hospital Association. To advertise, email magazine@arkhospitals.org.

ARKANSAS HOSPITALS | SUMMER 2021 3

Arkansas Heart Hospital Bryant, Arkansas

CHI CHI St. St. Vincent Vincent Arkansas Arkansas Neuroscience Neuroscience Institute Institute Sherwood, Sherwood, Arkansas Arkansas

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Arkansas Heart Hospital Bryant, Arkansas (currently under construction)

UAMS South Central Campus (at JRMC) Arkansas Heart Hospital Pine Bluff, Arkansas Bryant, Arkansas

Little Rock | Bentonville | Dallas

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PRESIDENT’S MESSAGE

The Journey

Continues A

rkansas: Summer of 2021. This looks and feels like a different world than the one we lived in a year ago. Maybe it’s just that we’re different ourselves. COVID-19 has changed everyone and the way we look at everything. Today, we’re vaccinating; in the summer of 2020 we were bracing for the pandemic fight of our lives. Today, we’re diagnosing viral variants; a year ago we struggled to understand and manage an unknown and highly transmissible disease. In this issue of Arkansas Hospitals, we look back over the past year and a half as we begin to venture past COVID-19. We focus on what pandemics can teach us and how to move beyond them. I’m incredibly proud of Arkansas’s hospitals and how each has adapted over the last 18 months. Each is different, and each community faced challenges of its own. Exhausting, perilous, frightening, precarious… the journey has been each of these and more. And yet … and yet … the number of lives saved, situations met head-on, hands held, patients healed

… the simple amount of loving care delivered is astounding. Some hospitals set up childcare centers so their staff members could work. Some found ways to keep staff members and their families fed when store shelves emptied. Some innovated ways to test for COVID-19 when tests were hard to get. Some expanded care capabilities by creating patient wards from workrooms and storerooms. Whatever it took to meet the needs, that’s what was done. In thinking back over our COVID-19 journey, I’m amazed at the obstacles we’ve not only encountered, but met and solved together: • We procured PPE when it seemed there was none to be had. • We increased testing capacity when backlogs mounted.

• We found ways to purchase ventilators and other necessary equipment as hospitalizations soared. • We converted rooms with normal ventilation to negative pressure facilities in record time. • We managed financial pressures that were in constant flux. • We found ways to acquire additional staff where needed and to hang on to our own valuable staff where possible. • We increased ICU bed capacity, finding beds for people in the next town if we had to. • We developed vaccination strategies while still managing patients sick with the virus. One of the most important lessons this pandemic has taught us is that we can accomplish almost anything if we move forward together. And now we begin the transition to a world profoundly changed by the COVID-19 pandemic. One day at a time, one challenge at a time, but always together. Thank you to each of you for your inspiring work. It’s an honor to go with you on this journey.

Bo Ryall

President and CEO Arkansas Hospital Association

ARKANSAS HOSPITALS | SUMMER 2021 5

6 SUMMER 2021 | ARKANSAS HOSPITALS

EDITORS’ LETTER

A Shift in Perspective I

t has been my privilege to serve as editor-in-chief of Arkansas Hospitals for the past seven years. Together, we have examined critical policy issues, discussed leadership and culture, and shared the occasional family memory while telling the story of Arkansas hospitals. Whether you’re a clinician, administrator, or any of the myriad other team members who keep our hospitals running smoothly, you have been on my mind each and every day of my 14 years with the Arkansas Hospital Association. With each editor’s letter, I hope I have communicated the great respect I have for each of you. My tenure has seen some changes to this magazine – adding a theme for each issue, offering original articles from state and national authors, and reimagining the design of the publication from the cover to the back page. In the last two years, the magazine has benefitted tremendously from the creative vision of the AHA’s Director of Communications, Ashley Warren. I am so pleased that Ashley has agreed to step into the role of Arkansas Hospitals’ Editor-in-Chief. You already know Ashley from her work managing ArkPrepare communications throughout the pandemic. She is also the force behind our new website, the voice of AHA’s social media presence, and the producer of countless other compelling and inviting communication tools that serve AHA members and the patients and communities they serve. In Ashley’s capable hands, I know the improvements will continue, and I can’t wait to see what the future brings. As always, thank you for all you do,

Elisa M. White Editor in Chief

he COVID-19 pandemic is building a mosaic of lived experiences. Schoolteachers turned I.T. experts, service-industry workers struggling to survive, hospitalized patients fighting for every breath: Each piece of the mosaic has its own color, texture, and shape. It’s only when all the pieces are seen as a whole that we feel its full impact. Only by hearing stories from a variety of perspectives can we begin to know what is happening, what it means, and how it is shaping the future. This issue of Arkansas Hospitals offers various points of view: American Hospital Association President and CEO Rick Pollack considers what lessons U.S. hospitals have learned – and are still learning; Erin Bolton, Director of Quality Improvement at Jefferson Regional, shares a frontline perspective starting with the moment one of her hospital’s patients was identified as the first confirmed case of COVID-19 in the state; and two authors show us the present through the lens of the past, as they juxtapose the current pandemic with the deadly influenza of 1918. The Arkansas Hospitals team is grateful to the contributors who shared stories of their own pandemic experiences throughout the past year. We pledge to continue to enrich our community by bringing a variety of diverse health care perspectives to every edition. We are grateful for the leadership of Elisa White, our outgoing Editor in Chief, whose wide range of interests and deep respect for the work of hospitals shone through in every page. I come to the role of Editor full of curiosity, humility, and with a sense of responsibility to her legacy. I look forward to the stories we will tell together.

Ashley Warren

Incoming Editor in Chief

ARKANSAS HOSPITALS | SUMMER 2021 7

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HOSPITAL NEWSMAKERS Jerry Mabry, former Arkansas market president and CEO of National Park Medical Center in Hot Springs, passed away in early May. We extend our condolences to his wife, Mary, his son, his daughter, and to his hospital family. Chambers Memorial Hospital in Danville and White River Medical Center in Batesville have both been named to The Chartis Center for Rural Health’s Top 100 Rural and Community Hospitals for 2021. Compiled by The Chartis Center for Rural Health, the Top 100 list honors outstanding performance among the nation’s rural hospitals. This is the eleventh year for the program. The Arkansas Neuroscience Institute at CHI St. Vincent North in Sherwood has opened a new Epilepsy Monitoring Unit in partnership with Advanced Monitoring Services. The new unit provides epilepsy patients and their physicians a suite of advanced neurodiagnostic resources including long-term seizure monitoring and ambulatory monitoring so patients can be monitored in the home setting.

Lori House is the newly selected first CEO/Administrator for the Sevier County Medical Center being built in DeQueen. The new hospital is under construction on an 18acre site north of the community. House formerly served as Director of Revenue Cycle at Healthy Connections in Mena. The Arkansas Hospital Association is now accepting entries for the 2021 Diamond Awards. The open nominations are co-sponsored by the AHA and the Arkansas Society for Healthcare Marketing and Public Relations. Last year, 15 hospitals received the highly distinguished Diamond Award. This year’s recipients will receive their awards during the October 7 Awards Luncheon at the Little Rock Marriott. The Diamond Awards recognize excellence and encourage improvement in the quality, effectiveness, and impact of health care marketing and public relations in the state of Arkansas. Awards are presented in several categories and across hospital divisions including Critical Access Hospitals, hospitals with 26-99 beds, hospitals with 100-249 beds, and those with 250 or more beds. Nominations and entries accompanied by the appropriate documentation must arrive at AHA headquarters no later than 4:00 p.m. July 16, 2021. For more information, go to arkhospitals.org. With the goal of dramatically improving responses for patients suffering heart attack, stroke, or other trauma, CHI St. Vincent has adopted an advanced communication system called Pulsara. Pulsara is a telehealth and communication platform that enables HIPAA-compliant, dynamic networked communications between EMS, hospitals, and other health care providers for any patient event.

A new Epilepsy Monitoring Unit recently opened at the Arkansas Neuroscience Institute located at CHI St. Vincent North in Sherwood.

The University of Arkansas for Medical Sciences (UAMS) held its fourth annual Day of Giving this spring to support education, clinical care, and research across the institution. Since 2017, the Day of Giving event has been the organization’s largest single-day philanthropic effort. This year, the event raised $352,933. Donations of nonperishable food items and heartfelt, handwritten notes for UAMS’s front-line health care heroes were also collected. The donations of food go to the Stocked & Reddie food pantry sponsored by UAMS.

The new podcast "Speaking of Grief" has been launched by Arkansas Hospice.

Arkansas Hospice recently launched a new podcast, “Speaking of Grief,” as an expansion of its communitybased grief support during the COVID-19 pandemic. New episodes launch on the first of every month.

ARKANSAS HOSPITALS | SUMMER 2021 9

2021 Virtual Learning & Events

This summer, you'll find lots of webinars, webinar series, and virtual training events to meet your needs. You may access just one or every session in a series. For registration, click Calendar at arkhospitals.org. We're excited to note that in-person events will slowly ramp up beginning in July, and that an in-person Annual Meeting (revamped to accommodate COVID-19 safety precautions) is set for October 6-7 (see highlight).

JUNE-AUGUST Virtual Leadership Summit JUNE 3 | Diversity and Inclusion (Moderated Q & A) JUNE 17 | Supply Chain Excellence in the Post-Pandemic World JULY 15 | The Emotional Impact of COVID-19: Leading Your Team and Culture Past the Collective COVID PTSD to an Emotionally Healthy Workplace AUGUST 19 | A Path Forward – Thriving in Rural Healthcare after COVID-19

10 SUMMER 2021 | ARKANSAS HOSPITALS

Compliance Event

JUNE 16 | Compliance – Board Accountability and Repercussions

Employment Law Series

JUNE 22 | Session Two – From Facebook to Firearms: How to Protect Your Organization from Threats and Violence JULY 6 | Session Three – Americans with Disabilities Act: Common Examples and Best Practices AUGUST 31 | Session Four – Avoiding and Defending Retaliation Claims

Quality Improvement: A Two-Part Webinar Series JUNE 24 | Session Two – High Reliability in the Time of COVID-19

Governance: A Four-Part Webinar Series JULY 13 | Session Two – What You Should Know: Exec Compensation and Tax Exemption SEPTEMBER 14 | Session Three – Expectations of Board Oversight of Compliance Programs NOVEMBER 16 | Session Four – Cyberthreats: Board Oversight of Information Security

Quality Improvement: A Two-Part Webinar Series JULY 22 | Session One – Quality Measurement and Display AUGUST 22 | Session Two – Interpreting Data and Improvement

July 23

Arkansas Organization of Nurse Leaders ArONL 2021 Summer Conference Baptist Health Barrow Training Center, Little Rock

EMTALA Update 2021 AUGUST 4 | Session One AUGUST 11 | Session Two AUGUST 18 | Session Three

August 26

Arkansas Hospital Association Workers' Compensation Self-Insured Trust (AHAWCSIT) Board Meeting Teleconference

Join Us October 6-7 In-Person for Your Annual Meeting! Plan now to join us October 6-7 for AHA's in-person Annual Meeting, to be held at the Little Rock Marriott. Registration information for the event will be mailed soon. Check AHA's website, arkhospitals.org, for updates.

Lots of Changes for 2021:

• Two-Day, In-Person Meeting • COVID-19 Precautions Will Be Observed • No In-Person Trade Show This Year, but Lots of Giveaways • Awards Luncheon Replaces Awards Dinner

Learn from Experts, Including:

Speakers include:

Ginger Zee, author and Chief Meterologist for ABC News, will discuss her life's many adventures and her own mental health journey. Dr. Kevin Ahmaad Jenkins, national journalist, lecturer and visititing scholar with the University of Pennsylvania, will discuss cultural diversity, equity, and inclusion. Brian Uridge, Michigan Medicine security director from the University of Michigan Health System, will discuss how to achieve a culture of zero violence.

Additional Topics:

• Human Trafficking: Recognizing and Responding to Victims • Health Care in the “No Normal Era” • The Four Disciplines of Execution in Leadership • Toxic Behaviors in Health Care (ACHE 3-Hour Workshop)

Ginger Zee

Dr. Kevin Ahmaad Jenkins

Brian Uridge

ARKANSAS HOSPITALS | SUMMER 2021 11

Rick Pollack, President and Chief Executive Officer of the American Hospital Association

Lessons for the Future:

Learning from COVID-19 By Rick Pollack, President and Chief Executive Officer, American Hospital Association

hen COVID-19 hit, more than a year ago, people instinctively turned to a community cornerstone, their local hospital, for skilled treatment and compassionate care. The women and men of America’s hospitals and health systems did what they’ve always done: They continued caring for their patients and communities in the midst of this historic public health crisis. Despite huge logistical and financial challenges, they adapted, innovated, and quickly adjusted hospital operations to care for a vast and unexpected influx of patients. This total team effort included everyone from the corner office and the back office to the Boardroom. Whether nurse, physician, respiratory therapist, housekeeping staff, member of the EMT crew, or a cafeteria worker, each person made a difference.

12 SUMMER 2021 | ARKANSAS HOSPITALS

The American Hospital Association recently commissioned an original song from Musicians On Call (MOC) to honor these hospital workers and celebrate National Hospital Week and National Nurses Week, and the women and men who worked tirelessly over the last year. For more than 20 years MOC has brought the healing power of music to the bedside of patients in health care facilities. The song’s lyrics, inspired by conversations the songwriter had with front line health care workers, include a chorus that sums up the calling that so many caregivers answered: “We see what you’ve been through, this is what you’re called to do. You know this is nothing new, so just do what you’re born to do.”

From the first COVID-19 case, hospitals and health systems did what they were created to do, providing hope and healing, comfort and compassion.

Through the pandemic, hospitals and health systems and their care teams carried out their mission, doing what they were born to do. In some ways, it was “their finest hour,” words from Sir Winston Churchill that are often used by Rod Hochman, M.D., president and CEO of Providence Health in Seattle, and current chair of the AHA’s Board of Trustees, to describe the hospital field’s heroic efforts. From the first COVID-19 case, hospitals and health systems did what they were created to do, providing hope and healing, comfort and compassion. Our effective response reinforced that we are the most trusted and indispensable health partners to the communities we serve. And this response is not finished. While we can be proud of our role in saving lives and battling the pandemic, COVID-19 is still an everyday presence for America. As of this writing, the nation had reported more than 13,000 new COVID-19 cases and 387 deaths, just from the previous day. While we continue to treat and heal these COVID-19 patients, we’ve already begun to look ahead and focus on rebuilding, guided by the experiences of the last 18 months. We’re certain to see many afteraction analyses in scores of public health journals. However, for those who experienced first-hand the need

to pivot, adjust, and innovate, there are some lessons from this experience that will aid us as we reimagine our health care system for the future. There are many lessons, but here are a few that stand out.

EQUITY OF CARE

The pandemic has disproportionately affected people of color, and it highlighted long-standing disparities in health care. Data have shown that communities of color experienced disproportionately high rates of disease, death, and negative social impacts. The American Rescue Plan, passed earlier this year by Congress, provided the National Institutes of Health with $29 million to strengthen vaccine confidence and access, in addition to testing and treatment in communities of color. The new law also expanded tax credits and subsidy enhancements to a greater number of lower- and middle-income people and families, and it is projected to extend health coverage to about 800,000 uninsured people in 2021, according to the Congressional Budget Office. At the same time, COVID-19’s disproportionate impact on people of color has accelerated the integration of health equity into health care strategy playbooks across the nation, in almost every health care setting, from rural and urban hospitals to ambulatory care clinics.

As Wright L. Lassiter III, president and CEO of Henry Ford Health System and chair-elect of the AHA Board of Trustees, reminds us, “We must act on behalf of every life we serve, partnering to earnestly and courageously lift up our communities. If we fail to do this, we dare not call ourselves successful stewards of health and wellness.”

SUPPLY CHAIN DIVERSITY

It’s also become clear that we must have a greater awareness of global trends, whether they are global health issues or our supply chain structure. As we saw with COVID-19, the disease migrated with ease around the globe on a scale not seen since the 1918 influenza pandemic. This global migration had a direct impact on the production and transportation of critical medical supplies, like PPE, leading us to rethink and diversify our health care supply chain.

NEW MODELS OF CARE

In addition, hospitals had to quickly adjust how they safely cared for all patients, including those who arrived seeking care for chronic and emergency conditions, as well as those with coronavirus. This necessitated creating new models of care, expanding team-based staffing models, cross-training physicians

ARKANSAS HOSPITALS | SUMMER 2021 13

and other health care providers across specialties, and identifying alternative sites of care. Adaptability was also apparent as we realized the benefits of practice waivers that allowed health professionals to expand their scope of practice and offer a wider range of services and care options to patients. This flexibility proved its value, and we are pressing for most of the pandemic-related waivers to become permanent. Adjustments for patient safety extended to the physical layout of buildings as well, as many hospitals reacted to the need to create more adaptable space that could quickly be transformed for patient care.

beyond the four walls of the hospitals and into communities. One promising approach is the hospital-at-home model, which offers acute-level care to patients in their homes instead of a hospital. It has been shown to reduce costs, improve outcomes, and enhance the patient experience. New Mexico-based Presbyterian Healthcare Services, for instance, is one organization that found treating patients at home helps prevent the onset of delirium, reduces fall risk, reduces the risk of infection, and allows for increased mobility. This promising approach to patient convenience and improved outcomes was bolstered by the rise in remote

TELEHEALTH OPTIONS

At the same time, we saw an explosive growth in the use of telehealth, a trend that is likely here to stay. Providence Health, for example, reported an astounding jump from around 700 video visits a month pre-pandemic to 70,000 a week during the crisis. According to a McKinsey and Company survey, while just 11% of consumers used telehealth in 2019, that number jumped to 46% in 2020 as patients used telehealth to replace cancelled health care visits.

...COVID-19

is still an everyday

presence for America...

CARING FOR CAREGIVERS

It’s critical to note that while America’s caregivers are committed to caring for their patients and communities, we must take care of our health care workforce. While the pandemic prompted hospitals to pivot models of care and create temporary patient care sites, it also tested the resilience of our health care workforce as never before, inducing some to consider leaving the field altogether. This has magnified the need to create resources and provide tools to ease stress and anxiety, and increase the sense of well-being for our caregivers, enabling them to focus on their mission of providing healing care.

CONVENIENCE OF CARE

Looking ahead, we’ll continue to see more emphasis on providing care that is not only safe for patients but convenient as well, continuing the trend of taking care

14 SUMMER 2021 | ARKANSAS HOSPITALS

patient monitoring through the use of wearable devices that kept patients in their homes and sent critical care data to their providers for analysis, limiting patient exposure to the virus. These are just a few of the critical lessons that will become embedded into our hospital operations moving forward, as we continue to coexist with COVID-19 for the foreseeable future. This all adds up to a health care delivery system that will look different in coming years: one that is more centered on home care and patient convenience, more reliant on telehealth and technology in general, and more focused on the prevention and management of chronic conditions.

CHANGE, CHALLENGE, OPPORTUNITY

This is a time of tremendous change and challenge for our field, but also of great opportunity. As we prepare for tomorrow, we must continue to focus on our core mission of caring for patients and communities, redefining the “H” in a way that ensures hospitals remain irreplaceable cornerstones of their communities, fulfilling a role that chain drugstores and other new competitors in the marketplace cannot. We are always open, 24 hours a day, 7 days a week, 365 days a year. And we will continue to be that cornerstone, while exploring new collaborations, partnerships, and models to continue their legacy of caring. At the same time, hospitals and health systems will continue to attract dedicated women and men who are called to provide healing, hope, and health, like Jordan Northcutt, a facilities manager with Baptist Health Medical Center in North Little Rock. For the AHA video that celebrated 2021 National Hospital Week, Jordan said: “I went into this profession because I like giving back to people. Working in a health care system, to me, is one of the most rewarding things you can do … to know that you’re giving back to your community.” This dedication is why people depend on their local hospitals, turn first to hospitals in times of great joy and great sorrow, and it’s why they always will. Hospital teams’ bravery, compassion, and unwavering dedication have saved countless lives, helping to restore families and preserve entire communities.

