Arkansas Hospitals, Summer 2020 by Arkansas Hospital Association

ARKANSAS

HOSPITALS Summer 2020

ESSENTIAL FACING HEALTH DISPARITIES IN COVID-19 A 5-YEAR RETROSPECTIVE

Statistics Edition

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The ESSENTIAL Issue ESSENTIAL READING

10 Facing Social Inequality and Health Disparities in Times of COVID-19 18 Pharmacy Collaboration in Antimicrobial Stewardship 21 2020 Hospital Statistics

A 5-YEAR RETROSPECTIVE

37 Shaping the Hospital of the Future, Summer 2016

42 Embracing Telemedicine: Piggott Community Hospital, Summer 2017 48 Can a Bag of Food Improve Health?, Fall 2017 54 Heroes Caring for Heroes, Winter 2017 58 Linking the Underserved, Spring 2017 62 Answering the Call, Spring 2016

IN EVERY ISSUE

5 President’s Message 6 Virtual Learning Opportunities 8 Hospital Newsmakers 9 Editor’s Letter 14 Leader Profile: Gary Paxson

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

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 Jan Gardner, North Little Rock Phil Gilmore, Crossett Vince Leist, Harrison James Magee, Piggott Mike McCoy, Danville Gary Paxson, Batesville Rob Robinson, El Dorado 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

Summer 2020

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.

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PRESIDENT’S MESSAGE

Reducing the

Impact of COVID-19 T

he doctors, nurses, respiratory therapists, aides and techs, housekeepers, cafeteria staff, administrators, and more who work tirelessly throughout the pandemic – they’re showing us every day exactly what it means to be an “essential worker.” Under extreme difficulty – often with less than enough protective gear, testing supplies, ICU space, and, in some cases, even with reduced staff, these heroes keep stepping up and caring for the sickest among us. I’m inspired by the way our hospitals are collaborating. I see them rallying in ways I’ve never seen before. Competing hospitals in the same city or region are sharing data and dashboards, so that every organization knows exactly which facilities have ICU beds available at any given moment. They hold daily calls, keeping lines of communication open to make sure patients can access the care they need immediately.

In Fort Smith, Mercy and Baptist Health collaboratively sponsor and staff a COVID-19 call center and testing operation, where nearly 1,500 specimens were collected in its first 48 days of operation. In the northeast part of the state, hospitals hold daily check-in calls and emergency updates on testing capacity, ventilator availability, numbers of confirmed and suspected COVID-19 cases and intubations – all shared for the good of the community. And in the Little Rock metro area, a COVID-19 task force made up of hospital leaders and the Arkansas Hospital Association meets regularly to discuss the challenges of safely operating our hospitals during a pandemic. We’ve all come to rely on a communication structure set up by the

Arkansas Department of Health (ADH). In the earliest days of the pandemic’s arrival in Arkansas, ADH and its leaders communicated regularly with hospitals to understand the role testing would play in pandemic response and how testing availability was affecting our state. We’re grateful to Connie Melton and Dr. Jerrilyn Jones – and of course Dr. Nate Smith – for what they’re doing for hospitals on behalf of ADH. People say, “We’re all in this together,” and I can honestly say that’s how it feels in the midst of COVID-19. People in the health care field always have the health of patients at heart. But today, in this strange and difficult time, I see us pulling together as never before. I’d like to offer a pat on the back to every person working in health care in Arkansas. Few will ever know just how much your collaboration and expertise reduce COVID-19’s potential impact on Arkansans. We thank you, and we appreciate you!

Bo Ryall

President and CEO Arkansas Hospital Association ARKANSAS HOSPITALS | SUMMER 2020 5

2020 Virtual Learning To protect our health care teams during the COVID-19 pandemic, AHA’s in-person educational offerings are on hiatus. But webinars are still available to meet your training needs. Go virtual with these courses and series. For more details and registration information, visit the AHA Calendar of Events at arkhospitals.org.

JULY

July 1: EMTALA Webinar Series, Session 2 of 3 Topic: EMTALA Issues

July 9: Virtual Executive

Leadership & Resiliency Summit, Part 2 Topic: Update on Coronavirus: What’s Next & How to Plan, Marty Makary, MD

July 15: EMTALA Webinar Series, Session 3 of 3 Topic: Physician Involvement with the EMTALA Process

July 15: Employment Law

Webinar Series, Session 3 of 4 Topic: ERISA 101: Employee Benefits and Compliance

July 16: Webinar: 2020

Vision for Ostomies and Wound Managers

July 21: Governance Webinar

Series, Session 2 of 4 Topic: Health Care Fraud and Abuse 6 SUMMER 2020 | ARKANSAS HOSPITALS

July 23: Virtual Executive

August 6: Virtual Executive

July 29: CMS CoP Made Easy

August 12: CMS CoP Made Easy

Leadership & Resiliency Summit, Part 3 Topic: The Post-COVID Healthcare Landscape, Jeff Goldsmith

2020 Webinar Series, Session 1 of 5 Topic: CMS CoP Manual, Patient History Updates & Verbal Physician Orders

AUGUST

August 5: CMS CoP Made Easy 2020 Webinar Series, Session 2 of 5 Topic: Restraints and Patient Rights

August 6: Cultivating Good Health Webinar Series, Session 4 of 6 Topic: Developing Resilience: An Approach for Personal and Professional Well-Being

Leadership & Resiliency Summit, Part 4 Topic: How Hospitals & Health Systems Can Lead a “Quiet Revolution” for Healing During a Pandemic, Dayna Bowen Matthew, JD, PhD 2020 Webinar Series, Session 3 of 5 Topic: Medication and Medical Records

August 19: CMS CoP Made Easy

2020 Webinar Series, Session 4 of 5 Topic: Patient Safety, Radiology and Dietician Policies

August 20: Virtual Executive

Leadership & Resiliency Summit, Part 5 Topic: When Good isn’t Good Enough: How Unconscious Bias Harms Patients…Despite Good Intentions, Gloria Goins

August 26: CMS CoP Made Easy

2020 Webinar Series, Session 5 of 5 Topic: Infection Control and Discharge Policies

SEPTEMBER

September 2: CAH CMS CoPs 2020 Webinar Series, Session 1 of 4 Topic: Requirements for Telemedicine Services, Emergency Drugs & Gap Analysis

September 3: Virtual

Executive Leadership & Resiliency Summit, Part 6 Topic: The New Healthcare Ecosystem, Tom Koulopoulos

September 9: CAH CMS CoPs 2020 Webinar Series, Session 2 of 4 Topic: Pharmaceutical Requirements

FREE to AHA

Member Hospitals! Virtual Summit on Executive Leadership & Resiliency The Arkansas Hospital Association is excited to offer this Virtual Summit at NO CHARGE to its hospital members. In collaboration with other state hospital associations – and in partnership with the Executive Speakers Bureau – AHA is bringing hospital and health system leaders together for a one-of-a-kind executive leadership engagement opportunity. Each state association has 322 lines available, so register early to reserve your seat! All registrations must be faxed to AHA.

September 9: Employment Law Webinar Series, Session 4 of 4 Topic: Learning from Hospital Employer Mistakes

September 16: CAH CMS

CoPs 2020 Webinar Series, Session 3 of 4 Topic: Medication and Infection Control

September 17: Cultivating Good Health Webinar Series, Session 5 of 6 Topic: Gratitude: The Path to Resilience, Well-Being, and Joy

September 22:

Governance Webinar Series, Session 3 of 4 Topic: Health Care Fraud and Abuse

September 23: CAH CMS CoPs 2020 Webinar Series, Session 4 of 4 Topic: Informed Consent, Organ Procurement, and Patient Rights for Swing Beds

SESSION DATES June 25

Bite Size Coping During Times of Uncertainty Bryan Sexton

July 9

Update on Coronavirus: What’s Next & How to Plan Marty Makary, MD

July 23

The Post-COVID Healthcare Landscape Jeff Goldsmith

August 6

How Hospitals & Health Systems Can Lead a “Quiet Revolution” for Healing During a Pandemic Dayna Bowen Matthew, JD, PhD

August 20

When Good Isn’t Good Enough: How Unconscious Bias Harms Patients… Despite Good Intentions Gloria Goins

September 3

The New Healthcare Ecosystem Tom Koulopoulos

To support our member hospitals during the COVID-19 pandemic, AHA waives 100% of the event registration fee (normally $275 per person, per session). Learn from these renowned national experts at no cost, courtesy of the AHA. Find more information on each session, as well as registration forms, on the AHA Calendar at arkhospitals.org! ARKANSAS HOSPITALS | SUMMER 2020 7

HOSPITAL NEWSMAKERS Simmons Bank donated $1 million to support the construction of the Arkansas Children’s Pine Bluff Clinic. The project is led by Arkansas Children’s, in association with Jefferson Regional, and will establish a new pediatric clinic on the campus of Jefferson Regional in Pine Bluff. Kim Miller, MBA, FACHE, is the new President of the Baptist Health Western Region, serving both Baptist Health-Van Buren and Baptist Health-Fort Smith. She previously served in health care leadership roles in Wisconsin, North Dakota, and Iowa. The University of Arkansas for Medical Sciences (UAMS) Medical Center is the first hospital in Arkansas to operate with the ExcelsiusGPS robotic spine navigation system that helps improve accuracy and reduce the invasiveness of spinal surgery.

Noojan Kazemi, M.D., performing surgery with the ExcelsiusGPS robotic spine navigation system.

Degrees and certificates were conferred to 914 graduates of the University of Arkansas Medical Sciences’ (UAMS) five colleges and graduate school May 15. Degrees were awarded to 165 in the College of Medicine, 255 in the College of Nursing, 112 in the College of Pharmacy, 67 in the Fay W. Boozman College of Public Health, 257 in the College of Health Professions, and 58 in the Graduate School. Christopher Munton, MHA, is the new COO at National Park Medical Center in Hot Springs. He comes to Arkansas from his most recent position as Assistant Administrator with LifePoint Health in Rutherford, North Carolina. Bob Honeycutt, MBA, MHA, is the new CEO at Saint Mary’s Regional Medical Center in Russellville. He most recently served as Area CEO at Ennis Regional Medical Center & Parkview Regional Hospital in Ennis and Mexia, Texas. New York Institute of Technology College of Osteopathic Medicine (NYITCOM) at Arkansas State University honored four organizations and one individual with the Riland Medal of Public Service at the college’s inaugural graduation ceremony May 21. Barbara Ross-Lee, D.O., the founding dean of NYITCOM at A-State, along with Arkansas State University, the City of Jonesboro, NEA Baptist Health System, and St. Bernards Medical Center received the Riland Medal, which is awarded to individuals and organizations making significant contributions to enhancement of the health care workforce, medical education, community advocacy, osteopathic philosophy, research, academic leadership, and graduate medical education.