You may access the song “Worth Fighting For,” commissioned by the American Hospital Association to honor thonor the work of health care workers, by accessing the QR code below.

WORTH FIGHTING FOR

Words and music by Brailey Lenderman and Chris Sligh VERSE 1: I know you feel alone in this place Standing your ground, coming face to face With people’s lives falling apart Keeping it together by a thread Cuz you keep on giving till there’s nothing left It won’t always be this hard PRE-CHORUS: Yeah you know it’s nothing new This is what you’re called to do, and... CHORUS: That’s something worth fighting for A feeling that you can’t ignore When the whole world’s trying just to bring you down In the silence you can live out loud CUZ YOU KNOW You can feel it down to your core It’s love but it’s so much more...It’s something worth fighting for VERSE 2: I know you feel invisible But we see you, (pause) and you’re incredible (pause) You’re not by yourself, yeah, we’re here with you too No, ya can’t deny What you feel inside Just hold your head up high Cuz you know you know the truth CHORUS BRIDGE: Yeah we see what you’ve been through This is what you’re called to do Yeah you know this is nothing new So just do what you’re born to do, cuz CHORUS

Scan this QR code to hear the song

ARKANSAS HOSPITALS | SUMMER 2021 15

In early March of 2020 Erin Bolton, Jefferson Regional's Director of Quality Management (left), helped her hospital care for the state's first documented COVID-19 patient. Today, she manages the hospital's vaccination efforts. Pine Bluff Mayor Shirley Washington (right) sets a healthy example by receiving her vaccine at the hospital's first community vaccination clinic.

Full Circle:

Infection Control from the First Confirmed Case to Vaccinations By Lisa Rowland

ike many professional women, Erin Bolton, RN, is accustomed to a certain amount of chaos. As a wife, mother, church leader, and Director of Quality Management at Jefferson Regional in Pine Bluff, Erin has always juggled numerous responsibilities. But when her hospital became the first in Arkansas to identify a confirmed COVID-19 patient, all the balls came tumbling down … at least for a minute or two. On Wednesday, March 11 of 2020, a group of Jefferson Regional’s managers and directors were gathering for their 9 a.m. safety huddle when Erin received a call on her cell phone from a Little Rock number. “I was expecting to hear from the state health department,” Erin says. “We had sent off a COVID test earlier in the week, so

16 SUMMER 2021 | ARKANSAS HOSPITALS

I decided I’d better take the call. Kat Waters from the Arkansas Department of Health said, ‘Erin, I need you to sit down.’ I replied, ‘No, I don’t. I know what you’re about to tell me.’ But Kat was doing more than just delivering word about a positive test. She said, ‘You have the first COVID patient in the state of Arkansas.’ I grabbed a pen as she said, ‘OK, I have a list of things I need you to do, and we will call you back in an hour.’”

FIRST POSITIVE TEST IN ARKANSAS

Though Erin was momentarily shocked by the news, she was not unprepared. “We were readying in advance for COVID patients, and immediately set a 10 a.m. meeting to activate our internal command center,” she says.

It made us all realize that we had to do something different to protect ourselves from burnout.

As with all bad news, word traveled fast. “We contacted the health department, and from them we learned that Governor Asa Hutchinson was going on live television with the news at 10:15 a.m.,” Erin says. “As we immediately called hospital managers and directors, we found they were already hearing the news from family and friends.” That first patient was initially referred to as “Patient Zero” in order to protect his privacy. He was admitted to Jefferson Regional on Friday, March 6, was tested the next Monday, and as a precaution he was placed in isolation. “By the time he was diagnosed on March 11 he had already been in our facility for 48 to 72 hours,” Erin recalls. “Employees were calling in sick – people who had cared for him over the weekend. So, as we started looking back on the timing and who had been in contact with him, we had to devise ways to get all those people tested.” In the beginning, the infection control team created a grid to map and track known infections. It resembled a criminal investigation grid, with known infections all tracing back to Patient Zero. “It spread from his family members to other community members with whom he had contact. We further traced the spread to Jefferson Regional staff members who got sick after having contact with him (before

he was placed in isolation), their family members who got sick, physicians who cared for him and then became ill, and the possible infections that may have snowballed to their patients and families,” Erin remembers. That was the picture in the earliest days of the virus in Pine Bluff, and it was happening while Jefferson Regional staff were setting up their internal command center.

FINE-TUNING ON THE FLY

The Jefferson Regional command center consisted of leaders from every area of the hospital – from nursing and medical staff to environmental services, materials management, marketing, and, of course, infection control, which is one of Erin’s direct job responsibilities. It was a relief to have a master plan in place, but it was still untested ground, and the first few days were extremely tense. “We were there pretty late every night because it seemed like each time we tried to go home, the department of health would call with more results,” Erin says. “And each time they called with more results, we had to notify family members, patients, and employees. We worked all weekend the first weekend because it seemed like something major changed every day.”

Masking regulations were in flux. “First, staff members only had to wear a mask if they were taking care of a COVID-19 patient,” she recalls. “Then, anyone caring for patients anywhere in the hospital had to wear a mask, and then it shifted to everyone entering the hospital was required to be masked. “Of course, we had to get our screening stations up and going, and we needed to decide exactly what information to collect from those entering the hospital,” she continues. “We then had to decide what to do about visitors. And while these decisions were being made, we were simultaneously getting reports (every two and three hours) from the department of health with new results.” To keep testing results timely, Jefferson Regional staff members sometimes found it necessary to drive tests to Little Rock for processing. “Courier service was sometimes available, but there were many nights and weekends that one of us drove tests to Little Rock.” Ultimately, Jefferson Regional designated two wings strictly for COVID-19 patients, reserving most of the ICU beds for these patients as well. At the height of the pandemic, there were 27 inpatient COVID-19 patients being cared for at one time.

ARKANSAS HOSPITALS | SUMMER 2021 17

CONCERN FOR OUR FAMILIES

Jefferson Regional School of Nursing students received lots of practice getting shots into arms at the hospital's community vaccination clinics.

While Erin spent most of her day managing the pandemic, she was also worried about the safety and security of her own family. She is married to Bryan Bolton, Minister of Music and Children at First Baptist Church in Pine Bluff, and the couple has a daughter in college and a 14-year-old son. “On March 11, when I got that first phone call, I had my laptop at safety huddle, but I didn’t have the power cord, so I went back to my office to grab the cord. While I was upstairs, I called Bryan,” she says, her voice breaking at the memory. “I said, ‘I need you to know this. I don’t know when I’ll see you again.’” “I’m used to working on big projects,” she continues. “I’ve implemented software upgrades and helped to integrate new software. When I worked for Hospice, I evacuated patients during extreme flooding in South Arkansas, making certain we maintained our ability to care for them. I’m used to high-stress and busy situations, but in those instances, we could always go home and get away. “With COVID, we couldn’t simply go home, because restrictions affected the entire family. The first couple of weeks it was fine; it was kind of like an extra spring break. But then the kids couldn’t go anywhere.” Safety restrictions extended to the church, where Erin is a youth leader. “We didn’t go to church for a couple of weeks, we canceled all activities. But how do you minister in this situation? We started virtual church, and then parking lot church, those kinds of things. Like everyone else, I couldn’t see my parents or my brothers and sisters. Every part of my life was affected by COVID-19. Just trying to make sure everything got done, trying to keep everyone relatively happy, it was extremely difficult.”

STRESS CARE FOR CAREGIVERS

It was so difficult that three weeks into the crisis, the entire command center team got a serious wake-up call. “On April 1, I ended up in the emergency department with blood pressure at stroke level,” Erin says. “It made us all realize that we had to do something different to protect ourselves from burnout.” The next step became developing self-care processes for those watching over others. “It sounds like a no-brainer, but the command center team started taking breaks, no matter how busy we were,” Erin says. “Then we started cross training, to make sure there was someone else who could do our job in case we had to be out. Once the initial chaos calmed down, we also started staggering our work schedules, so we might work two or three days in the command center and then have two or three days to go back to our offices and catch up on other work.”

CLEAR COMMUNICATION

Erin Bolton delivers the vaccine to her 14-year-old son, Keith. He became eligible to be vaccinated when Arkansas approved shots for those aged 12-15.

18 SUMMER 2021 | ARKANSAS HOSPITALS

Implementing a timeline for release of information also relieved some of the pressure. “If we received updated guideline information on a Friday, unless it was critical, we would make it effective Monday, so we had time to get the word out,” she explains. “Rather than just saying, ‘Everybody’s got to wear a mask now,’ we were clear in the who, what, when, where, and why. ‘Starting Monday, everyone in the hospital will wear

ARKANSAS HOSPITALS | SUMMER 2021 19

a mask. Here is the plan, this is where can you get one, this is why we’re doing it.’ We found that very few guidelines had to be implemented immediately, and that clear communication was imperative to our success. We had to be realistic – we had to get the word out to first shift, second shift, weekend crew – so we would give ourselves a day or two to disseminate the information. “We’ve expanded the way we communicate, as well,” Erin says. “We can share information in safety huddle, we can send a memo out, but if information applies to everyone, we now share it on the electronic communication boards that are located around the hospital. That way the messages are being shown in multiple locations and are universally available.”

DECREASE IN CASES, THEN STORM OUTAGES

The months went by, COVID-19 cases began to drop, and health care workers began to see a light at the end of the tunnel. However, in February of 2021, an extreme snowstorm hit South Arkansas. Over a five-day period, the Pine Bluff area received between 18 and 22 inches of snow, bringing transportation in the area to a standstill. A smaller version of the emergency command center re-opened. Its first task was getting needed staff to the hospital. Security workers and executive staff members including Jefferson Regional’s President and CEO, Brian Thomas, joined together and, using four-wheel-drive vehicles borrowed from a local dealership, began picking up employees and taking them home. But, as the snow stopped falling, extensive water line breaks and a lack of water pressure were discovered around Pine Bluff, greatly limiting Jefferson Regional’s access to water, as well as the ability to care for patients. Command center staff worked within the hospital and with community leaders; it took more than a week to begin solving the water crisis and then to restore much-needed services at the hospital. “At first, there were only one or two people trying to coordinate all of this,” Erin says. “Because of our experience with COVID-19, we knew it took a full team to tackle any type of response plan, so our preparation allowed us to quickly open the snow command center.”

Clear communication was imperative to our success.

A NEW SOLUTION

While COVID-19 is still a significant threat, Jefferson Regional currently averages only a few COVID patients each week. Though hospital safety precautions are still heightened, the focus is now largely on vaccinations. “When we first learned we would have access to the vaccine, our first step was to create an online waiting list where people could sign up for vaccinations,” Erin says. “We called when the vaccine arrived to set up their appointments. Step two was identifying locations for large vaccine clinics. We wanted facilities sizable enough to physically space the patients from one another, but not too large for older people to easily manage. We also wanted to reach a wide variety of the community, including our minority populations. We held clinics in Pine Bluff at First Baptist Church, New St. Hurricane Baptist Church, and the University of Arkansas at Pine Bluff. Clinics were also held at the White Hall Community Center and at Drew Memorial 20 SUMMER 2021 | ARKANSAS HOSPITALS

It's remarkable to see the joy in people's eyes as they finally receive their COVID-19 vaccinations!

Hospital in Monticello. As soon as the age limit was lowered to include ages 16-17, we also conducted clinics at Pine Bluff High School and White Hall High. When the age limit dropped again to age 12, White Hall Middle School contacted us just before school was out, and we gave 101 shots there to students aged 12-15.”

NURSING STUDENTS GAIN EXPERIENCE

One bright spot in the vaccination stage of the pandemic is the service of students from the Jefferson Regional School of Nursing. “We couldn’t have done it without their people-power,” Erin says. “The students are allowed to use their hours vaccinating patients as clinical hours to replace time lost because COVID-19 kept them from the hospital. That senior class began in January of 2020 and got hit with COVID-19 in March. The students knew nursing school was going to be tough, but when they started as seniors in January, they had no idea it was going to be like this.” The hospital has given more than 9,600 shots to community members since vaccines became available. And after many months in the hospital and rehab, Patient Zero has recovered from the virus and recently visited some of the Jefferson Regional nurses who cared for him. Looking back, Erin Bolton realizes she was a key player in a historic event. “I got the first call, was part of the initial response and care planning all the way through,” she says. “Now, it’s come full circle and I’m heading up the vaccination effort. Those 9,600+ shots represent people to whom we’ve given a little bit of hope and encouragement. They can see their families again. They’ve missed weddings and graduations; they’ve missed grandbabies being born. It’s a privilege to serve with my Jefferson Regional team. Hopefully, we are a part of giving our community members their lives back.” Lisa Rowland, a member of Jefferson Regional's marketing team for more than 25 years, currently serves as its Advertising/Promotions Specialist. You may reach her at RowlandL@JRMC.org.

Quality Care Rooted in Arkansas

hope Is The Foundation. recovery Is The Journey. In response to the growing needs of our community, The BridgeWay has expanded its continuum of care for substance use disorders. The acute rehabilitation program will provide hope and recovery for adults struggling with substance use disorders. Led by Dr. Schay, and a Board Certified Psychiatrist and Addictionologist, the Substance Use Disorder Rehabilitation Program is for adults at risk of relapse. Rehabilitation requires the supportive structure of a 24-hour therapeutic environment. To learn more about our continuum of care for substance use disorders, call us at 1-800-245-0011.

Dr. Schay

Physicians are on the medical staff of The BridgeWay Hospital but, with limited exceptions, are independent practitioners who are not employees or agents of The BridgeWayHospital. The facility shall not be liable for actions or treatments provided by physicians.

Medical Director Of Substance Use Disorders & Patriot Support Program

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ARKANSAS HOSPITALS | SUMMER 2021 21

22 SUMMER 2021 | ARKANSAS HOSPITALS

2021

HOSPITAL STATISTICS

ARKANSAS HOSPITAL ASSOCIATION 2021 HOSPITAL STATISTICS 25 COVID-19 Response by the Numbers 26 Arkansas Hospitals 2021 by the Numbers 27 Member Organizations by Type 28 AHA Members by City, Type, Size, and Services 30 Statewide Hospital Financial and Utilization Indicators, 2015-2019 31 Arkansas Hospitals Receiving Local Tax Support, 2021 32 Key Financial Indicators: Arkansas and Surrounding States, 2019 33 Comparative Financial Indicators: U.S. Community Hospitals 34 Hospital Access by County 35 AHA-Member Organizations by Congressional District 36 AHA Members by Control and System Affiliation 38 Inpatient and Emergency Department Discharges by Payer, 2019 Uninsured Inpatient Admissions and Costs, 2010-2019

39 Hospital Uncompensated Care Costs, 2015-2019

Top 20 DRGs, 2019

40 Arkansas Hospitals Locator Map, 2021

Hospital Statistics uses the latest data available. This year, most of the financial and utilization data come from 2019. Because these predate the COVID-19 pandemic, they do not reflect the difficulties faced by Arkansans and our healthcare system in 2020 and 2021. Data from the COVID-19 pandemic will be better represented beginning in the Summer 2022 edition of Hospital Statistics. We thank AHA Vice President of Financial Policy and Data Analytics Melanie Thomasson for compiling this annual edition of Hospital Statistics.

24 SUMMER 2021 | ARKANSAS HOSPITALS

ARKANSAS HOSPITALS’ COVID-19 RESPONSE BY THE NUMBERS 44% of adult Arkansans are at higher risk of severe complications

due to COVID-19 because of their underlying health-related conditions. Hospitals across the state stood up testing centers in Spring 2020, helping increase the daily testing in Arkansas by more than 400% between April and June. In the first year of the pandemic, Arkansas hospitals cared for nearly 15,000 inpatients confirmed to have COVID-19. In mid-January, at the height of the Winter 2020-21 surge, hospitals reported more than 1,300 inpatients with confirmed COVID-19, representing 20% of the total hospitalized patient population. Hospitals are integral to the vaccination effort and worked with other providers in the state to vaccinate more than 1 million Arkansans in the first six months of the COVID-19 vaccination effort.

HOSPITALIZED COVID-19 PATIENTS IN ARKANSAS Hospitalized COVID-19 Patients in Arkansas Midnight Snapshot, 4/9/20 - 6/9/21 Midnight Snapshot, 4/9/20 - 6/9/21

1400 1200 1000 800 600 400 200 0 9-Apr 9-May 9-Jun

9-Jul

9-Aug

9-Sep

9-Oct

Confirmed in ICU beds

9-Nov 9-Dec

9-Jan

Confirmed in Other Beds

9-Feb 9-Mar

9-Apr 9-May 9-Jun

Suspected

Source: Self-reported by hospitals to EMResource

ARKANSAS HOSPITALS | SUMMER 2021 25

ARKANSAS HOSPITALS 2021 BY THE NUMBERS 113

Hospitals of all types are located in cities, towns and communities throughout Arkansas.

105

Hospitals and other health care organizations are members of the Arkansas Hospital Association.

Community hospitals have fewer than 100 acute care beds.

Hospitals are designated by the federal government as Critical Access Hospitals, having no more than 25 acute care beds.

Counties are served by a single hospital. Eighteen of those counties are served by a single Critical Access Hospital.

Counties in the state count hospitals among their top five employers. In 22 counties, a hospital is among the top three employers.

Arkansas counties and cities believe their hospitals to be important enough that people in those areas have voted to provide local tax support for the hospital.

Arkansas counties – nearly 30% of all counties in the state – do not have a local community hospital.

62%

Of AHA member organizations are charitable, not-for-profit organizations, while 25% are operated by private, for-profit companies, and 13% are public hospitals owned and operated by a city, county, state or federal government.

AHA members are designated Trauma Centers within the comprehensive, statewide trauma system, which was instrumental in helping develop the COVIDComm transfer system during the pandemic.

18,725

Arkansans sought inpatient or outpatient care from the state’s hospitals each day in 2019, on average, for illnesses, injuries, and other conditions that required medical attention.

34,678

Newborns were delivered in Arkansas hospitals in 2019. The Arkansas Medicaid program covered 68% of them.