Samuel Lynd, MBA, MHA, FACHE, is the new CEO at NEA Baptist Memorial Hospital in Jonesboro, where he previously served as Assistant Administrator before assuming the role of CEO at Baptist Memorial Hospital – Tipton and Baptist Cancer Center in Memphis. He returned to northeast Arkansas after most recently serving as COO at Baptist Memorial Hospital in Memphis. For the first time in the state’s 184-year history, a medical student has earned a Doctor of Osteopathic Medicine degree in Arkansas. New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, which became the first osteopathic medical school in the state when it opened its doors in 2016, celebrated the commencement and hooding of its inaugural class in a virtual ceremony held May 21. 8 SUMMER 2020 | ARKANSAS HOSPITALS

Dr. Emily Young, a member of the NYITCOM at Arkansas State inaugural class, recites the osteopathic oath with her father, Michael Young, D.O., as Emily participates in NYITCOM’s virtual graduation ceremony May 21.

EDITOR’S LETTER

Looking Back,

Moving Forward H

ospitals are essential. The unprecedented challenges of a worldwide pandemic have served to highlight, once again, the deep connections between hospitals and the communities they serve. As hospitals across the nation and across Arkansas are working together to provide critical care capacity for those who are seriously ill with COVID-19, it is not an exaggeration to call those who are caring for patients in our facilities true heroes. Yet, even as we appreciate and honor the selfless work involved in healing patients facing COVID-19, we also must acknowledge that this pandemic has laid bare – in ways we cannot ignore – the systemic disparities that exist in our national health care system. Those of us involved with health policy have long talked about social determinants of health and equity of care, and many have worked hard to address these issues. COVID-19 makes it clear, however, that there is much work yet to do. In this edition of Arkansas Hospitals, we are taking that first step forward into the future with our cover article by Dr. Melinda Estes, President and CEO of the St. Luke’s Health System in Kansas City, Missouri and Chair of the American Hospital Association’s Board of Trustees. Addressing health disparities, Dr. Estes combines her boots-on-the-ground experience with her big-picture perspective in an article urging us to give health disparities and social inequality our full attention. As health care providers, we are “uniquely positioned to provide leadership in this critical area at this critical time.” The editorial staff is combining this call to action by Dr. Estes with our annual compilation of hospital statistics, alongside a thoughtful retrospective of our favorite articles from the past five years. Reminding ourselves of what we’ve learned and challenging ourselves anew with the words of experts is a good way to chart our course forward.

Like many of you, I’ve struggled to nurture my inner optimist this year, but I still hear that voice in my head reassuring me that this is an exciting time to be in health care. This pandemic has offered us a unique opportunity to reshape the health care system in ways that may have seemed impossible just a few months ago. Join us in looking back to move forward and strengthen the essential ties between hospitals and our communities. It’s a time of change, and we have much to do.

Elisa M. White Editor in Chief

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A Health Care Challenge:

Facing Social Inequality and Health Disparities in Times of COVID-19 By Melinda L. Estes, MD

t Saint Luke’s Health System, the teams at our 18 hospitals and campuses across the Kansas City metro region have been fortunate to not yet experience the COVID-19 surge levels seen in New York, New Orleans, and San Francisco. But that doesn’t mean we haven’t seen firsthand the impact of the illness on our most vulnerable patients in a multitude of other ways. As president and CEO of Saint Luke’s, and this year’s Chair of the American Hospital Association’s Board of Trustees, I’m troubled by what COVID-19 is doing to our low-income

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and minority Americans – not just how their lungs burn and heads ache in our hospitals, but also how their lives are shattered in their homes, right in our hometowns. I know our providers are troubled, too. I’m sure one of Saint Luke’s primary care physicians, Dr. Lindsay Williams, didn’t expect that her career in medicine would lead her to personally deliver face masks to two patients who found themselves homeless, living in their car in a JCPenney parking lot, and suffering COVID-19 symptoms. Dr. Williams knew they were at-risk and lacking any support structure that

could offer help, especially in times of isolation. It wasn’t what she expected to be doing with her medical degree, but it fit within the mission to serve and care for her patients. So she checked in regularly, got them tested, and donated supplies. She did it without thinking twice.

THE DATA CAN’T BE IGNORED

Sadly, stories like these aren’t rare anymore. For far too many Americans, the fears surrounding COVID-19 go well beyond those of personal health.

St. Luke's Hospital in Kansas City, Missouri, is the flagship hospital of St. Luke's Health System.

Though, as Dr. Williams’s patients learned, that fear is very real – and it is even more daunting for black Americans, who are dying at 2.5 times the rate of white Americans, and Latinxs who only represent 18% of the U.S. population but account for more than 26% of COVID-19 deaths. The fact is that low-income populations and minorities are more at-risk, and in more ways, during this pandemic. Filling more service industry roles, they are more likely to be exposed. And when exposed, they are suffering higher mortality rates. Whether they become ill or not, the economic impact can be crippling. In the wake of its mounting death and economic toll, COVID-19 has also shined a blinding light on the bitter truths of social inequality and health disparities in this country, and the negative effects they are having on our health – as individuals and collectively as a society. In April, when the U.S. unemployment rate hit 14.7%, minority groups were clearly the hardest hit with job losses at 19% and 17% for Latinx and black workers, respectively. This is true even though minorities are more likely to be the essential workers we continue to count on. Of those still working those essential, often service-industry jobs, their personal health is left at risk. They are overwhelmingly people of color, and they are struggling more than most today in a number of ways:

• Service-industry employees, relying mostly on tips, have been deeply affected by the economic shutdown. Most are women and minorities. According to a recent PolicyLink COVID-19 & Race Commentary, more than 20 million people in the U.S. worked a job that relied heavily on tips, such as restaurant wait staff, delivery drivers, and salon technicians and stylists. Of those 20 million, 70 percent are women of color, who are three times as likely to live below the poverty line as other members of the U.S. workforce. • Social distancing and working from home are not options for many low-wage workers. As shown in recent data from the Kaiser Family Foundation , a large portion – 20% – of the unemployment claims filed in the wake of COVID-19 have been for people formerly employed in the accommodation and food services industries, where working from home simply isn’t possible. • This year’s high school and college graduates will struggle to find work – and health coverage – amid an expected economic recession.

Past economic downturns have shown us that the youngest of American workers tend to struggle most in finding work when recession hits. Not only do younger Americans disproportionately work in the hardhit and high-risk sectors of food service, retail, and hospitality, their future prospects are now dimmed thanks to COVID-19. The pandemic will leave 3.5 million high school graduates and 1.3 million college graduates with uncertain futures, and many without an employerprovided health insurance plan. • COVID-19 thrives in a body already struggling with underlying health conditions – and that description unfortunately fits too many American minorities. The CDC study released in early April, showing that about 90% of the most serious COVID-19 cases involve underlying health conditions, raised an alarm that couldn’t be ignored. Hypertension, diabetes, obesity, chronic heart and lung disease: all are conditions that seem to lead to worse COVID-19 outcomes and that are disproportionately found in minority populations. A recent New York

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Times Magazine article observed that “the health outcomes of black Americans are by several measures on par with those of people in poorer countries with much less sophisticated medical systems and technology. And though these health disparities are certainly worsened by poverty, they are not erased by increased income and education. The elevated rates of these serious illnesses have weaponized the coronavirus to catastrophic effect in black America.” As Qiana Thomason, president and CEO of Kansas City-based Health Forward Foundation stated in an April 23 blog post, “An abundance of national historical data reminds us that in public health, when America catches a cold, people of color catch pneumonia.” The data backs her up.

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THIS DESERVES OUR FULL ATTENTION

The problems magnified by the COVID-19 crisis are clearly significant and urgent, but they aren’t new. The facts and statistics surrounding these vast and varied health disparities have been known for too long. And as we manage this crisis into the summer and fall, we will continue to see the ways these disparities are compounded, putting more people, families, and entire communities at risk. It is an issue that deserves our full and dedicated attention as we look beyond the pandemic toward recovery – physical, economic, and societal. In April, I was proud to sign a letter as chair of the American Hospital Association Board of Trustees, along with my valued counterparts at the American Medical Association and

American Nurses Association, urging U.S. Department of Health and Human Services Secretary Alex Azar to address these issues. Focused always on the well-being of our patients across the country, we called on HHS to increase available testing, ensure access to equitable treatment, and disseminate timely, relevant, culturally appropriate and culturally sensitive public health information. Today, the AHA continues to work with Congress on key legislation that that will help bring about positive change in this critical area. As we continue to battle stigmas and misconceptions surrounding the health of minorities and lowincome Americans, we face a difficult struggle that can only be solved through education, research, community investment, and dedicated engagement from the professionals who are living in this crisis every day. As health care providers, we are uniquely positioned to provide leadership in this critical area at this critical time, because our pursuit to provide care does not extend only to those with enough; by its very definition, our mission is to care for those most in need. Today, we see so many in need. Just ask Dr. Williams. Now, building on systemwide population health initiatives studying food and transportation insecurity in the KC metro, Dr. Williams is committed to elevating the conversation and working with like-minded professionals and local

organizations to find solutions to the problems that led her patients to these dire circumstances. With dedicated health care servants like Dr. Williams – passionate to find a better way of doing things – those in our field can be leaders in this critical task of caring for entire communities, no matter race, country of origin, or economic status. We know that, in each of our hospitals across Kansas, Missouri, Arkansas, and the entire U.S., it is our responsibility to start looking for solutions – to examine our communities, see where we can improve lives through better health, and begin to take action. We also know that in each of these hospitals, passionate future leaders like Dr. Williams are raising their hands to help find those answers. Call on those leaders. Listen to them, empower them, and trust them. Challenge them to do great things and be amazed at the results you’ll yield. Encourage them to live out the possibilities they envision for a fairer and healthier community – in Little Rock, in Kansas City, and in every town in between and across the country.