26 SUMMER 2021 | ARKANSAS HOSPITALS

ARKANSAS HOSPITAL ASSOCIATION MEMBER ORGANIZATIONS BY TYPE, 2021 General Med-Surg Hospitals (44) Inpatient Psych Hospitals (11) Arkansas Methodist Medical Center Baptist Health Medical Center-Conway Baptist Health Medical CenterHot Spring County Baptist Health Medical Center-Little Rock Baptist Health Medical CenterNorth Little Rock Baptist Health Medical Center-Stuttgart Baptist Health-Fort Smith Baptist Health-Van Buren Baptist Memorial Hospital-Crittenden Baxter Regional Medical Center Chambers Memorial Hospital CHI St. Vincent Hot Springs CHI St. Vincent Infirmary CHI St. Vincent North Conway Regional Health System Drew Memorial Health System Forrest City Medical Center Great River Medical Center Helena Regional Medical Center Jefferson Regional Johnson Regional Medical Center Levi Hospital Magnolia Regional Medical Center Medical Center of South Arkansas Mena Regional Health System Mercy Hospital Fort Smith Mercy Hospital Northwest Arkansas National Park Medical Center NEA Baptist Memorial Hospital North Arkansas Regional Medical Center Northwest Health Physicians' Specialty Hospital Northwest Medical Center Bentonville Northwest Medical Center Springdale Ouachita County Medical Center Saint Mary's Regional Medical Center Saline Memorial Hospital Siloam Springs Regional Hospital St. Bernards Five Rivers St. Bernards Medical Center UAMS Medical Center Unity Health Unity Health - Harris Medical Center Washington Regional Medical System White River Health System

Arkansas State Hospital Conway Behavioral Health Methodist Behavioral Hospital Perimeter Behavioral Hospital of West Memphis Pinnacle Pointe Behavioral Healthcare System Rivendell Behavioral Health Services Riverview Behavioral Health Springwoods Behavioral Health Hospital The BridgeWay Valley Behavioral Health System Vantage Point of NWA

Inpatient Rehab Hospitals (5)

Baptist Health Rehabilitation Institute CHI St. Vincent Hot Springs Rehabilitation Hospital CHI St. Vincent Sherwood Rehabilitation Hospital Conway Regional Rehabilitation Hospital Encompass Health Rehabilitation Hospital

Veterans Affairs Hospitals (2)

Central Arkansas Veterans Healthcare System Veterans Healthcare System of the Ozarks

Long Term Care Hospitals (6)

Advanced Care Hospital of White County Arkansas Continued Care Hospital Ashley County Medical Center Baptist Health Medical Center-Arkadelphia of Jonesboro Baptist Health Extended Care Hospital Baptist Health Medical CenterCHRISTUS Dubuis Hospital of Fort Smith Heber Springs CHRISTUS Dubuis Hospital of Bradley County Medical Center Hot Springs CHI St. Vincent Morrilton Cornerstone Speciality Hospitals Chicot Memorial Medical Center Little Rock CrossRidge Community Hospital Dallas County Medical Center Special Focus Hospitals (3) Dardanelle Regional Medical Center Arkansas Children's Hospital Delta Health System Arkansas Children's Northwest DeWitt Hospital & Nursing Home Willow Creek Women's Hospital Eureka Springs Hospital Fulton County Hospital Out-of-State Border City Howard Memorial Hospital Hospitals (2) Izard County Medical Center CHRISTUS St. Michael Health System Lawrence Memorial Hospital Regional One Health Little River Medical Center McGehee Hospital Non-Hospital Facilities (3) Mercy Hospital Berryville 19th Medical Group Mercy Hospital Booneville Arkansas Hospice Mercy Hospital Ozark CARTI Mercy Hospital Paris Mercy Hospital Waldron New, Under Construction (1) Ozark Health Medical Center Sevier County Medical Center Ozarks Community Hospital Piggott Community Hospital SMC Regional Medical Center Stone County Medical Center

Critical Access Hospitals (28)

ARKANSAS HOSPITALS | SUMMER 2021 27

AHA MEMBERS BY CITY, TYPE, SIZE, AND SERVICES LICENSED BEDS

TRAUMA SYSTEM

MEDICAL-SURGICAL

LEVEL IV

MEDICAL-SURGICAL

VALLEY BEHAVIORAL HEALTH SYSTEM

PSYCHIATRIC

114

BATESVILLE

WHITE RIVER HEALTH SYSTEM

MEDICAL-SURGICAL

210

BENTON

RIVENDELL BEHAVIORAL HEALTH SERVICES

PSYCHIATRIC

BENTON

SALINE MEMORIAL HOSPITAL

MEDICAL-SURGICAL

177

LEVEL III

OB/PSYCH/REHAB/HH

BENTONVILLE

NORTHWEST MEDICAL CENTER BENTONVILLE

MEDICAL-SURGICAL

128

LEVEL III

HH/PALL

BERRYVILLE

MERCY HOSPITAL BERRYVILLE

MEDICAL-SURGICAL

BLYTHEVILLE

GREAT RIVER MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

BOONEVILLE

MERCY HOSPITAL BOONEVILLE

MEDICAL-SURGICAL

LEVEL IV

SB/HH/PALL

CALICO ROCK

IZARD COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

CAMDEN

OUACHITA COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

OB/PSYCH/SB/SNF/REHAB/HH

CLARKSVILLE

JOHNSON REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

OB/PSYCH/REHAB/HH

CLINTON

OZARK HEALTH MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

SB/SNF/HH

CONWAY

BAPTIST HEALTH MEDICAL CENTER-CONWAY

MEDICAL-SURGICAL

111

LEVEL III

OB/REHAB

CONWAY

CONWAY BEHAVIORAL HEALTH

PSYCHIATRIC

CONWAY

CONWAY REGIONAL HEALTH SYSTEM

MEDICAL-SURGICAL

150

CONWAY

CONWAY REGIONAL REHABILITATION HOSPITAL

REHABILITATION

CROSSETT

ASHLEY COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

OB/SB/REHAB/HH

DANVILLE

CHAMBERS MEMORIAL HOSPITAL

MEDICAL-SURGICAL

LEVEL IV

PSYCH/SB/HH

DARDANELLE

DARDANELLE REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

SB/PSYCH/HH

DEWITT

DEWITT HOSPITAL & NURSING HOME

MEDICAL-SURGICAL

DUMAS

DELTA HEALTH SYSTEM

MEDICAL-SURGICAL

EL DORADO

MEDICAL CENTER OF SOUTH ARKANSAS

MEDICAL-SURGICAL

166

LEVEL III

OB/REHAB

EUREKA SPRINGS

EUREKA SPRINGS HOSPITAL

MEDICAL-SURGICAL

LEVEL IV

SB/HH

FAYETTEVILLE

ENCOMPASS HEALTH REHABILITATION HOSPITAL

REHABILITATION

FAYETTEVILLE

NORTHWEST HEALTH PHYSICIANS' SPECIALTY HOSPITAL

MEDICAL-SURGICAL

FAYETTEVILLE

SPRINGWOODS BEHAVIORAL HEALTH HOSPITAL

PSYCHIATRIC

PSYCH

FAYETTEVILLE

VANTAGE POINT OF NWA

PSYCHIATRIC

114

PSYCH

FAYETTEVILLE

VETERANS HEALTHCARE SYSTEM OF THE OZARKS

VETERANS ADMIN.

FAYETTEVILLE

WASHINGTON REGIONAL MEDICAL SYSTEM

MEDICAL-SURGICAL

425

LEVEL II

HH/PALL

FORDYCE

DALLAS COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

SB/HH

FORREST CITY

FORREST CITY MEDICAL CENTER

MEDICAL-SURGICAL

118

LEVEL IV

OB/PSYCH/SB/HH

FORT SMITH

BAPTIST HEALTH-FORT SMITH

MEDICAL-SURGICAL

492

LEVEL III

PSYCH/HH

FORT SMITH

CHRISTUS DUBUIS HOSPITAL OF FORT SMITH

LONG TERM CARE

FORT SMITH

MERCY HOSPITAL FORT SMITH

MEDICAL-SURGICAL

348

GRAVETTE

OZARKS COMMUNITY HOSPITAL

MEDICAL-SURGICAL

HARRISON

NORTH ARKANSAS REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

174

LEVEL III

OB/PSYCH/HH

HEBER SPRINGS

BAPTIST HEALTH MEDICAL CENTER-HEBER SPRINGS

MEDICAL-SURGICAL

LEVEL IV

SB/HH

HELENA

HELENA REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

155

HOT SPRINGS

CHI ST. VINCENT HOT SPRINGS

MEDICAL-SURGICAL

282

HOT SPRINGS

CHI ST. VINCENT HOT SPRINGS REHABILITATION HOSPITAL

REHABILITATION

REHAB

HOT SPRINGS

CHRISTUS DUBUIS HOSPITAL OF HOT SPRINGS

LONG TERM CARE

PALL

HOT SPRINGS

LEVI HOSPITAL

MEDICAL-SURGICAL

PSYCH/REHAB

HOT SPRINGS

NATIONAL PARK MEDICAL CENTER

MEDICAL-SURGICAL

163

OB/PSYCH/REHAB

JACKSONVILLE

19TH MEDICAL GROUP

INFIRMARY

JOHNSON

WILLOW CREEK WOMEN'S HOSPITAL

MED-SURG (OB/GYN)

JONESBORO

ARKANSAS CONTINUED CARE HOSPITAL OF JONESBORO

LONG TERM CARE

JONESBORO

NEA BAPTIST MEMORIAL HOSPITAL

MEDICAL-SURGICAL

228

LEVEL IV

OB/REHAB/PALL

JONESBORO

ST. BERNARDS MEDICAL CENTER

MEDICAL-SURGICAL

440

LEVEL III

OB/PSYCH/HH/PALL

LAKE VILLAGE

CHICOT MEMORIAL MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

SB/HH

LITTLE ROCK

ARKANSAS CHILDREN'S HOSPITAL

MED-SURG (PED)

336

LEVEL I

REHAB/PALL

LITTLE ROCK

ARKANSAS HOSPICE

INPATIENT HOSPICE

CITY

HOSPITAL

TYPE OF HOSPITAL

ARKADELPHIA

BAPTIST HEALTH MEDICAL CENTER-ARKADELPHIA

ASHDOWN

LITTLE RIVER MEDICAL CENTER

BARLING

28 SUMMER 2021 | ARKANSAS HOSPITALS

ADDITIONAL SERVICE LINES OB/SB/HH SB/ICF/HH PSYCH

LEVEL III

OB/PSYCH/SNF/REHAB/PALL PSYCH

SB/HH/PALL

SB/HH

PSYCH LEVEL III

OB/PSYCH/REHAB/HH/PALL REHAB

SB/ICF SB/HH

REHAB

PSYCH

PALL LEVEL III

REHAB/HH SB

OB/SB/HH LEVEL II

OB/PSYCH/REHAB/HH

PALL

AHA MEMBERS BY CITY, TYPE, SIZE, AND SERVICES LICENSED BEDS

TRAUMA SYSTEM

CITY

HOSPITAL

TYPE OF HOSPITAL

LITTLE ROCK

ARKANSAS STATE HOSPITAL

PSYCHIATRIC

222

LITTLE ROCK

BAPTIST HEALTH EXTENDED CARE HOSPITAL

LONG TERM CARE

LITTLE ROCK

BAPTIST HEALTH MEDICAL CENTER-LITTLE ROCK

MEDICAL-SURGICAL

843

LITTLE ROCK

BAPTIST HEALTH REHABILITATION INSTITUTE

REHABILITATION

120

LITTLE ROCK

CARTI

OP CANCER CENTER

LITTLE ROCK

CENTRAL ARKANSAS VETERANS HEALTHCARE SYSTEM

VETERANS AFFAIRS

635

LITTLE ROCK

CHI ST. VINCENT INFIRMARY

MEDICAL-SURGICAL

615

LITTLE ROCK

CORNERSTONE SPECIALITY HOSPITALS LITTLE ROCK

LONG TERM CARE

LITTLE ROCK

PINNACLE POINTE BEHAVIORAL HEALTHCARE SYSTEM

PSYCHIATRIC

127

LITTLE ROCK

UAMS MEDICAL CENTER

MEDICAL-SURGICAL

450

LEVEL I

OB/PALL

MAGNOLIA

MAGNOLIA REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

OB/SB/HH

MALVERN

BAPTIST HEALTH MEDICAL CENTER-HOT SPRING COUNTY

MEDICAL-SURGICAL

LEVEL IV

PSYCH/SB/HH

MAUMELLE

METHODIST BEHAVIORAL HOSPITAL

PSYCHIATRIC

MCGEHEE

MCGEHEE HOSPITAL

MEDICAL-SURGICAL

MEMPHIS, TN

REGIONAL ONE HEALTH

MEDICAL-SURGICAL

620

LEVEL I

MENA

MENA REGIONAL HEALTH SYSTEM

MEDICAL-SURGICAL

LEVEL IV

MONTICELLO

DREW MEMORIAL HEALTH SYSTEM

MEDICAL-SURGICAL

MORRILTON

CHI ST. VINCENT MORRILTON

MEDICAL-SURGICAL

LEVEL IV

SB/HH

MOUNTAIN HOME

BAXTER REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

268

LEVEL III

OB/PSYCH/REHAB/HH

MOUNTAIN VIEW

STONE COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

NASHVILLE

HOWARD MEMORIAL HOSPITAL

MEDICAL-SURGICAL

LEVEL IV

SB/HH

NEWPORT

UNITY HEALTH - HARRIS MEDICAL CENTER

MEDICAL-SURGICAL

133

LEVEL IV

SB/PSYCH

NORTH LITTLE ROCK

BAPTIST HEALTH MEDICAL CENTER-N. LITTLE ROCK

MEDICAL-SURGICAL

225

LEVEL III

OB/REHAB/PALL

NORTH LITTLE ROCK

THE BRIDGEWAY

PSYCHIATRIC

127

OSCEOLA

SMC REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

OZARK

MERCY HOSPITAL OZARK

MEDICAL-SURGICAL

LEVEL IV

SB/HH/PALL

PARAGOULD

ARKANSAS METHODIST MEDICAL CENTER

MEDICAL-SURGICAL

129

LEVEL IV

OB/SB/REHAB/HH

PARIS

MERCY HOSPITAL PARIS

MEDICAL-SURGICAL

LEVEL IV

SB/HH/PALL

PIGGOTT

PIGGOTT COMMUNITY HOSPITAL

MEDICAL-SURGICAL

LEVEL IV

SB/HH

PINE BLUFF

JEFFERSON REGIONAL

MEDICAL-SURGICAL

300

LEVEL III

OB/PSYCH/REHAB/HH

POCAHONTAS

ST. BERNARDS FIVE RIVERS

MEDICAL-SURGICAL

LEVEL IV

PSYCH/SB/HH

ROGERS

MERCY HOSPITAL NORTHWEST ARKANSAS

MEDICAL-SURGICAL

208

LEVEL III

REHAB/HH

RUSSELLVILLE

SAINT MARY'S REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

170

LEVEL III

OB/PSYCH/REHAB

SALEM

FULTON COUNTY HOSPITAL

MEDICAL-SURGICAL

LEVEL IV

SEARCY

ADVANCED CARE HOSPITAL OF WHITE COUNTY

LONG TERM CARE

SEARCY

UNITY HEALTH

MEDICAL-SURGICAL

438

LEVEL III

OB/PSYCH/REHAB/HH/PALL

SHERWOOD

CHI ST. VINCENT NORTH

MEDICAL-SURGICAL

LEVEL IV

HH/PALL

SHERWOOD

CHI ST. VINCENT SHERWOOD REHABILITATION HOSPITAL

REHABILITATION

SILOAM SPRINGS

SILOAM SPRINGS REGIONAL HOSPITAL

MEDICAL-SURGICAL

LEVEL IV

SPRINGDALE

ARKANSAS CHILDREN'S NORTHWEST

MED-SURG (PED)

LEVEL IV

SPRINGDALE

NORTHWEST MEDICAL CENTER SPRINGDALE

MEDICAL-SURGICAL

222

LEVEL III

OB/PSYCH/SB/REHAB/HH

STUTTGART

BAPTIST HEALTH MEDICAL CENTER-STUTTGART

MEDICAL-SURGICAL

LEVEL IV

OB/SB/PALL

TEXARKANA

RIVERVIEW BEHAVIORAL HEALTH

PSYCHIATRIC

TEXARKANA, TX

CHRISTUS ST. MICHAEL HEALTH SYSTEM

MEDICAL-SURGICAL

312

LEVEL III

VAN BUREN

BAPTIST HEALTH-VAN BUREN

MEDICAL-SURGICAL

105

LEVEL IV

WALDRON

MERCY HOSPITAL WALDRON

MEDICAL-SURGICAL

LEVEL IV

WALNUT RIDGE

LAWRENCE MEMORIAL HOSPITAL

MEDICAL-SURGICAL

SB/PALL

WARREN

BRADLEY COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

OB/PSYCH/SB/HH

WEST MEMPHIS

BAPTIST MEMORIAL HOSPITAL-CRITTENDEN

MEDICAL-SURGICAL

WEST MEMPHIS

PERIMETER BEHAVIORAL HOSPITAL OF W. MEMPHIS

PSYCHIATRIC

WYNNE

CROSSRIDGE COMMUNITY HOSPITAL

MEDICAL-SURGICAL

ADDITIONAL SERVICE LINES PSYCH PALL

LEVEL II

OB/PSYCH/SNF/HH/PALL PALL PSYCH/REHAB

LEVEL II

PSYCH/HH/PALL PSYCH

SB OB/PSYCH/REHAB OB/PSYCH/SB/REHAB/HH

PSYCH

PALL

REHAB OB/SB/PALL

PSYCH

SB/HH/PALL

SB/HH

OB=Obstetrics, Psych=Psychatric, SB=Swing Beds, ICF=Intermediate Care Facility, SNF=Skilled Nursing Facility, Rehab=Rehabilitation, HH=Home Health, Hosp=Hospice Sources: American Hospital Association, Hospital Statistics 2021; Arkansas Department of Health

ARKANSAS HOSPITALS | SUMMER 2021 29

STATEWIDE HOSPITAL FINANCIAL AND UTILIZATION INDICATORS, 2015 - 2019 INDICATOR

2015

2016

2017

2018

2019

BEDS AVAILABLE

9,569

9,634

9,664

9,517

9,145

ADMISSIONS

357,286

359,359

363,070

358,222

364,291

PATIENT DAYS

1,859,244

1,846,634

1,861,122

1,828,470

1,826,976

AVG. LENGTH OF STAY

5.2

5.1

5.0

NON-EMERGENCY OP VISITS

4,184,351

4,570,177

4,629,383

4,925,120

4,914,195

OUTPATIENT VISITS

5,676,710

6,086,166

6,148,539

6,434,568

6,470,401

73.7%

75.1%

75.3%

76.5%

75.9%

3,942,232

3,963,653

4,125,703

4,148,600

4,276,157

53.2%

52.5%

52.8%

52.6%

54.7%

NON-EMERGENCY AS A % OF TOTAL OP VISITS ADJUSTED PATIENT DAYS OCCUPANCY RATE INPATIENT SURGERIES

94,607

94,627

95,013

94,924

92,357

OUTPATIENT SURGERIES

195,650

200,832

203,105

215,656

226,136

TOTAL SURGERIES

290,257

295,459

298,118

310,580

318,493

OUTPATIENT AS % OF TOTAL SURGERIES

67.4%

68.0%

68.1%

69.4%

71.0%

TOTAL FULL-TIME EQUIVALENT EMPLOYEES

47,102

47,825

49,832

50,358

50,173

4.36

4.40

4.41

4.43

4.28

GROSS REVENUE, INPATIENT

$11,700,149,701

$12,460,694,916

$13,396,489,708

$13,777,391,679

$14,814,502,613

GROSS REVENUE, OUTPATIENT

$11,967,218,307

$12,952,790,887

$14,212,477,805

$15,450,146,464

$17,025,641,576

GROSS PATIENT REVENUE

$23,667,368,008

$25,413,485,803

$27,608,967,513

$29,227,538,143

$31,840,144,189

BAD DEBTS

$543,253,884

$444,692,383

$469,305,416

$502,016,281

$509,174,368

CHARITY

$336,830,549

$376,732,202

$339,342,080

$358,871,422

$442,315,671

MEDICARE, MEDICAID & OTHER PAYER WRITEOFFS

$16,168,309,507

$17,636,673,879

$19,440,530,333

$20,647,010,804

$22,702,507,161

TOTAL DEDUCTIONS

$17,048,393,940

$18,458,098,464

$20,249,177,829

$21,507,898,507

$23,653,997,200

NET PATIENT REVENUE

$6,618,974,068

$6,955,387,339

$7,359,789,684

7,719,639,636

$8,186,146,989

$250,191,038

$307,097,211

$381,973,773

$395,516,849

$433,117,737

FULL-TIME EQUIVALENT EMPLOYEES PER ADJUSTED OCCUPIED BED

OTHER OPERATING REVENUE NONOPERATING REVENUE

$42,144,248

$82,544,865

$118,736,986

$44,821,792

$145,788,360

TOTAL NET REVENUE

$6,911,309,354

$7,345,029,415

$7,860,500,443

$8,159,978,277

$8,765,053,086

PAYROLL EXPENSE

$2,367,195,116

$2,510,431,790

$2,833,267,007

$2,989,469,225

$3,040,326,208

TOTAL EXPENSE

$6,428,954,340

$6,803,364,553

$7,372,516,174

$7,797,448,234

$8,049,927,966

PATIENT REVENUE MARGIN

2.87%

2.19%

-0.17%

-1.01%

1.66%

TOTAL MARGIN

6.98%

7.37%

6.21%

4.44%

8.16%

CHARGE PER ADJUSTED INPATIENT DAY

$6,003.55

$6,411.63

$6,691.94

$7,045.16

$7,445.97

PAYMNT PER ADJUSTED INPATIENT DAY

$1,678.99

$1,754.79

$1,783.89

$1,860.78

$1,914.37

EXPENSE PER ADJUSTED INPATIENT DAY

$1,630.79

$1,716.44

$1,786.97

$1,879.54

$1,882.51

PAYROLL PER ADJUSTED INPATIENT DAY

$600.47

$633.36

$686.74

$720.60

$710.99

PAYROLL AS % OF TOTAL EXPENSE

36.8%

36.9%

38.4%

38.3%

37.8%

BAD DEBT AND CHARITY AS % OF TOTAL CHARGE

3.7%

3.2%

2.9%

3.0%

TOTAL DEDUCTIONS AS % OF TOTAL CHARGE

72.0%

72.6%

73.3%

73.6%

74.3%

OUTPT. REVENUE AS % TOTAL PATIENT REVENUE

50.6%

51.0%

51.5%

52.9%

53.5%

ADMISSIONS PER BED

37.3

37.6

39.8

PATIENT DAYS PER 1,000 POPULATION

624.3

618.0

619.5

606.7

605.4

ADMISSIONS PER 1,000 POPULATION

120.0

120.3

120.9

118.9

120.7

POPULATION (000'S)

2,978

2,988

3,004

3,014

3,018

Source: American Hospital Association, Hospital Statistics 2021

30 SUMMER 2021 | ARKANSAS HOSPITALS

ARKANSAS HOSPITALS RECEIVING LOCAL TAX SUPPORT, 2021 YEAR APPROVED

ANNUAL AMOUNT ESTIMATE

0.25%

2016

$649,000

YES

0.5%

2009

$1,200,000

BAPTIST HEALTH MEDICAL CENTER-STUTTGART

YES

1.00%

2014

$2,300,000

BRADLEY COUNTY MEDICAL CENTER

YES

1.00%

YES

.4 MILL

2009

$1,200,000

CHI ST. VINCENT MORRILTON

YES

0.25%

YES

.25 MILL

2008

$1,000,000

CHICOT MEMORIAL MEDICAL CENTER

YES

1.00%

YES

.5 MILL

2003

$1,100,000

CROSSRIDGE COMMUNITY HOSPITAL

YES

1.00%

2020

$2,200,000

DALLAS COUNTY MEDICAL CENTER

YES

1.00%

2005

$840,000

DELTA HEALTH SYSTEM

YES

1.25%

2019

$840,000

DEWITT HOSPITAL & NURSING HOME

YES

1.50%

2003

$850,000

DREW MEMORIAL HEALTH SYSTEM

YES

0.25%

2015

$670,000

FULTON COUNTY HOSPITAL

YES

0.50%

2007

$310,000

GREAT RIVER MEDICAL CENTER

YES

0.50%

JOHNSON REGIONAL MEDICAL CENTER

LAWRENCE MEMORIAL HOSPITAL

YES

LITTLE RIVER MEDICAL CENTER

YES

MAGNOLIA REGIONAL MEDICAL CENTER (A)

YES

INDICATOR

TAX

RATE

YES

BAPTIST HEALTH MEDICAL CENTER-HOT SPRING COUNTY

ASHLEY COUNTY MEDICAL CENTER

MAGNOLIA REGIONAL MEDICAL CENTER (B)

MILLAGE

YES

RATE

.5 MILL

YES

1 MILL

2015/1952

$2,439,800

YES

.3 MILL

1977

$65,000

1.00%

2014

$1,900,000

1.125%

2007

$2,600,000

0.25%

2004

$540,000

MCGEHEE HOSPITAL

YES

1.00%

1999

$600,000

MERCY HOSPITAL BOONEVILLE

YES

1.00%

2003

$360,000

MERCY HOSPITAL OZARK

YES

1.00%

2001

$350,000

MERCY HOSPITAL PARIS

YES

1.00%

OUACHITA COUNTY MEDICAL CENTER

YES

1.00%

2015

$2,400,000

1951

$150,000

2010

$360,000

2015/1952

$829,300

2007

$800,000

OZARK HEALTH MEDICAL CENTER

YES

PIGGOTT COMMUNITY HOSPITAL

YES

1.00%

SMC REGIONAL MEDICAL CENTER

YES

0.50%

ST. BERNARDS FIVE RIVERS

YES

1.00%

YES

.6 MILL

1 MILL

NA=Information not available Source: Self-reported information provided to the Arkansas Hospital Association

ARKANSAS HOSPITALS | SUMMER 2021 31

32 SUMMER 2021 | ARKANSAS HOSPITALS 8.16%

$715,125,120

That resulted in total funds available to reinvest in new equipment, update facilities, expand programs and repay debt equalling:

For a return on investment totalling:

$145,788,360

6.61%

$569,336,760

Hospitals also collected other types of revenue from sources including contributions, tax appropriations, and the rental of office space. Those amounted to:

As a result, the "operating margin" rose to:

Which raised total operating income to:

$433,117,737

7.39%

$1,203,046,742

$280,550,018

5.77%

$922,496,724

$1,179,587,455

-1.74%

1.66%

Yielding a "patient service" margin of:

In addition, hospitals also received revenues from normal, day-today operations from services other than health care provided to patients, such as space rental, cafeteria and gift shop sales, and operating gains:

($35.47)

($257,090,731)

7,248,832

$15,069,875,085

$31.86

$136,219,023

4,276,157

$8,049,927,966

$14,812,784,354

$44,578,381,239

$59,391,165,593

Louisiana

In other words, hospitals made (or lost) this much on each of the equivalent days of care they provided to inpatients and outpatients:

So the revenue excess (loss) was:

…to patients needing care for this many adjusted patient days while being served.

At the same time, hospitals spent this much providing patient care services…

$8,186,146,989

$23,653,997,200

But patients and payer groups didn't pay the full amount of billed charges for various reasons. Government programs like Medicare and Medicaid, workers' comp programs, and others never pay the full hospital bill. Managed care plans and other insurers typically pay discounted amounts only, and individual patients often can't afford to pay some or any of the out-of-pocket costs related to their hospital bills. For those reasons, hospitals had to forfeit this much of their billed charges:

As a result, actual payments to hospitals were:

$31,840,144,189

Hospitals charged this amount for the inpatient and outpatient care they provided in 2019:

Arkansas

4.99%

$428,050,453

$97,459,379

3.90%

$330,591,074

$259,694,972

0.86%

$12.15

$70,896,102

5,832,924

$8,148,566,981

$8,219,463,083

$28,118,389,497

$36,337,852,580

Mississippi

6.58%

$1,710,294,021

$472,574,787

4.85%

$1,237,719,234

$1,571,948,238

-1.40%

($33.72)

($334,229,004)

9,911,142

$24,264,933,681

$23,930,704,677

$60,326,122,841

$84,256,827,518

Missouri

8.44%

$991,438,467

$108,214,528

7.59%

$883,223,939

$347,257,456

4.75%

$104.99

$535,966,483

5,104,726

$10,758,963,822

$11,294,930,305

$38,119,486,791

$49,414,417,096

Oklahoma

5.96%

$1,222,646,923

$232,989,610

4.88%

$989,657,313

$914,710,142

0.39%

$7.87

$74,947,171

9,526,893

$19,292,745,024

$19,367,692,195

$67,227,510,526

$86,595,202,721

Tennessee

12.35%

$10,551,228,784

$1,188,040,961

11.11%

$9,363,187,823

$6,655,120,964

3.49%

$96.09

$2,708,066,859

28,182,982

$74,912,405,760

$77,620,472,619

$300,993,198,996

$378,613,671,615

Texas

8.83%

$102,380,606,846

$21,220,276,450

7.13%

$81,160,330,396

$73,503,463,990

0.72%

$19.08

$7,656,866,406

401,318,395

$1,056,497,068,465

$1,064,153,934,871

$3,047,888,562,684

$4,112,042,497,555

United States

KEY FINANCIAL INDICATORS ARKANSAS AND SURROUNDING STATES, 2019

Source: American Hospital Association, Hospital Statistics 2021

COMPARATIVE FINANCIAL INDICATORS U.S. COMMUNITY HOSPITALS AVERAGE CHARGE PER HOSPITAL STAY

AVERAGE PAYMENT PER HOSPITAL STAY

AVERAGE OPERATING COST PER HOSPITAL STAY

MARGIN ON PATIENT CARE SERVICES

ALASKA

98,609

ALASKA

27,813

DISTRICT OF COLUMBIA

24,529

ALASKA

18.69%

DISTRICT OF COLUMBIA

89,167

DISTRICT OF COLUMBIA

24,640

ALASKA

22,615

IDAHO

18.15%

COLORADO

87,169

UTAH

20,770

NEW YORK

21,724

UTAH

17.52%

CALIFORNIA

86,880

CALIFORNIA

20,324

CALIFORNIA

20,310

COLORADO

11.48%

NEVADA

77,982

COLORADO

20,115

MAINE

19,761

VIRGINIA

7.91%

TEXAS

72,048

NEW YORK

19,753

WASHINGTON

19,385

NORTH CAROLINA

7.35%

PENNSYLVANIA

68,871

WASHINGTON

19,399

MASSACHUSETTS

19,093

NEVADA

7.14%

FLORIDA

68,301

MAINE

18,746

MINNESOTA

17,961

INDIANA

6.64%

UTAH

67,710

DELAWARE

18,484

COLORADO

17,806

MONTANA

5.86%

10.

NEW JERSEY

66,120

MINNESOTA

17,654

OREGON

17,676

DELAWARE

5.84%

11.

WASHINGTON

65,651

MONTANA

17,601

HAWAII

17,594

SOUTH CAROLINA

5.79%

12.

NEW YORK

65,650

NEBRASKA

17,415

DELAWARE

17,405

ARIZONA

5.78%

13.

ARIZONA

65,457

OREGON

17,337

UTAH

17,130

FLORIDA

5.02%

14.

WSC REGION

64,430

MASSACHUSETTS

16,967

NEBRASKA

17,057

OKLAHOMA

4.75%

15.

U.S.

60,605

NEW HAMPSHIRE

16,953

MARYLAND

16,874

KENTUCKY

4.69%

16.

INDIANA

58,768

IDAHO

16,730

NEW HAMPSHIRE

16,760

NEW MEXICO

4.64%

17.

ILLINOIS

56,136

INDIANA

16,681

MONTANA

16,569

TEXAS

3.49%

18.

OKLAHOMA

55,660

MARYLAND

16,336

VERMONT

16,452

WISCONSIN

3.30%

19.

VIRGINIA

55,188

WISCONSIN

15,971

SOUTH DAKOTA

16,161

WSC REGION

2.79%

20.

OHIO

55,173

CONNECTICUT

15,805

CONNECTICUT

16,053

NEBRASKA

2.05%

21.

KANSAS

53,221

SOUTH DAKOTA

15,769

NORTH DAKOTA

15,771

WYOMING

1.68%

22.

TENNESSEE

52,889

U.S.

15,684

OHIO

15,628

ARKANSAS

1.66%

23.

KENTUCKY

52,640

OHIO

15,676

INDIANA

15,575

GEORGIA

1.49%

24.

NEW HAMPSHIRE

52,592

HAWAII

15,576

U.S.

15,571

ALABAMA

1.38%

25.

HAWAII

52,528

PENNSYLVANIA

15,453

WISCONSIN

15,444

NEW HAMPSHIRE

1.14%

26.

GEORGIA

51,888

WYOMING

15,357

PENNSYLVANIA

15,308

PENNSYLVANIA

0.94%

27.

NEBRASKA

51,739

VERMONT

14,979

WYOMING

15,100

MISSISSIPPI

0.86%

28.

IDAHO

51,680

NORTH DAKOTA

14,925

ILLINOIS

14,746

U.S.

0.72%

29.

SOUTH CAROLINA

51,643

TEXAS

14,771

MICHIGAN

14,495

DISTRICT OF COLUMBIA

0.45%

30.

MASSACHUSETTS

50,975

ILLINOIS

14,701

MISSOURI

14,479

TENNESSEE

0.39%

31.

MISSOURI

50,276

VIRGINIA

14,654

TEXAS

14,255

OHIO

0.31%

32.

CONNECTICUT

50,166

MICHIGAN

14,531

NEW JERSEY

13,910

MICHIGAN

0.24%

33.

NEW MEXICO

48,826

ARIZONA

14,378

KANSAS

13,809

KANSAS

0.23%

34.

MINNESOTA

48,794

MISSOURI

14,279

WEST VIRGINIA

13,792

WASHINGTON

0.07%

35.

SOUTH DAKOTA

48,684

NEW MEXICO

14,279

RHODE ISLAND

13,771

CALIFORNIA

36.

LOUISIANA

48,677

WSC REGION

13,886

IDAHO

13,694

ILLINOIS

-0.31%

37.

ALABAMA

48,190

KANSAS

13,840

NEW MEXICO

13,617

WEST VIRGINIA

-0.96%

38.

NORTH CAROLINA

47,905

NEVADA

13,835

ARIZONA

13,547

NEW JERSEY

-0.99%

39.

WISCONSIN

45,872

NEW JERSEY

13,773

WSC REGION

13,499

MISSOURI

-1.40%

40.

MISSISSIPPI

45,438

GEORGIA

13,688

VIRGINIA

13,495

CONNECTICUT

-1.57%

41.

DELAWARE

44,912

NORTH CAROLINA

13,679

GEORGIA

13,484

LOUISIANA

-1.74%

42.

MAINE

44,570

WEST VIRGINIA

13,661

IOWA

12,917

MINNESOTA

-1.74%

43.

OREGON

43,820

KENTUCKY

13,080

NEVADA

12,847

OREGON

-1.95%

44.

MICHIGAN

43,182

OKLAHOMA

12,722

NORTH CAROLINA

12,674

SOUTH DAKOTA

-2.49%

45.

WEST VIRGINIA

42,351

RHODE ISLAND

12,703

KENTUCKY

12,466

MARYLAND

-3.30%

46.

ARKANSAS

40,667

SOUTH CAROLINA

12,452

LOUISIANA

12,351

IOWA

-4.96%

47.

RHODE ISLAND

39,843

FLORIDA

12,385

OKLAHOMA

12,119

MAINE

-5.41%

48.

MONTANA

39,711

IOWA

12,307

TENNESSEE

11,783

NORTH DAKOTA

-5.66%

49.

WYOMING

38,539

LOUISIANA

12,140

FLORIDA

11,763

RHODE ISLAND

-8.40%

50.

NORTH DAKOTA

38,155

TENNESSEE

11,829

SOUTH CAROLINA

11,731

VERMONT

-9.83%

51.

IOWA

37,704

ALABAMA

10,459

ALABAMA

10,314

NEW YORK

52.

VERMONT

36,152

ARKANSAS

10,455

ARKANSAS

10,281

MASSACHUSETTS

-12.53%

53.

MARYLAND

22,757

MISSISSIPPI

10,278

MISSISSIPPI

10,189

HAWAII

-12.95%

0.07%

-9.98%

Source: American Hospital Association, Hospital Statistics 2021

ARKANSAS HOSPITALS | SUMMER 2021 33

HOSPITAL ACCESS BY COUNTY COUNTY

NO ACUTE CARE COMMUNITY HOSPITAL (21)

SINGLE CRITICAL ACCESS HOSPITAL (18)

SINGLE NON-CAH COMMUNITY HOSPITAL (22)

MULTIPLE COMMUNITY HOSPITALS (14)

COUNTY

ARKANSAS

GARLAND

ASHLEY

GRANT

BAXTER

GREENE

BENTON

HEMPSTEAD

BOONE

HOT SPRING

BRADLEY

HOWARD

CALHOUN

INDEPENDENCE

CARROLL

IZARD

CHICOT

JACKSON

CLARK

JEFFERSON

CLAY

JOHNSON

CLEBURNE

LAFAYETTE

CLEVELAND

LAWRENCE

COLUMBIA

LEE

CONWAY

LINCOLN

CRAIGHEAD

LITTLE RIVER

CRAWFORD

LOGAN

CRITTENDEN

LONOKE

CROSS

MADISON

DALLAS

MARION

DESHA

MILLER

DREW

MISSISSIPPI

FAULKNER

MONROE

FRANKLIN

MONTGOMERY

FULTON

NEVADA NEWTON

NO ACUTE CARE COMMUNITY HOSPITAL (21)

•

POINSETT

• • •

•

• • • • • • • • • • •

POPE PULASKI

•

POLK PRAIRIE

MULTIPLE COMMUNITY HOSPITALS (14)

• •

PHILLIPS PIKE

SINGLE NON-CAH COMMUNITY HOSPITAL (22)

•

OUACHITA PERRY

SINGLE CRITICAL ACCESS HOSPITAL (18)

•

RANDOLPH

• • • • • •

SALINE

•

SCOTT SEARCY

•

SEBASTIAN SEVIER SHARP ST. FRANCIS

• •

STONE

• •

UNION VAN BUREN WASHINGTON

•

WHITE WOODRUFF YELL

34 SUMMER 2021 | ARKANSAS HOSPITALS

•

• •

AHA-MEMBER ORGANIZATIONS BY CONGRESSIONAL DISTRICT 1st Congressional District

Congressman Rick Crawford Arkansas Continued Care Hospital of Jonesboro Arkansas Methodist Medical Center Baptist Health Medical Center-Heber Springs Baptist Health Medical Center-Stuttgart Baptist Memorial Hospital-Crittenden Baxter Regional Medical Center Chicot Memorial Medical Center CrossRidge Community Hospital Delta Health System DeWitt Hospital & Nursing Home Forrest City Medical Center Fulton County Hospital Great River Medical Center Helena Regional Medical Center Izard County Medical Center Lawrence Memorial Hospital McGehee Hospital NEA Baptist Memorial Hospital Perimeter Behavioral Hospital of W. Memphis Piggott Community Hospital SMC Regional Medical Center St. Bernards Five Rivers St. Bernards Medical Center Stone County Medical Center Unity Health - Harris Medical Center White River Health System

Total = 26

2nd Congressional District

Congressman French Hill 19th Medical Group Advanced Care Hospital of White County Arkansas Children's Hospital Arkansas Hospice Arkansas State Hospital Baptist Health Extended Care Hospital Baptist Health Medical Center-Conway Baptist Health Medical Center-Little Rock Baptist Health Medical Center-N. Little Rock Baptist Health Rehabilitation Institute CARTI Central Arkansas Veterans Healthcare System CHI St. Vincent Infirmary CHI St. Vincent Morrilton CHI St. Vincent North CHI St. Vincent Sherwood Rehabilitation Hospital Conway Behavioral Health Conway Regional Health System Conway Regional Rehabilitation Hospital Cornerstone Specialty Hospitals Little Rock Methodist Behavioral Hospital Ozark Health Medical Center Pinnacle Pointe Behavioral Healthcare System Rivendell Behavioral Health Services Saline Memorial Hospital The BridgeWay UAMS Medical Center Unity Health