FINDING ANSWERS, TOGETHER

The answers are not simple nor readily available. They will require curiosity and tenacity, innovation and compassion, and a cross-section of advocates, diverse in expertise and background, invested in this worthy goal. With the AHA guiding us as a field and advocating for us at the federal level, and with valued local organizations like the Arkansas Hospital Association advocating for the health equity of all Arkansans, I expect these conversations to get louder, more frequent, and more productive in the months to come. To help arm us with valuable information and guidance through this work, the AHA has provided several new resources, including “5 Actions to Promote Health Equity during the COVID-19 Pandemic” and a guide demonstrating how Awareness of Social Needs Can Help Address Health Inequity during COVID-19. To learn more about how the AHA has redoubled its efforts in this fight, visit the Institute for Diversity and Health Equity and AHA Hospital Community Collaborative pages on the AHA website (www.aha.org). Working together toward a goal of health equity in the U.S. is not an easy challenge, but it is worthy of our best effort. It ties directly to our universal mission to care for our patients, to improve the lives of individuals and families, and to lift entire communities so that they are stronger and healthier for future generations. References 1 Kansas City Star, “Laid off, homeless and coronavirus positive: KC couple’s problems pile up in pandemic. March 29, 2020. 2 PolicyLink, COVID-19 & Race, May 13, 2020. 3 KFF, “Double Jeopardy: Low Wage Workers at Risk for Health and Financial Implications of COVID-19,” April 29, 2020. 4 The New York Times Magazine, “’A Terrible Price’: The Deadly Racial Disparities of COVID-19 in America,” Updated: May 20, 2020. 5 Health Forward Foundation, “Emerging data show COVID-19 disproportionately impacts communities of color,” April 23, 2020. 6 AHA/AMA/ANA Letter to HHS Sec. Azar. April 16, 2020.

Melinda L. Estes, MD, is president and CEO of Saint Luke’s Health System in Kansas City, Missouri. Saint Luke’s, with its 18 hospitals and campuses in the metro and surrounding rural communities, is the area’s thirdlargest private employer. Dr. Estes currently serves as the Chair of the American Hospital Association’s Board of Trustees. As a board-certified neurologist and neuropathologist, she is a champion of strengthening physician engagement and, in 2018, she served as the chair of the task force that created the AHA Physician Alliance. Dr. Estes is a past member of the AHA Metropolitan Hospital Council, the AHA Committee on Health Professions, and the AHA’s Advisory Committee on Health Care Reform. In 2018, Modern Healthcare named her one of its 50 Most Influential Physician Executives and Leaders, and since 2012 she has consistently been named to Becker’s Hospital Review lists of leaders to know.

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LEADERSHIP PROFILE

A Beautiful Evolution By Nancy Robertson

ary Paxson, RN, BSN, MS, is President and CEO of White River Health System, one of the state’s leaders in commitment to Quality and Patient Safety. His dedication to quality improvement has deep roots in his early career first as a registered nurse, then as a health care information systems manager. He joined WRHS in 2012 as Associate Administrator and Chief Information Officer, where each of his previous career skills came into play. “I arrived at WRHS soon after completing my master’s degree in Information Systems Management with a Healthcare Administration concentration,” he says. “Prior to that, I served hospitals in northern Illinois and southern Wisconsin for more than eight years, working the night shift as a full-time ICU Charge Nurse. With the impending birth of our third child, it was definitely time to find a day job, and I accepted a position in nursing informatics.” While hesitant to leave the ICU adrenaline rush in the past, he developed intense interest in the informatics field. “Informatics and critical thinking go hand in hand,” he says. “Clinical analytics and data review helped my team reveal opportunities for improvement. My job was to help the clinical staff members see where outcomes lagged and help devise plans to improve quality.” As his understanding of health care analytics grew, a promotion to Information Systems Manager for his longtime career “home,” Kishwaukee Health System, exposed him to the business side of health care. “Policy and procedure development, departmental budgeting and, of course, staff management became cornerstones of my daily routine,” he says. “So did monitoring and compliance with all Joint Commission, CMS and state regulations pertaining to IS. I loved this work – the people and the analytics. With six years in informatics under my belt, I was comfortable. But a mentor urged me to pursue a master’s degree. He also gave me sage advice: To grow your career, sometimes you

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Gary Paxson serves as President and CEO of the White River Health System, headquartered in Batesville.

must leave the place you’re comfortable and blaze your own trail. That’s exactly what I did.” With Paxson’s acceptance of his new role at White River, he and his family found the move to Arkansas to be a good fit. Part of his work involved collaboration with the system’s CEO, COO, CNO and CMO to ensure that projects and technological needs were matched, and that both regularly met strategic plan goals. “During those years and continuing to today, I worked hard to help others do their jobs better,” he says. This was a time when quality reporting was gaining prominence, and each department regularly reported its quality numbers to the board. “We realized that each department was approaching quality improvement differently,” Paxson says. “We needed to develop a consistent way of looking at improvement and reporting it within our health care system. We were all over the place – we needed to come together.” Over the period of several months, Paxson and his CEO, Gary Bebow, worked out a new position for the White River System. The role would be Chief Quality Officer, and the

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WE ASKED.. What would you be doing if you weren’t in health care? The only other career I contemplated as a child was being a pastor. Right now, I believe I am in health care for a reason, have a strong passion for fulfilling the mission required in health care and see no path for myself outside of this meaningful career. Do you have a favorite movie? Why do you like it? The Patriot. I’ve always been a fan of American history, especially military history. This is a great story of dedication and service to both family and country, things I am very passionate about. Who is someone you greatly admire? My father. He has been a great example of leading in a godly manner with compassion and concern, but with goals in mind that must be accomplished. What is something people don’t know about you? I am an introvert at heart. People assume that because I enjoy public speaking that I am an extrovert. What they don’t know is that I am thoroughly exhausted after those speaking engagements, despite the enjoyment that it does bring. What’s on your desk right now? Not much. I am rather obsessive about keeping my desk clutter free. Where would you travel, if you could go anywhere? I am a huge history buff. My wife and I have determined that we will go to Hawaii on our 30th anniversary, particularly to see the Pearl Harbor memorial. I would love to add Normandy to that list as well.

two developed a plan for how this “new person” would work with each department to bring the System’s fragmented quality improvement efforts together, to form a cohesive whole. “It seemed to me we were getting pretty close to filling the position,” he says. “We had the job outlined and I felt we were ready to go. I remember asking Gary Bebow who we were developing this position for. ‘Don’t you know?’ he asked. ‘It’s you.’ I was totally surprised.” But what a splendid merge of his informatic and clinical backgrounds! “My mantra became: You can’t fix what you can’t measure,” he says. “So, we started measuring everything we could think of, so better data could be gathered and problems could be identified. This work required that we find ways to present our data in meaningful ways.” In the beginning, each department focused only inside the box – inside its own area of expertise – and outcomes improvement remained somewhat elusive. It was when they began to look at the data as a whole that patterns of practice emerged.

Comparing patterns of practice with standards of practice opened everyone’s eyes. “We began to work together across departments, bringing everyone to the table,” he says. “We talked about best practices and how to apply them across every department’s procedures.” Knowing what it’s like to be a nurse on the floor, he found he could weave the need for new analytics with daily care processes to form an effective way of approaching quality. “Our biggest task, at the onset, was to just fix the problems,” he says. “Penalties [for not meeting national quality measures] were starting to kick in, and this was a major wakeup call to hospitals across America.” The improvement team members asked themselves, “How can we make our reporting most useful and develop a system that the board can understand?” Their solution was to develop a report card, used across all clinical areas, that gave synopses of programs matched with measures required by CMS and national quality projects. “We aimed first for meeting

What’s on your music playlist? A strange combination of ‘80s bands and worship music. What do you like to do in your downtime? Lawn care, playing games with my family, watching movies. What are you reading? Executive Values by Kurt Senske What is the best advice you were ever given? Sometimes, in order to grow your career/leadership experience, you need to look outside of your current organization.

16 SUMMER 2020 | ARKANSAS HOSPITALS

Gary Paxson and his family. (From left) Bekah, Jody, Gary, Bryce, and Ben.

the national averages, then aimed to do 10% better than the averages,” he says. “We color coded our results with red, yellow, and green to depict our current status in progressing toward those goals. The board began to understand the data – so did the doctors and nurses. Everyone was excited as they saw progress and our report card showed us moving from red to green. We could see exactly where we were in our process and where we needed to improve.” They first went after the low-hanging fruit, areas that were directly tied to financial penalties. Each improvement led to another, and performance improvement scores climbed. “Quickly, mortality improved, we came into sepsis compliance, adopted best practices to prevent SSIs in our colon surgeries, and all the while we kept monitoring results on the report card,” he says. “It has been a beautiful evolution, allowing us to move from retrospective analysis to prospective analysis,” Paxson says. “We’re very proud of the 4-Star rating we have achieved. Our current report card continues to predict what we need to work on, where we need to improve. Departmental silos were a barrier to improvement. Now, they’re gone. We continue to sit at the same table, and collaboration is our normal way of doing business.” The work continues. In 2019, Paxson assumed the role of White River Health Systems President and CEO. He feels that developing a culture of safety, where employees feel well taken care of and that they can safely speak up if they see something that needs attention, is a key to maintaining excellence in quality improvement. Keeping tabs on report card results also helps. But the key to it all is collaboration, breaking down the silos, and moving forward together to meet a common goal. The data tell the story; patients and their families reap the rewards.