Total = 28

3rd Congressional District

Congressman Steve Womack Arkansas Children’s Northwest Baptist Health-Fort Smith Baptist Health-Van Buren CHRISTUS Dubuis Hospital of Fort Smith Encompass Health Rehabilitation Hospital Eureka Springs Hospital Mercy Hospital Berryville Mercy Hospital Fort Smith Mercy Hospital Northwest Arkansas North Arkansas Regional Medical Center Northwest Health Physicians’ Specialty Hospital Northwest Medical Center Bentonville Northwest Medical Center Springdale Ozarks Community Hospital Saint Mary's Regional Medical Center Siloam Springs Regional Hospital Springwoods Behavioral Health Hospital Valley Behavioral Health System Vantage Point of NWA Veterans Health Care System of the Ozarks Washington Regional Medical System Willow Creek Women’s Hospital

Total = 22

4th Congressional District

Congressman Bruce Westerman Ashley County Medical Center Baptist Health Medical Center-Arkadelphia Baptist Health Medical Center-Hot Spring County Bradley County Medical Center Chambers Memorial Hospital CHI St. Vincent Hot Springs CHI St. Vincent Hot Springs Rehabilitation Hospital CHRISTUS Dubuis Hospital of Hot Springs Dallas County Medical Center Dardanelle Regional Medical Center Drew Memorial Health System Howard Memorial Hospital Jefferson Regional Johnson Regional Medical Center Levi Hospital Little River Medical Center Magnolia Regional Medical Center Medical Center of South Arkansas Mena Regional Health System Mercy Hospital Booneville Mercy Hospital Ozark Mercy Hospital Paris Mercy Hospital Waldron National Park Medical Center Ouachita County Medical Center Riverview Behavioral Health

Total = 26 Additional AHA Member Hospitals Include: CHRISTUS St. Michael Health System, Texarkana, TX Regional One Health, Memphis, TN

ARKANSAS HOSPITALS | SUMMER 2021 35

AHA MEMBERS BY CONTROL AND SYSTEM AFFILIATION TYPE OF CONTROL

DESIGNATION

NONPROFIT

CORPORATE

19TH MEDICAL GROUP

MULTIHOSPITAL GOV'T

CONTROLLING ORGANIZATION

SYSTEM

SYSTEM HOME

U.S. DEPARTMENT OF DEFENSE

√

ADVANCED CARE HOSPITAL OF WHITE COUNTY

LTCH

√

UNITY HEALTH

SEARCY

ARKANSAS CHILDREN'S HOSPITAL

CHILDREN'S

√

ARKANSAS CHILDREN'S

LITTLE ROCK

ARKANSAS CHILDREN'S NORTHWEST

CHILDREN'S

√

ARKANSAS CHILDREN'S

LITTLE ROCK

ARKANSAS CONTINUED CARE HOSPITAL OF JONESBORO LTCH

√

COMMUNITY HOSPITAL CORPORATION

PLANO, TX

ARKANSAS HOSPICE

√

LOCAL BOARD

√

LOCAL BOARD

ARKANSAS METHODIST MEDICAL CENTER

RURAL/RRC

ARKANSAS STATE HOSPITAL

IP PSYCH

ASHLEY COUNTY MEDICAL CENTER

CAH

√

BAPTIST HEALTH EXTENDED CARE HOSPITAL

LTCH

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST HEALTH MEDICAL CENTER-ARKADELPHIA

CAH

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST HEALTH MEDICAL CENTER-CONWAY

URBAN

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST HEALTH MEDICAL CENTER-HEBER SPRINGS

CAH

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST HEALTH MEDICAL CENTER-HOT SPRING COUNTY RURAL/MDH

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST HEALTH MEDICAL CENTER-LITTLE ROCK

URBAN

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST HEALTH MEDICAL CENTER-N. LITTLE ROCK

URBAN

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST HEALTH MEDICAL CENTER-STUTTGART

RURAL/MDH

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST HEALTH REHABILITATION INSTITUTE

IRF

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST HEALTH-FORT SMITH

URBAN

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST HEALTH-VAN BUREN

URBAN

√

BAPTIST HEALTH

LITTLE ROCK

BAPTIST MEMORIAL HOSPITAL-CRITTENDEN

URBAN

√

BAPTIST MEMORIAL HEALTHCARE CORP.

MEMPHIS, TN

BAXTER REGIONAL MEDICAL CENTER

RURAL/SCH/RRC

√

LOCAL BOARD

BRADLEY COUNTY MEDICAL CENTER

CAH

√

LOCAL BOARD

CARTI

STATE

√

LOCAL BOARD

√

CENTRAL ARKANSAS VETERANS HEALTHCARE SYSTEM

U.S. DEPARTMENT OF VETERANS AFFAIRS

√

CHAMBERS MEMORIAL HOSPITAL

RURAL/SCH

√

CHI ST. VINCENT HOT SPRINGS

URBAN/RRC

√

CHI ST. VINCENT HOT SPRINGS REHABILITATION HOSPITAL IRF

LOCAL BOARD Y √

COMMONSPIRIT HEALTH

CHICAGO, IL

ENCOMPASS HEALTH

BIRMINGHAM, AL

CHI ST. VINCENT INFIRMARY

URBAN

√

COMMONSPIRIT HEALTH

CHICAGO, IL

CHI ST. VINCENT MORRILTON

CAH

√

COMMONSPIRIT HEALTH

CHICAGO, IL

CHI ST. VINCENT NORTH

URBAN

√

COMMONSPIRIT HEALTH

CHICAGO, IL

ENCOMPASS HEALTH

BIRMINGHAM, AL

CHI ST. VINCENT SHERWOOD REHABILITATION HOSPITAL IRF

√

CHICOT MEMORIAL MEDICAL CENTER

CAH

√

CHRISTUS DUBUIS HOSPITAL OF FORT SMITH

LTCH

√

CHRISTUS HEALTH

IRVING, TX

CHRISTUS DUBUIS HOSPITAL OF HOT SPRINGS

LTCH

√

LHC CORPORATION

LAFAYETTE, LA

CHRISTUS ST. MICHAEL HEALTH SYSTEM

URBAN (TX)

√

CHRISTUS HEALTH

IRVING, TX

CONWAY BEHAVIORAL HEALTH

IP PSYCH

ACADIA HEALTHCARE

FRANKLIN, TN

CONWAY REGIONAL HEALTH SYSTEM

URBAN

CONWAY REGIONAL HEALTH SYSTEM

CONWAY

CONWAY REGIONAL REHABILITATION HOSPITAL

IRF

√

CONWAY REGIONAL HEALTH SYSTEM

CONWAY

CORNERSTONE SPECIALITY HOSPITALS LITTLE ROCK

LTCH

√

CORNERSTONE HEALTHCARE GROUP

DALLAS, TX

CROSSRIDGE COMMUNITY HOSPITAL

CAH

ST. BERNARDS HEALTH SYSTEM

JONESBORO

DALLAS COUNTY MEDICAL CENTER

CAH

DARDANELLE REGIONAL MEDICAL CENTER

CAH

√

DELTA HEALTH SYSTEM

CAH

√

LOCAL BOARD

DEWITT HOSPITAL & NURSING HOME

CAH

√

LOCAL BOARD

DREW MEMORIAL HEALTH SYSTEM

RURAL/SCH

ENCOMPASS HEALTH REHABILITATION HOSPITAL

IRF

EUREKA SPRINGS HOSPITAL

CAH

FORREST CITY MEDICAL CENTER

RURAL/SCH

FULTON COUNTY HOSPITAL

CAH

36 SUMMER 2021 | ARKANSAS HOSPITALS

LOCAL BOARD

√ √

√

COUNTY

√ Y

Y √ Y

√ √

CONWAY

COUNTY

√ √

CONWAY REGIONAL HEALTH SYSTEM

ENCOMPASS HEALTH

BIRMINGHAM, AL

EUREKA SPRINGS HOSPITAL COMMISSION

EUREKA SPRINGS, AR

QUORUM HEALTH

FRANKLIN, TN

COUNTY

TYPE OF CONTROL

DESIGNATION

NONPROFIT

CORPORATE

MULTIHOSPITAL GOV'T

CONTROLLING ORGANIZATION

SYSTEM HOME

SYSTEM

GREAT RIVER MEDICAL CENTER

RURAL/SCH/RRC

HELENA REGIONAL MEDICAL CENTER

RURAL/SCH

COUNTY

HOWARD MEMORIAL HOSPITAL

CAH

√

LOCAL BOARD

IZARD COUNTY MEDICAL CENTER

CAH

√

LOCAL BOARD

JEFFERSON REGIONAL

URBAN/SCH

√

LOCAL BOARD

JOHNSON REGIONAL MEDICAL CENTER

RURAL/MDH

√

LAWRENCE MEMORIAL HOSPITAL

CAH

√

LEVI HOSPITAL

URBAN

√

LITTLE RIVER MEDICAL CENTER

CAH

MAGNOLIA REGIONAL MEDICAL CENTER

RURAL/SCH

√

MCGEHEE HOSPITAL

CAH

√

MEDICAL CENTER OF SOUTH ARKANSAS

RURAL/SCH

MENA REGIONAL HEALTH SYSTEM

RURAL/SCH

MERCY HOSPITAL BERRYVILLE

CAH

√

MERCY HEALTH SYSTEM

ST. LOUIS, MO

MERCY HOSPITAL BOONEVILLE

CAH

√

MERCY HEALTH SYSTEM

ST. LOUIS, MO

MERCY HOSPITAL FORT SMITH

URBAN

√

MERCY HEALTH SYSTEM

ST. LOUIS, MO

MERCY HOSPITAL NORTHWEST ARKANSAS

URBAN

√

MERCY HEALTH SYSTEM

ST. LOUIS, MO

MERCY HOSPITAL OZARK

CAH

√

MERCY HEALTH SYSTEM

ST. LOUIS, MO

MERCY HOSPITAL PARIS

CAH

√

MERCY HEALTH SYSTEM

ST. LOUIS, MO

MERCY HOSPITAL WALDRON

CAH

√

MERCY HEALTH SYSTEM

ST. LOUIS, MO

METHODIST BEHAVIORAL HOSPITAL

IP PSYCH

√

METHODIST FAMILY HEALTH

LITTLE ROCK

NATIONAL PARK MEDICAL CENTER

URBAN/RRC

LIFEPOINT

BRENTWOOD, TN

NEA BAPTIST MEMORIAL HOSPITAL

URBAN/RRC

√

BAPTIST MEMORIAL HEALTHCARE CORP.

MEMPHIS, TN

NORTH ARKANSAS REGIONAL MEDICAL CENTER

RURAL/SCH/RRC

√

NORTHWEST HEALTH PHYSICIANS' SPECIALTY HOSPITAL

URBAN

√

COMMUNITY HEALTH SYSTEMS

FRANKLIN, TN

NORTHWEST MEDICAL CENTER BENTONVILLE

URBAN

√

COMMUNITY HEALTH SYSTEMS

FRANKLIN, TN

NORTHWEST MEDICAL CENTER SPRINGDALE

URBAN

√

COMMUNITY HEALTH SYSTEMS

FRANKLIN, TN

OUACHITA COUNTY MEDICAL CENTER

RURAL/SCH

√

OZARK HEALTH MEDICAL CENTER

CAH

√

OZARKS COMMUNITY HOSPITAL

CAH

√

OZARKS COMMUNITY HOSPITAL HEALTH SYSTEM

GRAVETTE, AR

PERIMETER BEHAVIORAL HOSPITAL OF W. MEMPHIS

IP PSYCH

√

WOODRIDGE BEHAVIORAL CARE

JACKSON, TN

PIGGOTT COMMUNITY HOSPITAL

CAH

√ Y

√

FRANKLIN, TN

LOCAL BOARD Y

ST. BERNARDS HEALTH SYSTEM

JONESBORO

LOCAL BOARD COUNTY

√

LOCAL BOARD LOCAL BOARD Y

√

COMMUNITY HEALTH SYSTEMS

FRANKLIN, TN

CITY

√

LOCAL BOARD

LOCAL BOARD LOCAL BOARD

CITY

√

PINNACLE POINTE BEHAVIORAL HEALTHCARE SYSTEM IP PSYCH

QUORUM HEALTH

UNIVERSAL HEALTH SERVICES

KING OF PRUSSIA, PA

REGIONAL ONE HEALTH

MEMPHIS, TN

√

UNIVERSAL HEALTH SERVICES

KING OF PRUSSIA, PA

IP PSYCH

√

ACADIA HEALTHCARE

FRANKLIN, TN

SAINT MARY'S REGIONAL MEDICAL CENTER

RURAL/RRC

√

LIFEPOINT

BRENTWOOD, TN

SALINE MEMORIAL HOSPITAL

URBAN

√

LIFEPOINT

BRENTWOOD, TN

SILOAM SPRINGS REGIONAL HOSPITAL

URBAN

√

COMMUNITY HEALTH SYSTEMS

FRANKLIN, TN

SMC REGIONAL MEDICAL CENTER

CAH

SPRINGWOODS BEHAVIORAL HEALTH HOSPITAL

IP PSYCH

ST. BERNARDS FIVE RIVERS

RURAL/SCH

ST. BERNARDS MEDICAL CENTER

URBAN/RRC

STONE COUNTY MEDICAL CENTER

CAH

THE BRIDGEWAY

IP PSYCH

UAMS MEDICAL CENTER

URBAN

UNITY HEALTH

RURAL/SCH/RRC

√

UNITY HEALTH

SEARCY

UNITY HEALTH - HARRIS MEDICAL CENTER

RURAL

√

UNITY HEALTH

SEARCY

VALLEY BEHAVIORAL HEALTH SYSTEM

IP PSYCH

√

ACADIA HEALTHCARE

FRANKLIN, TN

VANTAGE POINT OF NWA

IP PSYCH

√

ACADIA HEALTHCARE

FRANKLIN, TN

REGIONAL ONE HEALTH

URBAN (TN)

RIVENDELL BEHAVIORAL HEALTH SERVICES

IP PSYCH

RIVERVIEW BEHAVIORAL HEALTH

√ √

COUNTY

√ Y

UNIVERSAL HEALTH SERVICES

KING OF PRUSSIA, PA

√

ST. BERNARDS HEALTH SYSTEM

JONESBORO

√

ST. BERNARDS HEALTH SYSTEM

JONESBORO

√

WHITE RIVER HEALTH SYSTEM

BATESVILLE

UNIVERSAL HEALTH SERVICES

KING OF PRUSSIA, PA

√

STATE

√

VETERANS HEALTHCARE SYSTEM OF THE OZARKS

U.S. DEPARTMENT OF VETERANS AFFAIRS

√

WASHINGTON REGIONAL MEDICAL SYSTEM

URBAN

√

WHITE RIVER HEALTH SYSTEM

RURAL/SCH/RRC

√

WILLOW CREEK WOMEN'S HOSPITAL

URBAN

LOCAL BOARD √

WHITE RIVER HEALTH SYSTEM

BATESVILLE

COMMUNITY HEALTH SYSTEMS

FRANKLIN, TN

CAH=Critical Access Hospital; MDH=Medicare Dependent Hospital; RRC=Rural Referral Center; SCH=Sole Community Hospital; IRF=Inpatient Rehabilitation Facility; LTCH=Long-term Care Hospital; IP Psych=Inpatient Psychiatric

ARKANSAS HOSPITALS | SUMMER 2021 37

INPATIENT AND EMERGENCY DEPARTMENT DISCHARGES BY PAYER, 2019 ED

33%

23%

27%

2% 7%

9%1

HMO/COMM.INS MEDICAID MEDICARE OTHER GOV. PROGRAMS

INPATIENT

27%

23%

20%

40%

60%

1Percentages rounded to nearest whole number for clarity.

2% 5% 3%

80%

OTHER UNKNOWN SELF PAY/NO CHARGE

100%

Arkansas Department of Health, Hospital Discharge Program, 2019

In 2019, hospitals saw a second year of increasing uncompensated costs and greater numbers of uninsured patients.

UNINSURED INPATIENT ADMISSIONS AND COSTS, 2010-2019 35,000

$250

$200

25,000 $150

20,000 15,000

$100

10,000 $50

5,000 0

2010

2011

38 SUMMER 2021 | ARKANSAS HOSPITALS

2012

2013

2014

2015

2016

2017

2018

2019

COST ($MILLIONS)

ADMISSIONS

30,000

SELF-PAY/ NO CHARGE PATIENTS ADMITTED EST. TOTAL UNCOVERED COSTS ($MILLIONS)

Arkansas Department of Health, Hospital Discharge Program, 2019

HOSPITAL UNCOMPENSATED CARE COSTS, 2015-2019 YEAR

GROSS REVENUES (BILLED CHARGES)

NET REVENUES (AMOUNT COLLECTED)

OTHER OPERATING REVENUE

GROSS+ OTHER REVENUE

TOTAL OPERATING COSTS

COST-TO-CHARGE RATIO

2015

$23,667,368,008

$6,618,974,068

$250,191,038

$23,917,559,046

$6,428,954,340

24.61%

2016

$25,413,485,803

$6,955,387,339

$307,097,211

$25,720,583,014

$6,803,364,553

24.72%

2017

$27,608,967,513

$7,359,789,684

$381,973,773

$27,990,941,286

$7,372,516,174

24.66%

2018

$29,227,538,143

$7,719,639,636

$395,516,849

$29,623,054,992

$7,797,448,234

24.63%

2019

$31,840,144,189

$8,186,146,989

$433,117,737

$32,273,261,926

$8,049,927,966

23.37%

CHANGE

34.53%

23.68%

73.11%

34.94%

25.21%

YEAR

TOTAL UNCOLLECTED AMOUNTS DUE

BAD DEBT

CHARITY CARE

UNCOMPENSATED CARE CHARGES

UNCOMPENSATED CARE COSTS

UNCOMPENSATED CARE % OF TOTAL COSTS

2015

$16,788,731,845

$543,253,884

$336,830,549

$880,084,433

$216,573,662

3.37%

2016

$18,458,098,464

$444,692,383

$376,732,202

$821,424,585

$203,073,532

2.98%

2017

$20,249,177,829

$469,305,416

$339,342,080

$808,647,496

$199,431,096

2.71%

2018

$21,507,898,507

$502,016,281

$358,871,422

$860,887,703

$212,015,528

2.72%

2019

$23,653,997,200

$509,174,368

$442,315,671

$951,490,039

$222,318,771

2.76%

CHANGE

40.89%

-6.27%

31.32%

8.11%

2.65% Source: American Hospital Association, Hospital Statistics 2021

TOP 20 DRGS, 2019 # DISCHARGES

TOTAL CHARGES

MEAN CHARGES PER DISCHARGE

MEAN STAY PER DISCHARGE

MEAN DAILY RATE

885 - PSYCHOSES

33,601

$593,979,017

$17,677

9.6

$1,843

795 - NORMAL NEWBORN

20,032

$103,139,986

$5,149

1.7

$3,083

807 - VAGINAL DELIVERY WITHOUT STERILIZATION

17,277

$249,412,060

$14,436

1.8

$7,932

871 - SEPTICEMIA W/O MV 96+ HOURS W MCC

14,983

$704,628,457

$47,029

6.1

$7,659

470 - MAJ JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC

11,487

$497,816,389

$43,337

2.6

$16,668

794 - NEONATE W OTHER SIGNIFICANT PROBLEMS

8,746

$65,359,622

$7,473

2.2

$3,397

8,529

$283,049,731

$33,187

6.1

$5,423

788 - CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

6,547

$138,827,449

$21,205

2.7

$7,767

189 - PULMONARY EDEMA & RESPIRATORY FAILURE

6,431

$204,301,552

$31,768

5.1

$6,241

392 - ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC

5,366

$100,412,147

$18,713

3.3

$5,671

193 - SIMPLE PNEUMONIA & PLEURISY W MCC

4,573

$159,898,485

$34,966

5.0

$7,021

872 - SEPTICEMIA W/O MV 96+ HOURS W/O MCC

4,386

$105,782,674

$24,118

4.2

$5,702

057 - DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC

4,265

$148,506,309

$34,820

12.7

$2,744

881 - DEPRESSIVE NEUROSES

4,262

$66,058,289

$15,499

6.6

$2,363

897 - ALCOHOL/DRUG ABUSE/DEPENDENCE W/O REHABILITATION THERAPY W/O MCC

4,125

$55,047,981

$13,345

4.2

$3,177

194 - SIMPLE PNEUMONIA & PLEURISY W CC

3,755

$78,014,875

$20,776

3.8

$5,482

690 - KIDNEY & URINARY TRACT INFECTIONS W/O MCC

3,725

$65,048,374

$17,463

3.6

$4,824

247 - PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC

3,554

$258,176,869

$72,644

2.5

$29,651

603 - CELLULITIS W/O MCC

3,547

$63,766,331

$17,978

3.8

$4,756

190 - CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC

3,525

$96,902,447

$27,490

4.3

$6,378

172,716

$4,038,129,046

$25,954

4.6

$5,650

DIAGNOSIS-RELATED GROUP

291 - HEART FAILURE & SHOCK W MCC

TOP 20 DRGS

Source: Arkansas Department of Health, Hospital Discharge Program, 2019

ARKANSAS HOSPITALS | SUMMER 2021 39

40 SUMMER 2021 | ARKANSAS HOSPITALS

Eureka Springs Eureka Springs Hospital

CARROLL

Berryville Mercy Hospital–Berryville

Mountain Home Baxter Regional Medical Center Pocahontas St. Bernards Five Rivers Medical Center Paragould Arkansas Methodist Medical Center