ARKANSAS HOSPITALS | SUMMER 2020 17

Pharmacy Collaboration in

Hospitals’ Antimicrobial Stewardship By Marsha F. Crader, PharmD, FASHP

lthough antibiotics are powerless against viruses, many COVID-19 patients die from pneumonia, for which antibiotics can be the best weapon. It would be a significant challenge if antibiotics became ineffective against secondary bacterial infections. Thus, antimicrobial stewardship (AS) takes prominence in every hospital’s current safety protocols, and it will continue its crucial role into the future, long after the coronavirus pandemic subsides. Pharmacists assume a vital leadership role in hospitals’ AS programs (ASPs), especially in hospitals that do not work closely with infectious-disease physicians. According to 2018 National Healthcare Safety Network hospital survey data, 85% of hospitals’ ASPs include pharmacist leadership; 59% are co-led by pharmacists and physicians and 26% have pharmacist-only-led programs.1 The Centers for Disease Control and Prevention (CDC)

18 SUMMER 2020 | ARKANSAS HOSPITALS

specifically recognized the critical role of pharmacists to AS when it replaced its “Drug Expertise” section with “Pharmacy Expertise” in its 2019 update.2 In 2014 the CDC released the first core elements for successful ASPs, 2 followed by Joint Commission and Centers for Medicare and Medicaid Services (CMS) AS requirements within hospitals, clinics and nursing homes. In January 2020, the Joint Commission began requiring hospital outpatient departments to implement stewardship practices: Determine an annual goal, provide education to improve usage, and track and report.

HEIGHTENED TRAINING

The role of pharmacists is changing, and many seek additional knowledge to meet their essential AS team roles. Limited residency positions for pharmacists seeking post-

graduate infectious disease training has prompted many to seek certified AS training to demonstrate advanced specialty coursework. Certificate programs are available from the Society of Infectious Diseases Pharmacists, and most include a hands-on quality improvement project as part of their required achievements. In 2019, 60 certificate program scholarships were awarded to Arkansas pharmacists practicing in hospitals and nursing homes. CDC also offers a free AS continuing education series (10+ hours) for health care professionals. CDC’s training modules meet certain requirements for the CMS Merit-Based Incentive Programs. In Arkansas, AS collaboratives provide other opportunities for education. The first collaborative (2015-16), led by the Arkansas Hospital Association and the Arkansas Association of Health-System Pharmacists, trained pharmacists in the basics of hospital AS. The 2018-19 AS collaborative, led by the Arkansas Foundation for Medical Care, expanded this education to include additional hospital and nursing home disciplines. Collaborative participants obtain basic or advanced AS and infection prevention education through this type of programming. Collaboration is key to Arkansas's successful work in the vital area of antimicrobial stewardship. General AS education is important, but understanding each discipline’s unique role and thought processes can lead to greater AS success across the health care field. References 1 Clinical Infect. Diseases 2007;44:159-77. 2 CDC: "What's New in the Core Elements of Hospital ASPs, 2019,” Arjun Srinivasan, MD. 3 CDC. Antibiotic Resistance and Patient Safety Portal. Hospitals Meeting All Seven Core Elements:2014-18. arpsp.cdc.gov/profile/ geography/5. 4 CDC. 5 Ways Pharmacists Can Be Antibiotics Aware. www.cdc.gov/antibiotic-use/community/ pdfs/Hospital-Pharmacist-Poster-508.pdf. 5 Clinical Infect. Diseases 2019;69(9):1476-9. 6 Am J Respir Crit Care Med 2019;200(7):e45-e67. 7 CDC. Is It Really a Penicillin Allergy? www.cdc.gov/ antibiotic-use/community/pdfs/penicillin-factsheet. pdf. 8 Clinical Infect. Diseases 2010;50:625-663. 9 Clinical Infect. Diseases 2019;68(10):e83-75. 10 Clinical Infect. Diseases 2018;67(1):1-7.

YIELDING RESULTS

Pharmacists can assist in improving patient care and outcomes, education, patient and AS program interventions, and provide leadership skills to fulfill AS requirements. The first AS collaborative training yielded a 20% rise in the number of Arkansas hospitals meeting all seven of CDC’s hospital AS core elements (43% in 2015 to 63% by 2016). The second AS collaborative yielded a gain of 22% (67% in 2017 to 79% in 20183). Of the 57 facility professionals participating in the second AS collaborative, 72% reported gaining needed education and said they planned to implement aspects of what they learned; 72% also reported subsequent implementation of at least one AS intervention.

TIPS TO INCORPORATE

To improve antibiotic usage: 1. Limit antibiotic duration by re-assessing patient’s improvement at 72 hours for evidence-based duration of therapy. Pharmacists can collaborate with physicians to determine if these lengths of therapy can be considered based on clinical improvement: • Skin and soft tissue infections: 5 days.4,5 • Urinary tract infections: 5-7 days.4,5 • Community-acquired pneumonia: 5 days.4-6 2. Verify penicillin allergy. Less than 1% of the population has a true penicillin allergy. Pharmacists can assist physicians in determining if a beta-lactam antibiotic is appropriate4,7 by assessing patients’ allergy history and previous usage. 3. Avoid treatment of asymptomatic bacteriuria (ASB). A positive urine culture with or without pyuria alone does not indicate a urinary tract infection (UTI) and could be ASB if no symptoms are present. 4,8-9 Pharmacists can discourage unnecessary urine culture collection and inappropriate antibiotics. ASB should not be treated in most patients. • 100% of patients with a chronic urinary catheter will grow an organism from a urine culture with or without a UTI. 4,9 • Changes in urine cloudiness or odor alone does not indicate a UTI.4,8-9 • Delirium should be interpreted with caution since delirium alone has low specificity for UTI. 4,9 4. Avoid duplicative anaerobic coverage. Pharmacists can inform physicians when unnecessary duplicate coverage is prescribed.4 5. Re-assess antibiotic therapy including anti-Methicillin-resistant Staphyloccocus aureus (MRSA) antibiotics. Pharmacists can alert physicians when new culture information is available to de-escalate antibiotics.10

Marsha F. Crader, PharmD, FASHP serves as an Associate Professor in the Department of Pharmacy Practice at the University of Arkansas for Medical Sciences. She co-leads the Antimicrobial Stewardship program at St. Bernards Healthcare in Jonesboro.

ARKANSAS HOSPITALS | SUMMER 2020 19

20 SUMMER 2020 | ARKANSAS HOSPITALS

2020 HOSPITAL STATISTICS ARKANSAS HOSPITALS | SUMMER 2020 21

ARKANSAS HOSPITALS 2020 BY THE NUMBERS 112

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

104

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 – more than 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 24% are operated by private, for-profit companies, and 14% 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 has been credited with cutting the rate of preventable deaths due to injuries by 50%.

18,495

Arkansans sought inpatient or outpatient care from the state’s hospitals each day in 2018, on average, for illnesses, injuries, and other conditions that required medical attention.

34,821

Newborns were delivered in Arkansas hospitals in 2018. The Arkansas Medicaid program covered almost 65% of them.

Figures from 2018 are the most current available.

22 STATS | SUMMER 2020 | ARKANSAS HOSPITALS

ARKANSAS HOSPITAL ASSOCIATION MEMBER ORGANIZATIONS BY TYPE, 2020 General Med-Surg Hospitals (44) Inpatient Psych Hospitals (12) 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 Freedom Behavioral Hospital of Central Arkansas 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 Northwest Arkansas

Inpatient Rehab Hospitals (4)

Baptist Health Rehabilitation Institute 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 of Jonesboro Baptist Health Extended Care Hospital Critical Access Hospitals (28) CHRISTUS Dubuis Hospital of Fort Smith Ashley County Medical Center Baptist Health Medical Center-Arkadelphia CHRISTUS Dubuis Hospital of Hot Springs Baptist Health Medical CenterCornerstone Speciality Hospitals Heber Springs Little Rock Bradley County Medical Center CHI St. Vincent Morrilton Special Focus Hospitals (3) Chicot Memorial Medical Center Arkansas Children's Hospital CrossRidge Community Hospital Arkansas Children's Northwest Dallas County Medical Center Willow Creek Women's Hospital Dardanelle Regional Medical Center Delta Memorial Hospital Out-of-State Border City DeWitt Hospital & Nursing Home Hospitals (2) Eureka Springs Hospital CHRISTUS St. Michael Health System, Texarkana, Texas Fulton County Hospital Regional One Health, Howard Memorial Hospital Memphis, Tennessee Izard County Medical Center Lawrence Memorial Hospital Non-Hospital Facilities (3) Little River Medical Center 19th Medical Group, McGehee Hospital Little Rock Air Force Base Mercy Hospital Berryville Arkansas Hospice Mercy Hospital Booneville CARTI Mercy Hospital Ozark Mercy Hospital Paris Mercy Hospital Waldron Ozark Health Medical Center Ozarks Community Hospital Piggott Community Hospital SMC Regional Medical Center Stone County Medical Center