KEY

SOURCE: https://www.hrsa.gov/ruralhealth/programopportunities/ fundingopportunities/?id=b56d4504-7bf6-4f79-b0e8-37b766f2213e

BENTON

BOONE

Piggott Salem RANDOLPH MARION BAXTER Piggott Community Hospital CLAY Fulton County Harrison Siloam Springs FULTON Hospital North Arkansas Springdale IZARD Blytheville Siloam Springs Regional Medical Center • Arkansas Children’s Northwest Calico Rock Walnut Ridge Great River Regional Hospital GREENE • Northwest Medical Center–Springdale Izard County SHARP Lawrence Medical Center WASHINGTON Gravette Mountain View Johnson NEWTON SEARCY Medical Center Memorial Hospital MADISON Fayetteville (3) Ozarks Stone County LAWRENCE Northwest Medical Center– Batesville • Washington Regional Medical Center CRAIGHEAD Community MISSISSIPPI Willow Creek Women’s Hospital Medical Center STONE White River • Northwest Health Physicians’ Jonesboro (2) Hospital Heber Springs Osceola Clarksville VAN Medical Center Specialty Hospital • St. Bernards of Gravette Baptist Health Medical South Mississippi County Russellville BUREN Johnson Regional POINSETT • Veterans Health Care System Medical Center Newport Center–Heber Springs INDEPENDENCE Regional Medical Center Saint Mary’s Medical Center of the Ozarks • NEA Baptist FRANKLIN Unity Health– Clinton JOHNSON Regional JACKSON CRAWFORD Van Buren Harris Medical Center Memorial Hospital Ozark Health Medical Center CLEBURNE Ozark Baptist Health Medical Searcy Medical Center CROSS Mercy Hospital− WHITE CONWAY Center–Van Buren POPE Unity Health– White Paris Conway (2) Ozark Wynne CRITTENDEN Mercy SEBASTIAN • Conway Regional Medical Center County Medical Center LOGAN Fort Smith (2) CrossRidge West Memphis Hospital− Dardanelle • Baptist Health – Conway • Baptist Health Medical WOODRUFF ST. FRANCIS Community Morrilton Baptist Memorial Paris Dardanelle Booneville Center–Fort Smith Hospital Acute care SCOTT FAULKNER Hospital PERRY CHI St. Vincent Regional LONOKE YELL Mercy • Mercy Hospital− Forrest City Morrilton hospitals Medical Center PRAIRIE Sherwood Hospital Fort Smith Forrest City LEE Danville Bryant PULASKI CHI St. Vincent North Booneville Chambers Memorial Hospital Medical Center Critical access Encore Medical Center Waldron Helena SALINE North Little Rock (2) MONROE MONTGOMERY GARLAND hospitals Mercy Hospital− Helena Regional • Arkansas Surgical Hospital Hot Springs (3) Stuttgart PHILLIPS Waldron Benton Medical Center • Baptist Health – Acute care • CHI St. Vincent–Hot Springs Baptist Health POLK Saline Mena North Little Rock • Levi Hospital Medical Center−Stuttgart Little Rock (6) hospital–SHIP* Memorial Mena Regional • National Park Medical Center • Arkansas Children’s Hospital HOT SPRING Hospital DeWitt JEFFERSON Health System ARKANSAS Malvern *Small Rural Hospital GRANT • Arkansas Heart Hospital DeWitt CLARK PIKE Pine Bluff Baptist Health – Improvement Grant Program. • Baptist Health – Little Rock Hospital and HOWARD Jefferson Regional Arkadelphia Hot Spring County Map revised June 2021. SEVIER Nursing • CHI St. Vincent Infirmary Baptist Health – Home Nashville DALLAS • Central Arkansas Veterans Healthcare Arkadelphia Dumas CLEVELAND LINCOLN Howard System – John L. McClellan Veterans Hospital Delta Memorial Memorial Hospital DESHA Fordyce • UAMS Medical Center Hospital HEMPSTEAD Monticello NEVADA LITTLE Dallas County RIVER McGehee Drew Camden Medical Center Hope McGehee Memorial Wadley Regional Ouachita County Warren CALHOUN Hospital Hospital DREW Medical Center Ashdown Medical Center Bradley County OUACHITA Little River at Hope Medical Center Magnolia ASHLEY El Dorado Memorial BRADLEY CHICOT MILLER Magnolia Crossett Medical Hospital COLUMBIA Lake Village Regional Ashley County Center UNION Chicot Memorial LAFAYETTE Medical Center Medical Center of South Arkansas Medical Center

Bentonville Northwest Medical Center–Bentonville

Rogers Mercy Hospital Northwest Arkansas

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Eberts Field in Lonoke was one of 32 U.S. Air Service training camps established during World War I. "Eberts Field, Lonoke, Arkansas - Convalescing influenza patients are isolated from sicker patients ... unit set up when hospital overflowed." (November 7, 1918, National Archives)

A Tale of Two Pandemics By J.B. Hogan Arkansas author and historian J.B. Hogan shares a portrait of the 1918 flu pandemic, the nearest medical phenomenon to the current SARS-CoV-2 pandemic our world has recently experienced. Like the pandemic of 1918, COVID-19 attacks the world’s nations in waves, and as people move from country to country, the virus spreads. More than a year after its appearance, COVID-19 continues its unrelenting march around the world. As of this writing, the nations of India and Brazil are under intense attack by this mutating, devastating disease.

ust over 100 years ago, a vicious pandemic spread across the globe, striking the oldest and youngest among us, but disproportionately attacking younger adults (aged 20-40), many of whom were heading off to war. Improperly labeled the Spanish Flu, this virus broke out during the final year of World War I and advanced through military units and then into the civilian population with extraordinary rapidity.

HISTORY REPEATS

With today’s SARS-CoV-2 (COVID-19) pandemic, there’s a sense that history is repeating itself. Historians and data show us that both the 1918 and 2020 pandemics attack with flu-like symptoms and involve the upper respiratory system. In both times, physical distancing was – and continues to be – used to bring transmission rates down. Masking, closures, and other enforced public health measures have proven key to discouraging both the viruses. Yet both pandemic events are responsible for tremendous loss of human life.

"Fighting Influenza in the United States - To successfully combat the influenza which has stricken a number of our Army and Navy boys, a special camp has been fitted up on the grounds of the Correy Hill Hospital in Brookline, Mass. Nurse wearing a mask as a protection against the disease, which is contagious, is filling a pitcher from the water hydrant." (September 16, 1918, Western Newspaper Union, National Archives)

ARKANSAS HOSPITALS | SUMMER 2021 43

Unlike its common name implies, the Spanish Flu didn’t originate in Spain, or even in Europe. Most historians now point to rural southwest Kansas – Haskell County to be exact – as the most likely source of the 1918 influenza. In January of that year, a local doctor named Loring Miner reported to the U. S. Public Health Service a severe outbreak of flu with pneumonialike symptoms. It is supposed that a young soldier from Haskell County

brought the novel (new) influenza with him to Camp Funston, a part of Camp Riley (now Fort Riley) near Junction City, Kansas.

WAVE I – MARCH-SUMMER 1918

On the morning of March 4, 1918, a Camp Funston cook, Private Albert Gitchell, went on sick call with flulike symptoms. By noon, more than

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one hundred more soldiers were sick, and by day’s end some five hundred had reported to the sickbay exhibiting similar symptoms – fever, sore throat, and headache. It was wartime, and soldiers were on the march. Because of constant troop movements both stateside and to overseas deployments, influenza swept through the United States military like a prairie fire. Within weeks, camps all over the country reported disturbingly large numbers of men sick with those same symptoms, and many ended up contracting pneumonia as well. Because the nation was primarily preoccupied with the war, the epidemic did not garner the amount of newspaper attention one might expect. During the war, most countries (including the U.S.) imposed censorship of the press to keep weaknesses hidden. In fact, the most comprehensive coverage of the disease occurred in Spain, which remained neutral in World War I. Its press was not censored, and wide reporting on the flu made people incorrectly assign Spain as the country of origin (Spanish Flu). We can see, in hindsight, how the movement of our troops domestically, then overseas, caused the U.S.-based epidemic to spread rapidly and become a full-fledged pandemic.

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"Emergency Hospital, Brookline, Massachusetts, set up to care for the influenza patients." (October 1918, The Boston Globe, National Archives)

WAVE II – AUGUST-FALL 1918

The second wave of the 1918 flu began in late summer and was the largest and most deadly wave of the pandemic. The flu’s virulence

is exemplified by cases stemming from a September 28, 1918, Liberty War Bond rally held in Philadelphia, Pennsylvania. This one-time event was blamed for a huge spike in the epidemic there – the rally alone responsible for the loss of 750 lives. Here in Arkansas, a statewide quarantine was issued in October 1918, lasting until November of that year. All theaters, restaurants, schools, and churches were completely closed down. Yet, overall, the second wave proved to be the most virulent and deadly of all the waves, striking civilian populations in the United States and around the world with vengeance. Some 200,000 deaths are attributed to Wave II in the U. S. alone.

WAVE III – JANUARY 1919

The Third Wave of the 1918 influenza was hardly distinguishable from the second, as it came right on its heels, lasting from late winter 1918 until the spring of 1919. In April 1919, it struck U.S. President Woodrow Wilson who was visiting Paris, France to engage in peace talks. Wilson became gravely ill, and although he recovered, he suffered a stroke that autumn. His death in 1925 at age 67 has been at least partially attributed to his bout with pandemic influenza.

WAVE IV – EARLY 1920

Fayetteville, Fort Smith, Clarksville, Lincoln, and Stuttgart, once again issued at least partial quarantines, although most were lifted just two weeks later.

Not all historians agree, but many consider the limited influenza outbreak of early 1920 to be a Fourth Wave of the 1918 pandemic. Some towns were hit hard, and their populations were forced to quarantine again – although for a shorter time – to combat the new wave. Here in Arkansas, around February 1, 1920, at least five cities, including

SIMILARITIES AND DIFFERENCES

The influenza of 1918 occurred more than 100 years ago, but there are similarities, as well as some

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differences, between that historical event and the present-day COVID-19 outbreak. VACCINES: We’re grateful that there has been a century of scientific and medical advancement since 1918 to improve the care of those infected with the COVID-19 virus. Perhaps most crucial, the vaccines being developed today are making a difference as their worldwide distribution grows. Did you know that a vaccine was also utilized in 1918? Unfortunately, it was for fighting bacterial infections only and quickly proved ineffective as a treatment for the viral influenza. PUBLIC HEALTH MEASURES: Newspapers and advertisements from 1918-1920 show that many recommendations for combating the influenza were pretty much the same public health measures recommended for COVID-19. Maintaining good hygiene, distancing from others, and wearing masks were suggested as ways to avoid the 1918 Flu, just as these same practices are applied to fight COVID-19 in today’s world. Keeping one’s person and one’s home clean was a key public health approach in 1918-1920, and folks were encouraged to breathe fresh air and get outside in the sunlight as much as possible. A five-foot distancing between people was called for in those days, and throughout much of 2020 the CDC recommended people maintain at least 6 feet of distance from others. Masks were important during the 1918 pandemic as well, although they were often made of a thin gauze or cheesecloth. Today, specific types of respirators or multiple layers of masking material are recommended. During the 1918 flu pandemic there was less resistance to masking than we have seen in our time, but it did exist. In early 1919 an Anti-Mask League briefly sprung up in San Francisco. The issuance of significant fines and jail time were punishments that kept most people maskcompliant during that early pandemic. QUININE: There was confusion in the early days of COVID-19 surrounding the possible effectiveness of the drug hydroxychloroquine, a synthetic form of quinine, to fight the virus. During the earlier pandemic, quinine itself was the drug primarily recommended to combat the 1918 influenza. Both treat malaria, symptoms of which include high fevers and chills, common to the influenza as well. Though proven ineffective in treating either virus, quinine remains effective in the treatment of the Plasmodium parasite, which causes malaria. COMPASSIONATE CAREGIVERS: One thing that is without doubt common to the two pandemics: the dedication and care of virus patients by the world’s medical professionals and caregivers. Stories of doctors, nurses, and volunteers working unimaginable hours and placing themselves in harm’s way to treat the afflicted abound in both eras. Without such 46 SUMMER 2021 | ARKANSAS HOSPITALS

"Masks for Protection Against Influenza - Red Cross workers making antiinfluenza masks for soldiers in camp, Boston, Massachusetts." (May 12, 1919, International Film Service Co, N.Y., National Archives)

remarkable professionalism and diligence, the numbers of deaths and/or lasting injuries caused by these historic pandemics might have been even worse.

AFTERMATH

When it finally ran its course, the 1918 influenza had lasted nearly two years. It ravaged our nation and our world, at last ending in early 1920. The final death numbers for it are staggering. Deaths are estimated at between 50 and 100 million worldwide, with an estimate of 675,000 dying here in the United States. With the much smaller U.S. population at that time, that was 0.64% of the total population at the time (a little more than six per every 1,000 people). Though that number appears most often in historical accounts, estimates of between 500,000 and 850,000 U.S. deaths have been attributed to the 1918 pandemic. One hundred years later, we are experiencing a similar outcome: More than 590,500 deaths have been attributed to COVID-19 in the United States, as of this writing. In terms of duration, COVID-19 has so far matched the length of the first three waves of the 1918 influenza. But as more U.S. citizens are vaccinated and as more work is done to develop vaccine boosters to protect from variants, we can begin to hope that the COVID-19 pandemic will soon join the 1918 influenza as part of our history, rather than our present. J. B. Hogan has published more than 270 stories and poems and 10 books, including "Bar Harbor," "Time and Time Again," "Mexican Skies," "Tin Hollow," "Living Behind Time," "Losing Cotton," "The Rubicon," "Fallen," and "The Apostate." His nonfiction book, "Angels in the Ozarks," is the history of local area professional baseball. You can find his author's page on Amazon.com and link to his "Did You Ever Wonder..." series through his channel on YouTube. He lives in Fayetteville, Arkansas.

PERSPECTIVES

Women's roles changed during the 1918 flu pandemic. (National Archives)

Pandemics Change the Workplace and Can Change Society By Lindsey Clark

veryone has responded in their own way over the months of the pandemic: Some have binge-watched TV and movies, some have shopped online, some “doomscrolled”; others have taken up new hobbies, like baking, jigsaw puzzles, or home improvement. But, for me, COVID-19 has renewed my love of history. Though it was my undergraduate major, history took a back seat to my other pursuits until now. I’m researching past pandemics, and I can’t help noting what profound effects each pandemic affords society. Especially striking to me, as I compare the 1918 influenza pandemic with our current SARSCoV-2 pandemic, are impacts on the lives of women. As a woman in science – I teach in the UAMS Medical Laboratory Sciences Program – I see both the wins and the losses that come with pandemics: Much is learned, but too many lives are lost. Recent public commentary compares various aspects of the two pandemics – statistics, mitigation efforts, economic impact – but as I look at the past, I’m most interested in the changes in women’s roles when looking at these two pandemics side by side. The 1918 flu pandemic was pivotal in advancing women’s role in the workplace and in promoting women’s suffrage. On the other hand, COVID-19 is charged with causing nearly three million women to drop out of the workforce, including people in the fields of medicine and science. How can one pandemic advance women, and another, just 100 years later, hold women back? What lessons do these two pandemics offer our society and those of us who work in the fields of flu-female-clerks-165-ww-269b-024.jpg[5/25/2021 9:53:00 PM] science and health care?

THE GREAT WAR AND THE GREAT PANDEMIC

The H1N1 influenza pandemic of 1918, incorrectly labeled the “Spanish flu,” hit the U.S. in the spring of 1918. It had a profound impact on troops training for World War I, also known as The Great War, as they moved from camp to camp before being shipped overseas. These troop movements set the stage for extensive spread of the flu virus, first in the U.S. and then in Europe. With young men away at war and a rise in the number of flu deaths, substantial vacancies in the workforce opened up back at home. These vacancies provided an opportunity for women to step into lines of work previously deemed inappropriate or too dangerous, such as the textile industry and manufacturing, science and research, and even occupations in medical laboratories. It’s satisfying to know that many scientific fields opened to women at that time, indicating significant progress on the horizon. Following the war, the number of women in the workforce was 25% higher than it had been previously, and by 1920 women made up 21% of all gainfully employed individuals in the country. In that same year, the 19th Amendment passed. The role of women in society was forever changed by the events of that decade.