ARKANSAS HOSPITALS | SUMMER 2020 | STATS 23

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

BENTONVILLE

NORTHWEST MEDICAL CENTER BENTONVILLE

MEDICAL-SURGICAL

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/HOSP

CALICO ROCK

IZARD COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

CAMDEN

OUACHITA COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

SB/SNF/PSYCH/REHAB/HH/OB/HOSP

CLARKSVILLE

JOHNSON REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

SB/SNF/PSYCH/REHAB/HH/OB

CLINTON

OZARK HEALTH MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

SB/HH/IMF

CONWAY

BAPTIST HEALTH MEDICAL CENTER-CONWAY

MEDICAL-SURGICAL

111

LEVEL III

CONWAY

CONWAY BEHAVIORAL HEALTH

PSYCHIATRIC

CONWAY

CONWAY REGIONAL HEALTH SYSTEM

MEDICAL-SURGICAL

150

LEVEL III

PSYCH/REHAB/HH/OB/PALL

CONWAY

CONWAY REGIONAL REHABILITATION HOSPITAL

REHABILITATION

CROSSETT

ASHLEY COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

SB/PSYCH/HH/OB

DANVILLE

CHAMBERS MEMORIAL HOSPITAL

MEDICAL-SURGICAL

LEVEL IV

SB/HH

DARDANELLE

DARDANELLE REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

SB/PSYCH/HH

DEWITT

DEWITT HOSPITAL & NURSING HOME

MEDICAL-SURGICAL

DUMAS

DELTA MEMORIAL HOSPITAL

MEDICAL-SURGICAL

EL DORADO

MEDICAL CENTER OF SOUTH ARKANSAS

MEDICAL-SURGICAL

166

LEVEL III

REHAB/OB

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

FAYETTEVILLE

VANTAGE POINT OF NWA

PSYCHIATRIC

114

FAYETTEVILLE

VETERANS HEALTHCARE SYSTEM OF THE OZARKS

VETERANS AFFAIRS

FAYETTEVILLE

WASHINGTON REGIONAL MEDICAL SYSTEM

MEDICAL-SURGICAL

425

LEVEL II

HH/OB/PALL/HOSP

FORDYCE

DALLAS COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

SB/HH

FORREST CITY

FORREST CITY MEDICAL CENTER

MEDICAL-SURGICAL

118

LEVEL IV

PSYCH/HH/OB

FORT SMITH

BAPTIST HEALTH-FORT SMITH

MEDICAL-SURGICAL

492

LEVEL III

HH/OB

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

HH/PSYCH/DPU/OB/HOSP

HEBER SPRINGS

BAPTIST HEALTH MEDICAL CENTER-HEBER SPRINGS

MEDICAL-SURGICAL

LEVEL IV

SB/HH/HOSP

HELENA

HELENA REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

155

HOT SPRINGS

CHI ST. VINCENT HOT SPRINGS

MEDICAL-SURGICAL

282

HOT SPRINGS

CHRISTUS DUBUIS HOSPITAL OF HOT SPRINGS

LONG TERM CARE

PALL/HOSP

HOT SPRINGS

LEVI HOSPITAL

MEDICAL-SURGICAL

PSYCH/REHAB

HOT SPRINGS

NATIONAL PARK MEDICAL CENTER

MEDICAL-SURGICAL

163

REHAB/OB

JACKSONVILLE

19TH MEDICAL GROUP

INFIRMARY

JACKSONVILLE

FREEDOM BEHAVIORAL HOSPITAL OF CENTRAL ARKANSAS

PSYCHIATRIC

PSYCH

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

REHAB/OB/PALL

JONESBORO

ST. BERNARDS MEDICAL CENTER

MEDICAL-SURGICAL

438

LEVEL III

PSYCH/HH/OB/PALL/HOSP

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

24 STATS | SUMMER 2020 | ARKANSAS HOSPITALS

ADDITIONAL SERVICE LINES SB/HH/OB/HOSP SB/HH/IMF

LEVEL III

SNF/PSYCH/REHAB/OB/PALL

177

LEVEL III

PSYCH/REHAB/HH/OB/HOSP

128

LEVEL III

HH SB/HH/PALL/HOSP

SB/HH

SB/IMF HH/SB

PSYCH

PALL/HOSP LEVEL III

SNF/REHAB/HH/OB/PALL/HOSP SB/OP GERIPSYCH/WOUND CLINIC

SB/REHAB/HH/OB LEVEL II

PSYCH/REHAB/HH/OB

PALL/HOSP

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

TRAUMA SYSTEM

CITY

HOSPITAL

TYPE OF HOSPITAL

LITTLE ROCK

ARKANSAS STATE HOSPITAL

PSYCHIATRIC

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

124

LITTLE ROCK

UAMS MEDICAL CENTER

MEDICAL-SURGICAL

450

LEVEL I

MAGNOLIA

MAGNOLIA REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

OB/PALL

LEVEL IV

MALVERN

BAPTIST HEALTH MEDICAL CENTER-HOT SPRING COUNTY

MEDICAL-SURGICAL

SB/HH/OB

LEVEL IV

MAUMELLE

METHODIST BEHAVIORAL HOSPITAL

PSYCHIATRIC

PSYCH/HH/HOSP

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

MOUNTAIN HOME

BAXTER REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

SB/HH/HOSP

268

LEVEL III

MOUNTAIN VIEW

STONE COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

PSYCH/REHAB/HH/OB/HOSP

LEVEL IV

NASHVILLE

HOWARD MEMORIAL HOSPITAL

MEDICAL-SURGICAL

LEVEL IV

NEWPORT

UNITY HEALTH - HARRIS MEDICAL CENTER

MEDICAL-SURGICAL

SB/HH

133

LEVEL IV

NORTH LITTLE ROCK

BAPTIST HEALTH MEDICAL CENTER-NORTH LITTLE ROCK

MEDICAL-SURGICAL

SB/PSYCH

225

LEVEL III

NORTH LITTLE ROCK

THE BRIDGEWAY

PSYCHIATRIC

REHAB/HH/OB/PALL/HOSP

127

OSCEOLA

SMC REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

LEVEL IV

OZARK

MERCY HOSPITAL OZARK

MEDICAL-SURGICAL

SB/PSYCH

LEVEL IV

PARAGOULD

ARKANSAS METHODIST MEDICAL CENTER

MEDICAL-SURGICAL

SB/HH/PALL/HOSP

129

LEVEL IV

PARIS

MERCY HOSPITAL PARIS

MEDICAL-SURGICAL

SB/REHAB/HH/OB

LEVEL IV

PIGGOTT

PIGGOTT COMMUNITY HOSPITAL

MEDICAL-SURGICAL

SB/HH/PALL/HOSP

LEVEL IV

PINE BLUFF

JEFFERSON REGIONAL

MEDICAL-SURGICAL

SB/HH

471

LEVEL III

POCAHONTAS

ST. BERNARDS FIVE RIVERS

MEDICAL-SURGICAL

SNF/PSYCH/REHAB/HH/OB

LEVEL IV

ROGERS

MERCY HOSPITAL NORTHWEST ARKANSAS

MEDICAL-SURGICAL

PSYCH/HH

208

LEVEL III

RUSSELLVILLE

SAINT MARY'S REGIONAL MEDICAL CENTER

MEDICAL-SURGICAL

PSYCH/HH/OB/PALL

170

LEVEL III

SALEM

FULTON COUNTY HOSPITAL

MEDICAL-SURGICAL

PSYCH/REHAB

LEVEL IV

SEARCY

ADVANCED CARE HOSPITAL OF WHITE COUNTY

LONG TERM CARE

SEARCY

UNITY HEALTH

MEDICAL-SURGICAL

438

LEVEL III

SHERWOOD

CHI ST. VINCENT NORTH

MEDICAL-SURGICAL

PSYCH/REHAB/HH/OB/PALL

LEVEL IV

SHERWOOD

CHI ST. VINCENT SHERWOOD REHABILITATION HOSPITAL

REHABILITATION

HH/PALL

SILOAM SPRINGS

SILOAM SPRINGS REGIONAL HOSPITAL

MEDICAL-SURGICAL

LEVEL IV

SPRINGDALE

ARKANSAS CHILDREN'S NORTHWEST

MED-SURG (PED)

SB/OB/PALL/HOSP

LEVEL IV

SPRINGDALE

NORTHWEST MEDICAL CENTER SPRINGDALE

MEDICAL-SURGICAL

222

LEVEL III

STUTTGART

BAPTIST HEALTH MEDICAL CENTER-STUTTGART

MEDICAL-SURGICAL

PSYCH/REHAB/HH/OB

LEVEL IV

TEXARKANA, TX

CHRISTUS ST. MICHAEL HEALTH SYSTEM

MEDICAL-SURGICAL

SB/OB/PALL/HOSP

312

LEVEL III

TEXARKANA

RIVERVIEW BEHAVIORAL HEALTH

PSYCHIATRIC

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

WARREN

BRADLEY COUNTY MEDICAL CENTER

MEDICAL-SURGICAL

SB/ICF/PALL

WEST MEMPHIS

BAPTIST MEMORIAL HOSPITAL-CRITTENDEN

MEDICAL-SURGICAL

SB/PSYCH/HH/OB

WEST MEMPHIS

PERIMETER BEHAVIORAL HOSPITAL OF WEST MEMPHIS

PSYCHIATRIC

WYNNE

CROSSRIDGE COMMUNITY HOSPITAL

MEDICAL-SURGICAL

ADDITIONAL SERVICE LINES

321 PALL/HOSP LEVEL II

SNF/PSYCH/HH/OB/PALL/HOSP PALL/HOSP

0 PSYCH/REHAB LEVEL II

PSYCH/HH/PALL PSYCH

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

PALL

SB/HH/PALL/HOSP

SB/HH

SB=Swing Beds; HH=Home Health; ICF=Intermediate Care Facility; OB=Obstetrics, Pall=Palliative Care, Hosp=Hospice Sources: American Hospital Association, Hospital Statistics 2020; Arkansas Department of Health