FAST FORWARD TO TODAY: NOTE THE NEEDS

In 2021, the world finds itself in the midst of another pandemic. However, instead of making advancements in the workplace as their predecessors did 100 years ago, many women today are leaving, rather than entering, the labor force. This affects women in science and health care just as it does in other fields. ARKANSAS HOSPITALS | SUMMER 2021 47

MEDICAL LAB SCIENCES AND COVID-19 By Lindsey Clark

Because they play essential roles in fighting the rapid spread of the SARS-CoV-2 virus, numerous health care professions are gaining visibility for their pandemic contributions. One such field is medical laboratory sciences. WHAT IS MEDICAL LABORATORY SCIENCE? Medical laboratory professionals work behind the scenes to deliver lab test results critical for patient care. Test results they generate provide nearly 70% of the data providers use to diagnose patients or establish treatment plans. Medical laboratories consist of numerous departments, each specializing in certain types of testing: hematology, clinical chemistry, immunohematology (blood bank), microbiology, molecular diagnostics, and specialty testing. Medical lab professionals are certified to work in all of these areas; they may microscopically identify cells, culture and identify bacteria, analyze blood or body fluids, prepare blood products for transfusion, or operate sophisticated instruments. WHAT KIND OF OPPORTUNITIES EXIST? Long before COVID-19, there were abundant job opportunities in this field. Today, there is a critical shortage of medical lab personnel, and jobs are readily available in Arkansas as well as across the country. The U.S. Bureau of Labor Statistics estimates that overall employment of laboratory professionals will continue to increase, and it lists median annual pay as $54,180 (2020 data). Medical lab professionals have a wide variety of career paths, including work in hospital laboratories, public health, research and development, private labs, forensic labs, biotechnology, the food or cosmetic industries, companies manufacturing laboratory instruments and analyzers, and many more. WHAT KIND OF EDUCATION IS REQUIRED? Performing complex laboratory testing requires attention to detail, critical thinking skills, and the ability to solve problems, which is why lab professionals are often called “diagnostic detectives.” Lab professionals may earn an associate degree and be certified as medical lab technicians (MLT), or a bachelor’s degree and be certified as medical lab scientists (MLS). Medical laboratory science is an ideal profession for those who enjoy biology or chemistry, or who plan to advance their education in medicine, pharmacy, molecular biology, microbiology, or any number of disciplines. This field allows you to contribute to patient and community health, but it requires less direct patient care and family interaction than other health care professions, such as nursing. A career in medical laboratory science offers flexible and stable job opportunities right here in Arkansas, as well as across the U.S. 48 SUMMER 2021 | ARKANSAS HOSPITALS

According to the National Women’s Law Center, since the first cases of COVID-19 were reported in the U.S., nearly three million women have left the country’s workforce. For the first time in 33 years, women’s labor force participation fell to 57%, the lowest level since 1988. What caused this vast turnaround? Declines in the systems meant to support working women have been laid bare over the past year. For example, when COVID-19 forced closing of the nation’s schools and day care centers, questions regarding the care of children quickly came to the fore. Women’s jobs were disproportionately affected because, in our society, women are often still the primary caregivers in the home. It became impossible for many women to both care for their children and report to the workplace. One in four women who became unemployed during this pandemic report they did so due to lack of childcare – double the rate of men. And because women are also more likely than men to work in low-wage jobs, in twoincome households where the pandemic forced one partner to leave the workforce in order to care for the children, it was typically the person with the lower income – very often a woman – who became unemployed.

LESSONS FROM THE PAST

Though each pandemic had drastically different effects on women and society, we can learn from the way women in the early part of the 20th century met challenges in their environment. Our historical counterparts showed perseverance, adaptability, vision, and the temerity to seize opportunities. And they entered fields previously unavailable to their gender, including the fields of scientific research and medical laboratory science. Challenges causing present-day women to leave the workforce affect society at large. The COVID-19 pandemic brings to light many barriers – including the need for better childcare and more flexible work schedules – faced by the workforce for decades. It is forcing our nation to seriously analyze alternatives to the traditional workday. And it is spawning policies that should better support those who work outside the home – whether female or male – while raising families.

FOCUSING FORWARD

Re-thinking workplace definitions during today’s pandemic is re-shaping possibilities for every worker. As a woman in the scientific world, I know that the focus for women in science has too long been mainly on increasing our numbers in research, industry, and academia. But as I research pandemics and societal response, I wonder: Could the answers simply lie in lowering the same old barriers of enough reliable childcare and flexibility in work schedules? Why don’t women further their educations after bearing children? They need reliable childcare and the ability to attend courses on a flexible schedule. COVID-19 has greatly advanced the idea of attending university while at home on Zoom. For any parent wanting to take courses in the sciences, I see this as a major leap forward.

Childcare in the United States is costprohibitive for some two-parent families, let alone for single mothers with little or no support system. Our society is reliant upon daycare, or before- and after-school care for school-aged children. When the SARS-CoV-2 pandemic forced schools and daycares to close, the nation’s reliance on an already-inadequate system became painfully obvious and impossible to ignore. Because the subject of childcare is currently dominating conversations, this is the time to examine what changes are necessary and to seriously begin working toward those changes. As we look to increase the number of those holding and pursuing careers in science, offering flexible modes of education will remove significant barriers to entry. The tradition of going off to college or graduate school has been transforming for a while, but COVID-19 forced academia to adapt to the times (perhaps faster than was comfortable). While not a perfect solution, offering college or graduate courses through virtual settings allows flexibility in access higher education. I challenge those of us already in academia to consider this option and what it could mean as a mechanism for helping greater numbers of qualified candidates enter our scientific fields.

IT’S TIME TO MOVE FORWARD

The 1918 influenza pandemic was pivotal in advancing women’s role in the workplace, and it played a part in passage of the 19th Amendment. In contrast, the SARS-CoV-2 pandemic highlighted two of the major barriers working women face. It’s time to address the need for reliable childcare and flexibility in the workday/workplace and in access to education. The fields of science and health care will be better for it. CM

Lindsey Clark, MPH, MLS (ASCP) , is an Assistant Professor in the UAMS College of Health Professions’ Medical Laboratory Sciences Program. She teaches Molecular Diagnostics and Current Topics in Medical Laboratory Sciences. Her research interests include teaching time management and incorporating Medical Laboratory Science students into Interprofessional Education activities relevant to laboratory settings. You may reach her at LKClark@uams.edu.

AMERICAN RESCUE PLAN FUNDING

What kind of funding is available right now from the American Rescue Plan, and does my facility qualify for it? The American Rescue Plan represents an enormous opportunity for healthcare facilities, but there are strings attached. With over $8.5 billion earmarked for rural providers, $120 billion for COVID vaccines, supplies and recovery, and more than $20 billion allocated to community health centers, public health and behavioral health priorities, it’s tough to know which funding can be used where and by whom. I’m Laura Gillenwater, a Senior Manager with HORNE’s COVID support team based in Conway. We’re helping manage over $1.25 billion in COVID recovery dollars for facilities here in Arkansas and throughout the southeast. If you have questions about American Rescue Plan dollars for your facility, I’m a phone call away.

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ARKANSAS HOSPITALS | SUMMER 2021 49

50 SUMMER 2021 | ARKANSAS HOSPITALS

LEADER PROFILE

Seeing Hospitals into the Future By Nancy Robertson

erry Amstutz arrived at McGehee hospital in January 2019 with the mandate to help it improve its financial health and move toward a sustainable future. “We want to move from survivability to sustainability and beyond,” he says. “Today’s rural hospitals have a tough time making it. Those that become sustainable can help their communities grow and prosper.” Helping small hospitals turn around financially and maintain viability is his specialty. “There are four things required to help hospitals of any size become successful,” Amstutz says. “You must have a good staff in place, providers who plan to stay in the community, a board that’s engaged in moving the hospital forward, and a community that’s supportive and enthusiastic about its hospital. Those are the four key elements that can help a hospital move forward.” Since he first came to Arkansas in 1990, Amstutz has served hospitals in the communities of Calico Rock, Magnolia, Hope, Stuttgart, and McGehee. For a time, he also worked out-of-state to help small hospitals in Texas, North Carolina, and Oklahoma increase their financial vigor. With more than 35 years in senior-level leadership, he is known for bringing hospitals through turnarounds to that realm of sustainability. Arkansas is fortunate to be the beneficiary of his leadership skills, and hospitals that have enjoyed his administrative service have improved in the areas of cashflow, recruiting, capital needs funding, Critical Access Hospital licensure, patient satisfaction, quality improvement, and community involvement. He has led several successful city-wide sales tax campaigns resulting in annual funding for hospital needs and expansion. He credits a willingness to learn, and a God-given skill set, for his ability to help lift small hospitals to reach their potential. “Every time I enter a new hospital, I find I learn new skills that will help another organization in the future,” he says. “Small hospitals experience many different setbacks, but a common thread is financial distress. This can result from a history of inconsistent or inexperienced management, an aging medical staff, or even a population that’s leaving the area, making it impossible for the hospital to grow.”

ARKANSAS HOSPITALS | SUMMER 2021 51

McGehee Hospital receives a $150,000 grant from Arkansas Blue Cross & Blue Shield to begin a Chronic Care Management project.

He says he can identify new models to help a hospital improve its business outlook, but if his four main elements – dedicated staff, committed providers, engaged board members, and an enthusiastic community – aren’t in place, it’s hard to move a hospital beyond subsistence.

RECRUITMENT IS KEY

Amstutz is thrilled with the physician recruitment that began before his move to the community and continues under his leadership. “Before my arrival, the community supported funding for a $10 million hospital expansion and the opening of a $2.5 million rural health clinic,” he explains. These facilities are powerful recruiting tools and have resulted in retaining long-time McGehee family practice physician, James Young, MD, with the addition of both James Renfroe, MD, and Sarah Pearce, APRN, just as the clinic opened in 2017. “They’re originally from McGehee, and have elected to settle here,” Amstutz says. “McGehee is fortunate 52 SUMMER 2021 | ARKANSAS HOSPITALS

to have a growing and extremely supportive young adults’ group. When people in their twenties and thirties move to town, they’re immediately welcomed and engaged by this group, whose members support one another through social and business networks.” He says the very presence of this group draws young adults to the area, including some who have attended college elsewhere but are returning home to settle down. “We have two more doctors moving to town in the near future – again, these are hometown folks,” Amstutz smiles. “Dr. Austin Beatty will join us in September, and Dr. Tessa Herren will settle here in 2023. This recruitment of young doctors prior to the retirement of our older physicians is truly a blessing. It allows the community to plan for a more medically secure future, and to see its way toward attracting new businesses and organizations.” It’s easy to see why this is a boon for the McGehee area. Too many times, physicians serve a community until it’s time to retire, and then they feel they must continue into

their golden years, because no one younger commits to move in locally. “All of our doctors (and our nurse practitioner) – both present and those coming – are from McGehee and the area,” Amstutz says. “They’re gaining the advantage of truly being wanted and needed, they’re moving to their hometown, and they’ll be supported by friends and family members as their families grow. It’s a win-win for them, and certainly for the community and the hospital.”

LEADING THROUGH A PANDEMIC

Like many hospitals across America, especially in rural venues, McGehee Hospital suffered some financial strain during the COVID-19 pandemic. “When I arrived here in 2019, we made changes in operations that resulted in improved financial metrics and increased admissions,” Amstutz says. “But in January through March of 2020 as the pandemic took hold, everything stopped. Admissions dropped, and very few people wanted

to come to the hospital and clinics. We knew this was the situation everywhere, but it was still a difficult position in which to be. To combat the downturn, we made ourselves a regional site where patients could be tested, treated, and even rehabilitate after a bout with the virus.” He says the community really came together during the pandemic. “Though we were less hard-hit than other communities, we found ways to successfully navigate through the pandemic. We had a city-wide plan in place that included the mayor, schools, college, law enforcement, and of course the hospital. We knew how we would react in different situations, should they present themselves. And we communicated with our citizens, so they knew what to expect.” Amstutz says he is particularly grateful to and proud of McGehee Hospital’s nursing team. “Hospitals all over the country, and all over Arkansas, lost their nurses to other cities that paid exorbitant amounts due to staffing shortages. Though nurses in towns around McGehee left to accept more lucrative contracts, our entire nursing staff stayed right here at home. They are so committed and so diligent in their care – we could not ask for a more devoted team.” And now, vaccination against the virus has taken top priority. “Our area is a leader in vaccinating, and it is one of the most vaccinated regions in the state,” he says. “We’re holding a Juneteenth Vaccination Clinic with other area organizations at the Dumas High School June 19. We hope people will come out, enjoy the food trucks and the arts and crafts show, and get vaccinated at the same time.”

I LIKE HELPING HOSPITALS

Terry Amstutz is truly a giver. He says he has the ability to be calm during calamity, and he thinks that is one reason he’s cut out to help small hospitals meet challenges and stay the course. “Working as a part of the community, tied to the community … it’s what is important,” he says. “It’s wonderful to help a community move from fearing closure of its hospital to the assurance that its hospital is gaining stability and moving to sustainability.” And then, with humility, he shrugs. “I just like helping hospitals,” he smiles.

We Asked...

What’s on your music playlist? Classic 70’s What is the best advice you were ever given? Scripture

from Luke 12:48 – “For to whom much is given, from him much will be required.”

Do you have a favorite movie? "The Wizard of OZ" Why do you like it? Because, “There’s no place like home.” Who is someone you greatly admire, and why? Frank

Wise, Arkansas hospital executive and an A. Allen Weintraub Awardee, was a great friend and mentor to me.

What would you be doing if you weren’t in health care? NASCAR driver! (in a perfect world) What is something people don’t know about you? I was telling bad “Dad Jokes” before it was a thing!

What do you like to do in your down time? Anything outdoors – biking, hiking, hunting, fishing, chilling on the back porch.

What’s on your desk right now? Work papers, family pictures, and duck taxidermy.

What are you reading? (non-work-related material) Erwin

Lutzer’s “He Will Be the Preacher” and John M. Barry’s “Rising Tide: The Great Mississippi Flood of 1927 and How it Changed America.”

Where would you travel, if you could go anywhere? Israel’s Holy Land, the Cappadocia Cave Dwellings, and Nepal.

What’s a life-changing lesson COVID-19 has taught you? We are all capable of working outside our comfort zones and doing extraordinary things, even for extended periods of time, as long as we have the support of those we love and care for.

Terry Amstutz, FACHE, and his wife, Julie, have three grown children and two grandsons. He can be reached at TAmstutz@mcgeheehospital.org. Nancy Robertson, MAC, is Senior Editor of Arkansas Hospitals magazine. She has worked with the Arkansas Hospital Association for 18 years and in the field of communications for 36 years. You may reach her at nrobertson@arkhospitals.org.

Duck Hunt - Terry and his son, Samuel, enjoyed their time living in Stuttgart, the Rice and Duck Capital of the World.

ARKANSAS HOSPITALS | SUMMER 2021 53

One Year Changes Everything: Lessons Learned from the COVID-19 Pandemic (so far) By Kristy Bondurant

he COVID-19 pandemic rapidly changed U.S. health care systems’ policies and procedures, challenging administrators, clinicians, patients, and families. In March 2020, following the World Health Organization’s (WHO) designation of the COVID-19 pandemic, Arkansas Governor Asa Hutchinson declared a disaster and public health emergency in the state. Schools and non-essential businesses closed their doors and elective medical procedures were put on hold so hospitals could most readily meet the needs of COVID-19 patients. As of June 2021, more than 33 million cases have been identified in the U.S., and more than 600,000 deaths recorded. 1 In Arkansas alone, 343,000 cases are officially 54 SUMMER 2021 | ARKANSAS HOSPITALS

identified, with more than 5,800 deaths recorded.2

A CONCISE TIMELINE

Cases in Arkansas increased slowly during the spring and summer of 2020, but during the fall and winter, hospitalizations increased to a critical level. Hospitals throughout the state converted non-clinical areas into temporary clinical units so that more patients could receive care, they worked together regionally to share data and resources, and they somehow found the space and staff necessary to meet the onslaught of those suffering with COVID-19. There are not enough words to express how hospital staff in every position gave their all to keep

patients as comfortable as possible. Doctors, nurses, other clinicians, pharmacists, respiratory therapists, social workers, housekeepers, maintenance experts, cafeteria workers, EMTs and paramedics, front office staff, administrators – in reality, every hospital worker at every single level – kept up a relentless pace for months on end to compassionately care for the sick. When available hospital beds were few and far between, hospitals implemented new policies and procedures, increased staffing, and built additional capacity to care for more Arkansans. The state supported hospitals’ activities by monitoring and helping coordinate hospital bed availability through COVIDComm, a program that helped identify

available hospital resources and facilitate transfers of sick patients to hospitals that could accommodate them. COVIDComm utilized processes first developed for trauma transfers among Arkansas providers.

VACCINES ARRIVE

In December, the FDA authorized two vaccines, developed by Pfizer and Moderna, for Emergency Use Authorization. They were recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) for use in individuals 16 and older or 18 and older, respectively. The CDC outlined priority populations to receive the vaccine. Across the U.S., states differed in their approaches to implementing CDC recommendations. In Arkansas, the first groups to be vaccinated included frontline health care workers, first responders, and long-term care facility residents and employees. As more vaccines became available, eligibility expanded to older people, educators, essential workers, individuals with co-morbidities, and eventually, the general public. Adolescents aged 12-15 were approved to receive vaccinations this spring, following an expansion of the Pfizer EUA and revised recommendations from the CDC.

ADJUSTING POLICIES AND GUIDANCE

Throughout the pandemic, the CDC monitored disease transmission and adjusted guidance. The rapidly changing scientific understanding of the virus resulted in changing and often confusing recommendations. As we continue to understand the dynamics of transmission and review the data, guidance from the CDC will change to match current science. Two significant changes over the past year were recommendations for wearing masks and vaccine eligibility. In April 2020, the White House Coronavirus Taskforce and the CDC recommended universal mask usage to slow the spread of the virus. The recommendations on how, where, when, and who should wear a mask have changed throughout the last 18 months.3 In mid-May 2021, guidance

related to wearing masks, including by fully vaccinated individuals, was revised by the CDC. 4,5 The rapidity of testing, emergency use authorization, and approval of vaccines are a result of improved processes. With safety in mind, vaccines were approved for emergency use by the FDA and ACIP and were available less than 12 months after the first documented U.S. case.

VIRUS SURVEILLANCE

Early detection is critical in reducing transmission of the virus. Testing and contact tracing identify the infected and their direct contacts so education can be provided to slow the spread. Arkansas found innovative ways to offer COVID-19 testing. Drivethrough clinics, walk-in testing sites, and hometown clinics made tests accessible. Hospital labs ordered new equipment and supplies to enable onsite testing of collected specimens. During the pandemic, federal funding through the CARES Act and the American Rescue Plan improved surveillance and reporting. Surveillance remains critical as virus variants expand.

VULNERABLE POPULATIONS

Pandemic research and our collective lived experience showed that communities with fewer resources fared worse in comparison with those that had access to more.6 Data revealed that minority populations suffered a higher disease burden, were more often exposed through essential workplaces, and experienced a higher risk of severe disease.7, 8 In response, a significant focus of the American Rescue Plan Act is building health care infrastructure to support essential providers, mental health services, community services, and the most vulnerable among us.

INCREASING THE NUMBERS OF VACCINATED

Thanks to decades of research, new technologies, and streamlined

approvals, vaccines were available in record time. Vaccine delivery evolved rapidly. Large vaccination clinics were established quickly. Removing barriers such as vaccine hesitancy, access, and transportation challenges remains critical to increasing the numbers of vaccinated.

HEALTH CARE AND CAPACITY

Early during the pandemic, a shortage of personal protective equipment limited health care services. The pandemic revealed weaknesses in supply chains, low stockpiles, and rapid shifts in health care workforce needs. Existing health care personnel shortages were exacerbated due to stress and burnout. Arkansas lost health care workers to COVID-19. Many nurses, physicians, and clinicians retired early due to stressful and exhausting conditions. Arkansas quickly onboarded those graduating in medicine and health sciences. This increased the number of available health care workers and provided graduates a powerful entry into their careers. In addition, licensure was expedited in certain fields, where appropriate.

TELEMEDICINE TAKES OFF

During the pandemic, telemedicine appointments in the U.S. increased by 50%. 9 The medical community quickly adapted to using telemedicine to improve care and expand access. Telemedicine research will continue to inform best practices, develop technology resources, and align reimbursement processes.

MOVING FORWARD

Few among us remain unaffected by the pandemic. We will remember its impact on people’s physical and mental health and its economic fallout. Yet, our fight against COVID-19 has taught us a lot. It has expanded our knowledge of virus transmission and opened our eyes to inequities that must be addressed. Increased funding for health care ARKANSAS HOSPITALS | SUMMER 2021 55

infrastructure, workforce development, surveillance, and technology will better prepare health systems for the future. Vaccination efforts will continue. Renewed focus on equity and support for vulnerable populations will improve lives disproportionately affected by the pandemic. References 1 CDC COVID Data Tracker. Accessed May 5, 2021. https://covid.cdc.gov/covid-datatracker/#datatracker-home 2ADH COVID Dashboard. Accessed May 5, 2021. https://www.healthy.arkansas.gov/programsservices/topics/novel-coronavirus 3 Fisher KA, Barile JP, Guerin RJ, et al. Factors Associated with Cloth Face Covering Use Among Adults During the COVID-19 Pandemic – United States, April and May 2020. MMWR Morb. Mortal Wkly Rep 2020; 69:933-937. DOI: https://www. cdc.gov/mmwr/volumes/69/wr/mm6928e3. htm?s_cid=mm6928e3_w 4 CDC Guidance for Wearing Masks. Updated April 19, 2021. https://www.cdc.gov/ coronavirus/2019-ncov/prevent-getting-sick/ cloth-face-cover-guidance.html 5 CDC Interim Public Health Recommendations for Fully Vaccinated People. Updated April 29, 2021. https://www.cdc.gov/coronavirus/2019ncov/vaccines/fully-vaccinated-guidance.html 6 Dasgupta S, Bowen VB, Leidner A, et al. Association Between Social Vulnerability and a County’s Risk for Becoming a COVID-19 Hotspot – United States, June 1-July 25, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1535-1541. DOI: https://www.cdc.gov/mmwr/volumes/69/wr/ mm6942a3.htm 7 Calo WA, Murray A, Francis E, Bermudez M, Kraschnewski J. Reaching the Hispanic Community About COVID-19 Through Existing Chronic Disease Prevention Programs. Prev Chronic Dis 2020;17:200165. DOI: https://www. cdc.gov/pcd/issues/2020/20_0165.htm 8 Romano SD, Backstock AJ, Taylor EV, et al. Trends in Racial and Ethnic Disparities in COVID-19 Hospitalizations, by Region – United States, March-December 2020. MMWR Morb Mortal Wkly Rep 2021;70:560-565. DOI: https:// www.cdc.gov/mmwr/volumes/70/wr/mm7015e2. htm 9 Koonin LM, Hoots B, Tsang CA, et al. Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic – United States, January-March 2020. MMWR Morb Mortal Wkly Rep 2020;69:1595-1599. DOI: https://www.cdc. gov/mmwr/volumes/69/wr/mm6943a3.htm

Kristy Bondurant, PhD, serves as the Epidemiologist for the Arkansas Foundation for Medical Care (AFMC).

56 SUMMER 2021 | ARKANSAS HOSPITALS

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ARKANSAS HOSPITALS | SUMMER 2021 57

COACH'S PLAYBOOK

Agility and Resilience in the Time of COVID-19 By Kay Kendall

hat’s the difference between agility and resilience? Both are included in the new 2021-2022 Baldrige Excellence Framework as core values and concepts that are embedded in high-performing organizations, and both are imperative in times of crisis, whether short-term or sustained (as we’re experiencing worldwide during the COVID-19 pandemic). The Framework tells us that “Agility requires a capacity for rapid change and for flexibility in operations.” Following the onset of the pandemic, we heard many leaders describe their organizations’ ability to “pivot,” to change direction and refocus on the demands of the 58 SUMMER 2021 | ARKANSAS HOSPITALS

crisis. This implies a reaction to sudden change. “Resilience” (a concept new to this revision of the Baldrige Criteria) is more than a reaction. It’s associated with rebounding from “disasters, emergencies, and other disruptions … to protect and enhance workforce and customer engagement, supplynetwork and financial performance, organizational productivity, and community well-being.” I particularly like what Bob Fangmeyer, Director of the Baldrige Performance Excellence Program, had to say recently. He explained that “Resilience is more than just bouncing back. It can be about bouncing forward, achieving performance better than your previous baseline.”

KEY ELEMENTS CONTRIBUTING TO AGILITY AND RESILIENCE

As I heard in a recent webinar, “You can’t change culture in the middle of a crisis.” What we’ve learned from many of our health care clients is how their use of the Baldrige Excellence Framework aided them – was a literal life-saver – when COVID-19 hit. They already had key work processes in place. They had well-trained staff ready to receive additional new training for preventing and controlling the infection. They had effective performance improvement systems engaging the entire workforce in problem solving and

Resilience is more than just bouncing back. It can be about bouncing forward, achieving performance better than your previous baseline.

process improvement. And they had dynamic cultures evolving from their performance excellence journeys. In other words, because of their work within the Baldrige Criteria, these leaders already had established the culture they needed to not only survive but to thrive in COVID-19’s constantly changing environment.

AN EXAMPLE FROM THE CLEVELAND CLINIC

Recently, I participated in the Institute for Healthcare Improvement’s (IHI) Virtual Learning Hour on the topic of Resilience in Healthcare. Nate Hurle, Senior Director of Enterprise Continuous Improvement at the Cleveland Clinic, explained that their clinic has employed Lean principles for more than 10 years, and that the entire workforce has been trained on the use of A3s (a Lean project improvement tool). Like one of our clients, Mary Greeley Medical Center in Ames, Iowa, (a Baldrige Award Recipient in 2018) that also has a long history in using the Lean methodology, employees at the Cleveland Clinic have two responsibilities: do your work, and improve your work. Here’s an example of doing and improving: The Cleveland Clinic responded to the need for COVID testing only two days after first being challenged to create a drive-

through testing center. On the first day of operation, they were able to conduct 30 tests per hour. After another two days of observation and implementing small tests of change, the same number of staff were able to conduct 120 tests per hour. And they had a very willing partner in identifying and implementing the changes – the Cleveland Chief of Police, who showed up the first day in response to the long lines of cars with people waiting to be tested. That’s agility in action!

TAKING INTELLIGENT RISKS

There’s another useful concept appearing several times in the Baldrige Excellence Framework: intelligent risks. The Glossary begins defining intelligent risks as “Opportunities for which the potential gain outweighs the potential harm or loss to your organization’s future success if you do not explore them.” It continues by describing the organizational culture and leadership

style required for intelligent risks to be viable. “Taking intelligent risks requires a tolerance for failure and an expectation that innovation is not achieved by initiating only successful endeavors.” How are you looking for intelligent risks that might allow you to bounce forward from this pandemic and achieve even higher performance levels than before? How do you reinforce a culture where ideas are sought from every member of the workforce and identification of intelligent risks is encouraged? What do you think could be possible if every person in your organization had two jobs – to do their work and to improve their work? I urge you to consider agility and resilience as goals in your excellence journey, and to look for ways your organization can encourage the taking of intelligent risks. The Baldrige Excellence Framework is all about helping you innovate and improve, and we’re ready to help.

The team at BaldrigeCoach would be glad to help guide your hospital’s quest for process improvement. As CEO and Principal of BaldrigeCoach, Kay Kendall coaches organizations on their paths to performance excellence using the Malcolm Baldrige National Quality Award Criteria as a framework. Her team, working with health care and other organizations, has mentored 24 National Quality Award recipients. In each edition of Arkansas Hospitals, Kay offers readers quality improvement tips from her coaching playbook. Contact Kay at 972.489.3611 or Kay@Baldrige-Coach.com. ARKANSAS HOSPITALS | SUMMER 2021 59

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60 SUMMER 2021 | ARKANSAS HOSPITALS

Your Quick-Reference Guide to the 2021 Legislative Session By Jodiane Tritt

January 11, 2021 Session Start Date

April 28, 2021

ACTS:

Session Recess

July 28, 2021

Potential Enactment Date for bills with no emergency clause or special enactment date

SPEAKER OF THE HOUSE: Matthew Shepherd PRESIDENT PRO TEMPORE OF THE SENATE: Jimmy Hickey, Jr.

House of Representatives (100 members):

2021 RESOLUTIONS House Concurrent Resolutions:

House Resolutions:

Senate Resolutions:

House Joint Resolutions:

Senate Joint Resolutions:

Men/Women

Freshmen (serving first term) second term third term fourth term fifth term

Each represents about 88,000 Arkansans

Republican/ Democrat

25 Women

Terms:

Senate (35 members):

Senate Concurrent Resolutions:

Each represents about 30,000 Arkansans 22 19 27 21 11

1,112

1,675

REGULAR BILLS FILED:

24 Democrat

75 Men

Men/Women

Terms:

4 Freshmen (serving first term) Term limited legislators (ALL have been hospital super-supporters – especially Sen. Teague): Senator Cecile Bledsoe Senator Joyce Elliott Senator Larry Teague

7 Women 28 Men

76 Republican

Republican/ Democrat/ Independent

7 Democrat

1 Common Ground/ Independent

27 Republican

ARKANSAS HOSPITALS | SUMMER 2021 61

BALLOT REFERRALS HJR 1005 – Requires 60% approval in each chamber to refer a constitutional amendment to the ballot and 60% approval by the electors to adopt a referred amendment or an amendment submitted through the initiative process.

SJR 10 – To amend the Arkansas Constitution to authorize the legislature to enter special session when twothirds of the legislature submits signatures, or by joint proclamation of the Speaker of the House and Senate President Pro Tempore.

MEDICAID FUNDING SB 55 > ACT 843

Appropriates funds to the Department of Human Services (DHS), Division of Medical Services, for 2021-2022 operations.

VISITATION HB 1061 > ACT 311, Effective March 10, 2021

Creates the No Patient Left Alone Act, ensuring that a legal guardian, parent, spouse, or another designated individual has the right to be physically present with a patient in a hospital, long-term care facility or similar facility.

EDUCATION AND LICENSURE HB 1582 > ACT 803

Authorizes the Arkansas State Medical Board to offer a multiyear license or registration for a two-year period after the person requesting the option provides required information and pays fees for two years.

HB 1780 > ACT 759

Provides that the educational program and courses for licensed practical nurses and medication assistive persons may be provided by a post-secondary educational institution, a hospital, or a consortium of five or more skilled nursing facilities.

Because Arkansas’s Medicaid Expansion program, created in 2013, expires on December 31, 2021, the AHA’s highest legislative priority this session was to ensure continued coverage for the almost 300,000 Arkansans who have benefitted from the program. Act 530 of 2021 is that program.

SB 410 (ACT 530 – EFFECTIVE JANUARY 1, 2022)

Creates the Arkansas Health and Opportunity for Me Act of 2021 (ARHOME), replacing the Arkansas Works Program for expanded M e d i c a i d c o v e r a g e . C re a t e s incentives for individuals to gain qualified health insurance premium assistance. Creates voluntary, hospital-led Rural HOMES, Maternity HOMES, and Success HOMES, which will be designed in a manner to pay hospitals per member, per month fees to provide social and other wraparound services to defined Medicaid beneficiaries.

HB 1931 > ACT 1079

Changes the composition of the Arkansas Rural Medicine Practice Student Loan and Scholarship Board and provides that all members are appointed by the Governor, are subject to confirmation by the Senate, and have term limits of three years.

HB 1932 > ACT 1080

Changes the priorities the Graduate Medical Education Residency Expansion Board

may consider with regard to the prioritization of planning grants; specifies an eligibility requirement for the grant.

SB 152 > ACT 634

Changes the size and composition of the

SJR 14 – A constitutional amendment prohibiting government from burdening one's freedom of religion absent a demonstration that the burden advances a compelling government interest and is the least restrictive means of furthering that interest. State Medical Board, providing that one additional member must be a practicing physician assistant; expands the scope of authority and prescriptive authority of physician assistants.

SCOPE OF PRACTICE / LICENSURE HB 1198 > ACT 449

Amends supervision requirements for certified registered nurse anesthetists (CRNAs). Each hospital will have the ability to set up supervisory or consultation requirements in its medical staff bylaws.

HB 1254 > ACT 569

Requires the Arkansas Medicaid program to recognize and reimburse an advanced practice registered nurse as a primary care provider authorized to carry out the duties of a primary care case manager.

TELEMEDICINE HB 1063 > ACT 829, Effective April 21, 2021

Authorizes audio-only consultations to qualify as covered services under the Telemedicine Act.

CRIMINAL INVESTIGATIONS HB 1897 > ACT 990

Authorizes a blood sample to be taken by a non-physician, without the supervision of a physician, when a person consents or is under a warrant or court order; requires a physician or nurse to draw blood in exigent circumstances.

HB 1722 > ACT 708

Authorizes coroners to issue subpoenas to secure antemortem blood, urine or other biological fluids or toxicological samples relevant to the determination of the cause of death; permits health care providers to make samples available to coroners; more.

FRIENDLY DISCLAIMER: Because the legislature recessed and did not adjourn sine die, the effective date for Acts without an emergency clause that specifies an effective date is unknown at this time. Leadership in the House and Senate believe that the effective date for those Acts without an emergency clause will be on the 91st day after a full 90-day recess. The legislature cannot adjourn without performing required redistricting tasks for Arkansas’s representation in the U.S. Congress and for each of Arkansas’s House and Senate seats. Arkansas is waiting on official census data to ensure that the redistricted lines are updated in accordance with the required population for each district.

62 SUMMER 2021 | ARKANSAS HOSPITALS

PHARMACY HB 1804 > ACT 665

Makes changes to the Arkansas Pharmacy Benefits Manager Licensure Act and requires rules that place pharmacy network locations within two to 15 miles of the majority of populations in areas, depending on the area's urban/rural status.

HB 1852 > ACT 922

Requires the State Board of Pharmacy to promulgate and maintain standards for prescription delivery services; prohibits certain pharmacists/pharmacies from requiring that a patient receive prescriptions through home delivery services; more.

HB 1881 > ACT 1103

Prohibits a third-party payor or pharmacy benefits manager from coercing or requiring a patient to use a mail-order pharmacy; requires the third-party to eliminate discrimination with regard to 340B drug pricing under the Veterans Health Care Act; more.

HB 1907 > ACT 1105

Authorizes health care providers to make a determination in the best interest of the enrollee to bill the health care payor or pharmacy benefits carrier; prohibits payors and pharmacy benefits carriers from placing certain requirements on enrollees. (CARTI)

SB 617 > ACT 1053

Places various restrictions and disclosure requirements on certain pharmacies, physicians or other licensed prescribers who utilize outof-state pharmacies and common carriers for deliveries; prohibits data mining, requires ownership disclosure; more.

HOSPITAL REQUIREMENTS SB 289 > ACT 462

Ensures a right of conscience for all health care institutions, health care payers and medical practitioners, prohibiting discrimination based on medical decisions made due to religious, moral, ethical, or philosophical principles with limited exceptions.

SB 590 > ACT 1002, Effective April 28, 2021

Ends the face covering (mask) requirement that was issued through executive order and extended until March 31, 2021. Prohibits state agencies, local governments, and local officials from mandating the use of a face covering.

HB 1136 > ACT 598

Requires a Hepatitis C screening during pregnancy or at the time of delivery if the health care provider did not attend the pregnant woman prenatally. Requires health benefit plans to provide coverage for screening, not subject to deductible/copay.

HB 1502 > ACT 697

Requires that clear face mask coverings be worn by those rendering professional services when encountering and interacting with an individual who is deaf or hard of hearing and that reasonable accommodation be made.

HB 1547 > ACT 977, Effective April 28, 2021

Prohibits schools, licensing entities, and employers (who are granted immunity from civil liability for injuries resulting from exposure) from mandating COVID-19 vaccinations through discrimination or coercion.

HB 1659 > ACT 674

Changes the conditions under which a waiver may be granted regarding the requirement to complete death certificate registration and medical certification of death using an electronic process or system; waivers granted only to those practitioners who complete and sign less than 10 death certificates per year.

HB 1570 > ACT 626

The SAFE Act – Prohibits providing any of a list of gender transition procedures to persons who are gender nonconforming or experiencing gender dysphoria and who are under 18; prohibits public funding and health insurance for such procedures.

IMMUNITY HB 1521 > ACT 510, Effective April 1, 2021

Codifies Executive Orders 20-18 and 20-34 related to the COVID-19 pandemic, holding health care providers immune from liability and exempt from specific licensing requirements for services provided during the emergency.

ELECTION SB 496 > ACT 610

Makes various changes to election law with regard to the dates special elections are held.

MISCELLANEOUS

FAILED NOTEWORTHY FAILED BILLS

HB 1546 – Sunsets the Soft Drink Tax Act by 2025, which is currently used to fund the state portion of federal matching funds in the Arkansas Medicaid Program Trust Fund that can be used to help ensure the Medicaid program can fulfill its obligations to Medicaid providers and patients in times of general revenue shortfalls. SB 611 – Creates the Committee on Acuity-Based Care to make recommendations with regard to nurse staffing ratios within hospitals and rehabilitation and long-term care facilities. HB 1707 – Repeals the requirement that enrollment positions at the University of Arkansas College of Medicine be based on apportionment by congressional district and Arkansas residency. SB 570 – Removes current appointees of the State Medical Board on December 31, 2021. Revises the membership structure and provides for appointment of some members by legislative leadership. SB 572 – Authorizes persons without medical licenses to be officers, directors, or shareholders in a medical corporation. Prohibits those persons from having part in treatment, consultation or advice being given by licensed employees. HB 1685 and HB 1686 – Changes to POLST and HCDA; would allow APNs to sign POLST forms; modifies which document controls patients’ wishes for treatment.

SB 621 > ACT 899

Requires the Medicaid Program and the Department of Human Services to reconsider a number of consent decrees resulting from court decisions in light of an intervening Supreme Court decision; requires quarterly reports to the Legislative Council.

Jodiane Tritt, JD, serves as Executive Vice President at the Arkansas Hospital Association. You may reach her at jtritt@ arkhospitals.org.

ARKANSAS HOSPITALS | SUMMER 2021 63

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Keep taking basic prevention steps Keep basic prevention steps whentaking recommended. when recommended.

U.S. Department of Health and Human Services U.S. Department Centers for Diseaseof Health and Human Services Control and Prevention Centers for Disease Control and Prevention

64 SUMMER 2021 | ARKANSAS HOSPITALS

Vaccinate the Natural State is an initiative to encourage all Arkansans to get their COVID-19 vaccination when it's their time. We’re working in collaboration with multiple business, healthcare and community organizations statewide — including the Arkansas Hospital Association — to educate and engage Arkansans in doing our part to help end the pandemic.

Let's work together to... Protect caregivers.

Protect families.

Protect communities.

Whether you are providing vaccinations, getting your workforce vaccinated, or encouraging your family and friends, everyone has a role in helping end the pandemic. Find out more at www.vaccinatethenaturalstate.com

In partnership with:

In collaboration with: ¡ Arkansas College of Osteopathic Medicine/ Fort Smith

¡ Arkansas Medical Dental Pharmacy Association

¡ Arkansas Faith Network

¡ Association of Federally Qualified Health Centers

¡ Arkansas Hospital Association

¡ Community Health Centers of Arkansas

¡ Arkansas Immunization Action Coalition (Immunize Arkansas)

¡ NYIT College of Osteopathic Medicine/Jonesboro

¡ Arkansas Pharmacists Association

10111 3/21

ARKANSAS HOSPITALS | SUMMER 2021 65

CONSTRUCTION

INDUSTRIAL

E XC AVAT I O N

E N V I R O N M E N TA L

WE BUILD PLACES OF HEALING

When Baxter Regional Medical Center needed to upgrade their current surgical department they called on Nabholz to build a new ambulatory surgery center. The 22,000 SF free-standing center includes six operating rooms, 27 prep/recovery beds, central sterilization, patient check-in, business office, and waiting room. The new facility allows surgeons to schedule a wider variety of procedures locally so the residence of Mountain Home can stay closer to home.

1 . 8 7 7. N A B H O L Z | n a b h o l z . c o m

S P E C I A LT Y

Arkansas Hospitals, Summer 2021

Articles inside

Leader Profile: Terry Amstutz

One Year Changes Everything

Pandemics Change the Workplace

Event Calendar, Learning Opportunities

President’s Message

A Tale of Two Pandemics

Hospital Newsmakers

Editor’s Letter