ARKANSAS HOSPITALS | SUMMER 2020 | STATS 25

STATEWIDE HOSPITAL FINANCIAL AND UTILIZATION INDICATORS, 2014 - 2018 INDICATOR

2014

2015

2016

2017

2018

BEDS AVAILABLE

9,449

9,569

9,634

9,664

9,517

ADMISSIONS

350,431

357,286

359,359

363,070

358,222

PATIENT DAYS

1,795,753

1,859,244

1,846,634

1,861,122

1,828,470

AVERAGE LENGTH OF STAY

5.1

5.2

5.1

NON-EMERGENCY OUTPATIENT VISITS

3,790,058

4,184,351

4,570,177

4,629,383

4,925,120

OUTPATIENT VISITS

5,149,087

5,676,710

6,086,166

6,148,539

6,434,568

73.6%

73.7%

75.1%

75.3%

76.5%

3,701,153

3,942,232

3,963,653

4,125,703

4,148,600

52.1%

53.2%

52.5%

52.8%

52.6%

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

96,353

94,607

94,627

95,013

94,924

OUTPATIENT SURGERIES

180,684

195,650

200,832

203,105

215,656

TOTAL SURGERIES

277,037

290,257

295,459

298,118

310,580

OUTPATIENT AS % OF TOTAL SURGERIES

65.22%

67.41%

67.97%

68.13%

69.44%

TOTAL FULL-TIME EQUIVALENT EMPLOYEES

45,916

47,102

47,825

49,832

50,358

4.53

4.36

4.40

4.41

4.43

GROSS REVENUE, INPATIENT

$11,007,915,107

$11,700,149,701

$12,460,694,916

$13,396,489,708

$13,777,391,679

GROSS REVENUE, OUTPATIENT

$10,568,638,798

$11,967,218,307

$12,952,790,887

$14,212,477,805

$15,450,146,464

GROSS PATIENT REVENUE

$21,576,553,905

$23,667,368,008

$25,413,485,803

$27,608,967,513

$29,227,538,143

$576,942,240

$543,253,884

$444,692,383

$469,305,416

$502,016,281

FULL-TIME EQUIVALENT EMPLOYEES PER ADJUSTED OCCUPIED BED

BAD DEBTS CHARITY

$432,816,585

$336,830,549

$376,732,202

$339,342,080

$358,871,422

MEDICARE, MEDICAID & OTHER PAYER WRITEOFFS

$14,535,076,964

$16,168,309,507

$17,636,673,879

$19,440,530,333

$20,647,010,804

TOTAL DEDUCTIONS

$15,544,835,789

$17,048,393,940

$18,458,098,464

$20,249,177,829

$21,507,898,507

NET PATIENT REVENUE

$6,031,718,116

$6,618,974,068

$6,955,387,339

$7,359,789,684

7,719,639,636

OTHER OPERATING REVENUE

$310,383,539

$250,191,038

$307,097,211

$381,973,773

$395,516,849

NONOPERATING REVENUE

$98,655,117

$42,144,248

$82,544,865

$118,736,986

$44,821,792

TOTAL NET REVENUE

$6,440,756,772

$6,911,309,354

$7,345,029,415

$7,860,500,443

$8,159,978,277

PAYROLL EXPENSE

$2,209,410,939

$2,367,195,116

$2,510,431,790

$2,833,267,007

$2,989,469,225

TOTAL EXPENSE

$6,090,855,820

$6,428,954,340

$6,803,364,553

$7,372,516,174

$7,797,448,234

-0.98%

2.87%

2.19%

-0.17%

-1.01%

PATIENT REVENUE MARGIN TOTAL MARGIN

5.43%

6.98%

7.37%

6.21%

4.44%

CHARGE PER ADJUSTED INPATIENT DAY

$5,829.68

$6,003.55

$6,411.63

$6,691.94

$7,045.16

PAYMENT PER ADJUSTED INPATIENT DAY

$1,629.69

$1,678.99

$1,754.79

$1,783.89

$1,860.78

EXPENSE PER ADJUSTED INPATIENT DAY

$1,645.66

$1,630.79

$1,716.44

$1,786.97

$1,879.54

PAYROLL PER ADJUSTED INPATIENT DAY

$596.95

$600.47

$633.36

$686.74

$720.60

36.3%

36.8%

36.9%

38.4%

38.3%

PAYROLL AS % OF TOTAL EXPENSE BAD DEBT AND CHARITY AS % OF TOTAL CHARGE

4.7%

3.7%

3.2%

2.9%

TOTAL DEDUCTIONS AS % OF TOTAL CHARGE

72.0%

72.6%

73.3%

73.6%

OUTPATIENT REVENUE AS % TOTAL PATIENT REVENUE

49.0%

50.6%

51.0%

51.5%

52.9%

ADMISSIONS PER BED

37.1

37.3

37.6

PATIENT DAYS PER 1,000 POPULATION

605.4

624.3

618.0

619.5

606.7

ADMISSIONS PER 1,000 POPULATION

118.1

120.0

120.3

120.9

118.9

POPULATION (000'S)

2,966

2,978

2,988

3,004

3,014

Source: American Hospital Association, Hospital Statistics 2020

26 STATS | SUMMER 2020 | ARKANSAS HOSPITALS

ARKANSAS HOSPITALS RECEIVING LOCAL TAX SUPPORT, 2020 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%

2000

$2,100,000

DALLAS COUNTY MEDICAL CENTER

YES

1.00%

2005

$840,000

DELTA MEMORIAL HOSPITAL

YES

1.25%

2019/2004

$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

JOHNSON REGIONAL MEDICAL CENTER

1977

$65,000

LAWRENCE MEMORIAL HOSPITAL

YES

1.00%

2014

$1,850,000

LITTLE RIVER MEDICAL CENTER

YES

N/A

MAGNOLIA REGIONAL MEDICAL CENTER (A)

YES

1.125%

2007

$2,600,000

0.25%

2004

$540,000

INDICATOR

TAX

RATE

ASHLEY COUNTY MEDICAL CENTER

YES

BAPTIST HEALTH MEDICAL CENTER-HOT SPRING COUNTY

MAGNOLIA REGIONAL MEDICAL CENTER (B)

MILLAGE

YES

RATE

.5 MILL

.3 MILL

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%

N/A

OUACHITA COUNTY MEDICAL CENTER

YES

1.00%

2015

$2,400,000

OZARK HEALTH MEDICAL CENTER

YES

1.00%

2000

$1,800,000

PIGGOTT COMMUNITY HOSPITAL

YES

1.00%

2010

$360,000

SMC REGIONAL MEDICAL CENTER

YES

0.50%

2015/1952

$2,732,000

ST. BERNARDS FIVE RIVERS

YES

1.00%

2007

$750,000

YES

1 MILL

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

ARKANSAS HOSPITALS | SUMMER 2020 | STATS 27

KEY FINANCIAL INDICATORS ARKANSAS AND SURROUNDING STATES, 2018 In other words, hospitals made (or lost) this much on each of the equivalent days of care they provided to inpatients and outpatients:

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:

Hospitals charged this amount for the inpatient and outpatient care they provided in 2018:

$395,516,849

-1.01%

($18.76)

($77,808,598)

4,148,600

7,797,448,234

7,719,639,636

21,507,898,507

$861,346,310

1,032,123,112

-1.17%

($23.56)

($170,776,802)

7,248,832

14,718,473,226

14,547,696,424

41,855,453,971

$29,227,538,143 $56,403,150,395

3.14%

$758,756,302

1,323,740,658

-2.47%

($57.00)

($564,984,356)

9,911,142

23,401,894,939

22,836,910,583

55,506,948,840

343,375,075

3.14%

$758,756,302

1,323,740,658

-2.47%

($57.00)

($564,984,356)

9,911,142

23,401,894,939

22,836,910,583

55,506,948,840

$78,343,859,423 $78,343,859,423

$1,033,641,960

127,331,220

8.26%

$906,310,740

322,347,396

5.49%

$114.40

$583,963,344

5,104,726

10,060,788,649

10,644,751,993

35,120,625,862

$45,765,377,855

Oklahoma

4.09%

$872,774,231

307,017,551

2.69%

$565,756,680

1,744,204,707

-6.11%

($123.70)

($1,178,448,027)

9,526,893

20,457,279,423

19,278,831,396

65,437,792,094

$84,716,623,490

Tennessee

9.71%

$7,897,985,213

1,058,969,357

8.52%

$6,839,015,856

6,530,019,174

0.42%

$10.96

$308,996,682

28,182,982

73,402,315,718

73,711,312,400

274,698,442,100

$348,409,754,500

Texas

7.63%

$83,464,445,695

$10,967,818,652

6.70%

$72,496,627,043

$66,870,658,766

0.55%

$14.02

$5,625,968,277

401,318,395

$1,010,271,111,825

1,015,897,080,102

$2,837,413,915,863

$3,853,310,995,965

United States

Missouri

Yielding a "patient service" margin of:

$317,708,251

5.53%

343,375,075

$1,102,131,377

9.32%

Mississippi

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:

3.91%

157,135,654

$1,102,131,377

4.50%

Louisiana

Which raised total operating income to:

$44,821,792

$1,018,481,964

4.50%

Arkansas

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

$362,530,043

6.47%

At the same time, hospitals spent this much providing patient care servicesâ&#x20AC;Ś â&#x20AC;Śto patients needing care for this many adjusted patient days while being served. So the revenue excess (loss) was:

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

28 STATS | SUMMER 2020 | ARKANSAS HOSPITALS

As a result, actual payments to hospitals were:

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

4.44%

For a return on investment totalling:

Source: American Hospital Association, Hospital Statistics 2020

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

DISTRICT OF COLUMBIA

91,787

DISTRICT OF COLUMBIA

25,807

DISTRICT OF COLUMBIA

25,360

UTAH

17.84%

COLORADO

81,128

ALASKA

21,479

NEW YORK

20,121

ALASKA

13.04%

CALIFORNIA

80,296

CALIFORNIA

19,366

CALIFORNIA

19,148

COLORADO

10.52%

ALASKA

77,246

COLORADO

19,322

MAINE

18,892

FLORIDA

10.47%

NEVADA

71,013

WASHINGTON

18,590

WASHINGTON

18,889

NEVADA

7.39%

TEXAS

67,446

NEW YORK

18,522

ALASKA

18,678

NEW MEXICO

7.11%

PENNSYLVANIA

67,119

HAWAII

18,095

HAWAII

18,454

NORTH CAROLINA

6.40%

FLORIDA

65,803

UTAH

17,890

MASSACHUSETTS

17,688

VIRGINIA

6.12%

NEW JERSEY

65,188

IDAHO

17,734

COLORADO

17,289

SOUTH CAROLINA

5.50%

10.

ARIZONA

64,529

MAINE

17,643

OREGON

17,046

OKLAHOMA

5.49%

11.

WASHINGTON

62,008

DELAWARE

17,229

MINNESOTA

17,001

DELAWARE

5.26%

12.

WSC REGION

60,809

MINNESOTA

17,054

IDAHO

16,881

IDAHO

4.81%

13.

NEW YORK

59,244

OREGON

16,615

DELAWARE

16,322

ARIZONA

4.24%

14.

HAWAII

57,313

NEBRASKA

16,255

VERMONT

15,872

WISCONSIN

3.68%

15.

U.S.

57,053

MONTANA

15,854

NEBRASKA

15,831

INDIANA

3.57%

16.

UTAH

56,424

WISCONSIN

15,566

CONNECTICUT

15,791

MONTANA

3.52%

17.

INDIANA

53,355

INDIANA

15,529

SOUTH DAKOTA

15,372

KANSAS

2.93%

18.

OKLAHOMA

53,122

SOUTH DAKOTA

15,517

MARYLAND

15,339

NEBRASKA

2.60%

19.

IDAHO

52,242

NEW HAMPSHIRE

15,466

NEW HAMPSHIRE

15,308

KENTUCKY

2.02%

20.

ILLINOIS

51,974

MASSACHUSETTS

15,242

MONTANA

15,296

DISTRICT OF COLUMBIA

1.73%

21.

TENNESSEE

51,580

CONNECTICUT

15,234

NORTH DAKOTA

15,142

GEORGIA

1.21%

22.

OHIO

51,318

WYOMING

15,170

WYOMING

15,048

CALIFORNIA

1.13%

23.

SOUTH CAROLINA

51,032

MARYLAND

15,146

WISCONSIN

14,992

PENNSYLVANIA

1.11%

24.

KANSAS

50,953

NEW MEXICO

15,059

INDIANA

14,975

NEW HAMPSHIRE

1.02%

25.

VIRGINIA

50,842

U.S.

15,042

U.S.

14,958

SOUTH DAKOTA

0.94%

26.

NEW MEXICO

50,341

VERMONT

14,994

OHIO

14,852

WYOMING

0.80%

27.

GEORGIA

49,944

PENNSYLVANIA

14,993

PENNSYLVANIA

14,827

WSC REGION

0.60%

28.

KENTUCKY

49,775

OHIO

14,902

UTAH

14,698

U.S.

0.55%

29.

ALABAMA

47,805

NORTH DAKOTA

14,502

TEXAS

14,209

ALABAMA

0.46%

30.

LOUISIANA

47,775

TEXAS

14,269

NEW MEXICO

13,988

TEXAS

0.42%

31.

CONNECTICUT

47,444

ILLINOIS

13,861

ILLINOIS

13,854

OHIO

0.34%

32.

NEBRASKA

46,823

ARIZONA

13,730

MISSOURI

13,851

MINNESOTA

0.31%

33.

MISSOURI

46,369

VIRGINIA

13,722

RHODE ISLAND

13,609

ILLINOIS

34.

NEW HAMPSHIRE

46,182

KANSAS

13,657

MICHIGAN

13,571

MICHIGAN

-0.32%

35.

SOUTH DAKOTA

46,042

MICHIGAN

13,528

NEW JERSEY

13,498

ARKANSAS

-1.01%

36.

MINNESOTA

46,041

MISSOURI

13,516

WSC REGION

13,431

LOUISIANA

-1.17%

37.

NORTH CAROLINA

45,835

WSC REGION

13,513

KANSAS

13,257

MARYLAND

-1.28%

38.

DELAWARE

44,213

NORTH CAROLINA

13,478

ARIZONA

13,148

MISSISSIPPI

-1.28%

39.

MISSISSIPPI

43,995

NEW JERSEY

13,307

GEORGIA

12,916

NEW JERSEY

-1.43%

40.

MASSACHUSETTS

43,870

GEORGIA

13,074

VIRGINIA

12,882

WEST VIRGINIA

-1.59%

41.

WISCONSIN

43,558

RHODE ISLAND

12,849

WEST VIRGINIA

12,708

WASHINGTON

-1.61%

42.

OREGON

41,464

NEVADA

12,629

IOWA

12,677

HAWAII

-1.98%

43.

MAINE

41,333

WEST VIRGINIA

12,509

NORTH CAROLINA

12,615

MISSOURI

-2.47%

44.

RHODE ISLAND

40,822

FLORIDA

12,493

LOUISIANA

12,467

OREGON

-2.59%

45.

MICHIGAN

39,849

OKLAHOMA

12,356

TENNESSEE

12,455

CONNECTICUT

-3.66%

46.

WEST VIRGINIA

38,878

LOUISIANA

12,322

KENTUCKY

11,826

NORTH DAKOTA

-4.41%

47.

ARKANSAS

38,460

KENTUCKY

12,070

NEVADA

11,695

VERMONT

-5.85%

48.

NORTH DAKOTA

36,185

SOUTH CAROLINA

12,034

OKLAHOMA

11,678

RHODE ISLAND

-5.92%

49.

VERMONT

35,732

IOWA

11,948

SOUTH CAROLINA

11,372

IOWA

-6.09%

50.

IOWA

35,513

TENNESSEE

11,738

FLORIDA

11,184

TENNESSEE

-6.11%

51.

WYOMING

35,257

ARKANSAS

10,158

ARKANSAS

10,261

MAINE

-7.08%

52.

MONTANA

34,908

MISSISSIPPI

10,089

MISSISSIPPI

10,218

NEW YORK

53.

MARYLAND

23,142

ALABAMA

9,744

ALABAMA

9,699

MASSACHUSETTS

0.05%

-8.63% -16.05%

Source: American Hospital Association, Hospital Statistics 2020

ARKANSAS HOSPITALS | SUMMER 2020 | STATS 29

HOSPITAL ACCESS BY COUNTY COUNTY

NO ACUTE CARE COMMUNITY HOSPITAL (22)

SINGLE CRITICAL ACCESS HOSPITAL (18)

SINGLE NON-CAH COMMUNITY HOSPITAL (22)

MULTIPLE COMMUNITY HOSPITALS (13)

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 (22)

•

POINSETT

• • •

•

• • • •

RANDOLPH

• • • • • • •

SALINE SCOTT SEARCY

• • •

• • • •

POPE PULASKI

•

• • • •

POLK PRAIRIE

•

SEBASTIAN SEVIER SHARP ST. FRANCIS

MULTIPLE COMMUNITY HOSPITALS (13)

• •

PHILLIPS PIKE

SINGLE NON-CAH COMMUNITY HOSPITAL (22)

•

OUACHITA PERRY

SINGLE CRITICAL ACCESS HOSPITAL (18)

• •

STONE

• •

UNION VAN BUREN WASHINGTON

•

WHITE WOODRUFF YELL

30 STATS | SUMMER 2020 | 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 Memorial Hospital 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 Freedom Behavioral Hospital of Central Arkansas 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 = 29

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 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 = 25

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

ARKANSAS HOSPITALS | SUMMER 2020 | STATS 31

AHA MEMBERS BY CONTROL AND SYSTEM AFFILIATION TYPE OF HOSPITAL

TYPE OF CONTROL PNP

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

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

RRC/SCH

√

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

√

CHI ST. VINCENT HOT SPRINGS

URBAN

√

COMMONSPIRIT HEALTH

CHICAGO, IL

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

LOCAL BOARD

√

CHICOT MEMORIAL MEDICAL CENTER

CAH

√

CHRISTUS DUBUIS HOSPITAL OF FORT SMITH

LTCH

√

CHRISTUS HEALTH

IRVING, TX

CHRISTUS DUBUIS HOSPITAL OF HOT SPRINGS

LTCH

√

CHRISTUS HEALTH

IRVING, TX

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 MEMORIAL HOSPITAL

CAH

√

DEWITT HOSPITAL & NURSING HOME

CAH

√

DREW MEMORIAL HEALTH SYSTEM

RURAL/SCH

ENCOMPASS HEALTH REHABILITATION HOSPITAL

IRF

EUREKA SPRINGS HOSPITAL

CAH

FORREST CITY MEDICAL CENTER

RURAL/SCH

√

FREEDOM BEHAVIORAL HOSPITAL OF CENTRAL ARKANSAS

IP PSYCH

√

FULTON COUNTY HOSPITAL

CAH

32 STATS | SUMMER 2020 | ARKANSAS HOSPITALS

LOCAL BOARD

√

√ √

COUNTY

√ Y

CONWAY REGIONAL HEALTH SYSTEM

CONWAY

LOCAL BOARD LOCAL BOARD COUNTY

√ Y

√

ENCOMPASS HEALTH

BIRMINGHAM, AL

EUREKA SPRINGS HOSPITAL COMMISSION

EUREKA SPRINGS, AR

QUORUM HEALTH

FRANKLIN, TN

FREEDOM BEHAVIORAL HEALTH

LAKE CHARLES, LA

√

COUNTY

TYPE OF HOSPITAL

TYPE OF CONTROL PNP

CORPORATE

MULTIHOSPITAL GOV'T

CONTROLLING ORGANIZATION

SYSTEM HOME

SYSTEM

GREAT RIVER MEDICAL CENTER

RURAL/RRC

HELENA REGIONAL MEDICAL CENTER

RURAL

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

√

COUNTY

MAGNOLIA REGIONAL MEDICAL CENTER

RURAL/SCH

√

CITY

MCGEHEE HOSPITAL

CAH

MEDICAL CENTER OF SOUTH ARKANSAS

RRC/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

RRC

LIFEPOINT

BRENTWOOD, TN

NEA BAPTIST MEMORIAL HOSPITAL

URBAN

√

BAPTIST MEMORIAL HEALTHCARE CORP.

MEMPHIS, TN

NORTH ARKANSAS REGIONAL MEDICAL CENTER

RRC/SCH

√

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

PIGGOTT COMMUNITY HOSPITAL

CAH

√ Y

√

FRANKLIN, TN

LOCAL BOARD Y

ST. BERNARDS HEALTH SYSTEM

JONESBORO

LOCAL BOARD

√ Y

√ √

√

COMMUNITY HEALTH SYSTEMS

FRANKLIN, TN

CITY

LOCAL BOARD

LOCAL BOARD LOCAL BOARD

√

PINNACLE POINTE BEHAVIORAL HEALTHCARE SYSTEM IP PSYCH

QUORUM HEALTH

JACKSON, TN

CITY Y

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

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

RRC/SCH

√

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 WASHINGTON REGIONAL MEDICAL SYSTEM

URBAN

√

WHITE RIVER HEALTH SYSTEM

RRC/SCH

√

WILLOW CREEK WOMEN'S HOSPITAL

URBAN

U.S. DEPARTMENT OF VETERANS AFFAIRS 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; PNP=Private Non-Profit

ARKANSAS HOSPITALS | SUMMER 2020 | STATS 33

INPATIENT AND EMERGENCY DEPARTMENT DISCHARGES BY PAYER ED

33%

23%

27%

2% 7%

HMO/COMM.INS MEDICAID MEDICARE OTHER GOV. PROGRAMS

INPATIENT

27%

23%

20%

41%

40%

60%

1% 5% 3%

80%

OTHER UNKNOWN SELF PAY/NO CHARGE

100%

Arkansas Department of Health, Hospital Discharge Program, 2018

In 2018, hospitals saw an increase in uncompensated care and uninsured patients for the first time since Arkansas expanded Medicaid.

UNINSURED INPATIENT ADMISSIONS AND COSTS, 2009-2018 35,000

$250

30,000

$200

25,000 $150

20,000 15,000

$100

10,000 $50

5,000 0

2009

2010

2011

2012

34 STATS | SUMMER 2020 | ARKANSAS HOSPITALS

2013

2014

2015

2016

2017

2018

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

Arkansas Department of Health, Hospital Discharge Program, 2018

HOSPITAL UNCOMPENSATED CARE COSTS, 2014-2018 YEAR

GROSS REVENUES (BILLED CHARGES)

NET REVENUES (AMOUNT COLLECTED)

OTHER OPERATING REVENUE

GROSS+ OTHER REVENUE

TOTAL OPERATING COSTS

COST-TO-CHARGE RATIO

2014

$21,576,553,905

$6,031,718,116

$310,383,539

$21,886,937,444

$6,090,855,820

25.19%

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%

CHANGE

35.46%

27.98%

27.43%

35.35%

28.02%

YEAR

TOTAL UNCOLLECTED AMOUNTS DUE

BAD DEBT

CHARITY CARE

UNCOMPENSATED CARE CHARGES

UNCOMPENSATED CARE COSTS

UNCOMPENSATED CARE % OF TOTAL COSTS

2014

$15,305,292,104

$576,942,240

$432,816,585

$1,009,758,825

$254,385,654

4.18%

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%

CHANGE

40.53%

-12.99%

-17.08%

-14.74%

-16.66%

TOP 20 DRGS # DISCHARGES

TOTAL CHARGES

MEAN CHARGES PER DISCHARGE

MEAN STAY PER DISCHARGE

MEAN DAILY RATE

885 - PSYCHOSES

29,704

$442,822,500

$14,908

9.2

$1,619

795 - NORMAL NEWBORN

20,746

$98,661,927

$4,756

1.7

$2,797

775 - VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES

14,073

$194,011,691

$13,786

1.8

$7,452

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

13,666

$603,618,535

$44,169

6.1

$7,265

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

11,274

$475,168,881

$42,147

4.1

$10,381

794 - NEONATE W OTHER SIGNIFICANT PROBLEMS

7,998

$55,667,211

$6,960

2.2

$3,164

291 - HEART FAILURE & SHOCK W MCC

7,743

$245,364,570

$31,689

5.6

$5,710

766 - CESAREAN SECTION W/O CC/MCC

5,547

$107,338,282

$19,351

2.5

$7,679

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

5,536

$99,970,414

$18,058

3.2

$5,574

189 - PULMONARY EDEMA & RESPIRATORY FAILURE

5,216

$168,754,396

$32,353

5.2

$6,222

881 - DEPRESSIVE NEUROSES

4,947

$65,287,036

$13,197

6.6

$1,988

193 - SIMPLE PNEUMONIA & PLEURISY W MCC

4,212

$139,172,919

$33,042

5.1

$6,492

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

4,192

$45,928,935

$10,956

4.3

$2,536

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

4,147

$94,173,773

$22,709

4.4

$5,197

057 - DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC

4,131

$132,907,531

$32,173

12.9

$2,500

194 - SIMPLE PNEUMONIA & PLEURISY W CC

4,031

$80,714,953

$20,024

3.9

$5,147

690 - KIDNEY & URINARY TRACT INFECTIONS W/O MCC

4,006

$65,503,565

$16,351

3.6

$4,580

807 - VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT CC/MCC

3,955

$55,193,755

$13,955

1.8

$7,884

603 - CELLULITIS W/O MCC

3,679

$64,980,406

$17,663

3.9

$4,576

190 - CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC

3,519

$96,194,396

$27,336

4.3

$6,328

162,322

$3,331,435,676

$21,779

4.6

$4,719

DIAGNOSIS-RELATED GROUP

TOP 20 DRGS

ARKANSAS HOSPITALS | SUMMER 2020 | STATS 35

36 SUMMER 2020 | ARKANSAS HOSPITALS

Our Favorite Articles - A Retrospective

It has been five years since Arkansas Hospitals underwent a total redesign under the leadership of Elisa White. We invite you to enjoy, with us, these articles that are our favorites from those five years. What are your favorite Arkansas Hospitals articles? We'd love to hear from you: elisawhite@arkhospitals.org.

This article by the nationally renowned health care analyst Paul Keckley is as sound today – and as challenging in its advice – as when we first published it in the summer of 2016. COVID-19 has changed a lot about the way hospitals operate, and it has possibly catapulted American hospitals into an intense decision-making process: Will we remain as a Gen Two hospital, or are we on a fast-track to Gen Three?

arkansas

hospitals www.arkhospitals.org

SUMMER 2016

Unlocking the Power of Data Charting Hospitals’ Futures The Business Case for Quality BONUS PULLOUT SECTION:

HOSPITAL STATISTICS 2016 A MAGAZINE FOR ARKANSAS HEALTHCARE PROFESSIONALS ARKANSAS HOSPITALS I Summer 2016 1

From the 2016 Summer Issue

Shaping the Hospital of the Future:

Charting Your Own Course By Paul H. Keckley, PhD Exclusive to the Arkansas Hospital Association

he origin of hospitals dates back 2,500 years to the facilities built by the ancient Greeks to serve their god of health, Asclepius, and to the third century B.C. Roman basilicas that housed healers who practiced their trade. From these beginnings, facilities devoted to identifying and treating diseases by healers migrated to Europe and then to North America where our first hospital, Pennsylvania Hospital, opened its doors in 1751. From these roots, the role of a hospital as a gathering place for health professionals focused on diagnosing and treating disease is unchanged. But how health is defined, how disease is diagnosed and treated, and how healing professionals engage with patients and with peers has changed dramatically. As a result, First and Second Gen(eration) hospitals have much in common. Third Gen hospitals in the U.S., however, are unlikely to resemble their predecessors.

FIRST GEN HOSPITALS (CIRCA 1947-2000)

Thanks to legislation (Hill Burton Act, 1947) that funded hospital construction in every community and the introduction of Medicare and Medicaid programs (1965), 7,200 hospitals were built in the United States. These First Gen hospitals were the anchors in their health care communities. They afforded employment to many, served as magnets for physicians and anchored the community’s economy. The science of healing was advancing as techniques for surgery improved and medication therapy became a mainstay. Hospital administrators focused on recruiting relationships, community support, and appropriating capital for a widening array of inpatient services. As resourcebased relative value scale (RBRVS) payments evolved ARKANSAS HOSPITALS | SUMMER 2020 37

and as investor-owned hospitals became prominent, competition for admissions became the prime determinant of success. First Gen hospitals enjoyed the “Field of Dreams” era for hospitals in the U.S. – when we built them, they came. Specialization took front seat to preventive and primary care. Four beds per thousand was the norm. But the costs associated became problematic to employers and insurers who launched HMOs and capitated models to constrain runaway spending. By 2000, the shortcomings of capitation had run their course. Competitive pressures shrank the First Gen hospitals’ ranks to 6,200, including 1,200 owned by private investors.

SECOND GEN HOSPITALS (CIRCA 2000-2015)

First Gen hospitals transitioned to Second Gen because the economics of running a hospital changed. Explosive growth in clinical innovation coupled with vexing medical inflation prompted Medicare, employers, and insurers to clamp down on hospitals. They criticized lack of transparency, variable quality and safety, and cost shifting as intrinsic flaws. Federal legislation is largely responsible for the tepid conditions faced by Second Gen hospitals as they navigated through the first post-Y2K decade: • The Medicare Modernization Act (2006) introduced managed care in Medicare and a new spotlight on prescription drugs. • The American Recovery and Reconstruction Act (2009) funded Medicaid expansion and forced meaningful use of electronic health records. • The Patient Protection and Affordable Care Act (2010) altered incentives for hospitals from volume to value. Quickly, hospital executives pivoted to efficiency and growth. Affiliations 38 SUMMER 2020 | ARKANSAS HOSPITALS

Second Gen hospitals developed accountable care organizations, public report cards and an array of outpatient services to compete. “Bending the cost curve” became job one and avoidance of penalties for poor clinical performance and avoidable errors an intense focus.

and consolidation accelerated as multihospital system operators played larger roles. Outsourcing and group purchasing arrangements became more sophisticated, and the aggregation of physicians into clinically integrated networks became imperative. Second Gen hospitals developed accountable care organizations, public report cards, and an array of outpatient services to compete. “Bending the cost curve” became job one and avoidance of penalties for poor clinical performance and avoidable errors an intense focus. In the U.S. today, 5,627 hospitals, including 4,926 community hospitals, have survived. But what’s next?

THIRD GEN HOSPITALS (2015 FORWARD)

Third Gen hospitals are significantly different from their ancestors. Unlike First Gen and Second Gen hospitals that defined their opportunities and challenges through the lens of thirdparty reimbursements and federal regulation, Third Gen hospitals think outside the box. Their responses are framed around emerging opportunities in a consistently expanding health care market. While regulatory compliance remains a constant, it is redefinition of this market that defines their strategies. They calculate their efforts around six realities: • Changing Demand for Health Services – 10,000 elderly Americans age into Medicare daily. Shortages in primary care services are driving alternative venues like retail clinics and tele-visits. Millennials and employers are demanding programs for well-being along with specialized services for those who are sick. They want a coordinated blend of alternative and traditional medicine, physical and mental health, technologies that equip them to participate actively in their care and instant information about the costs they’ll shoulder in every transaction with their hospitals and caregivers. Third Gen hospitals embrace an expanding definition of health that goes well beyond sick care services for patients. And they don’t see Medicare as a financially unattractive market. • Explosive Clinical Innovation – Medical science is expanding exponentially. More than 80 randomized control trials are published daily, and precision medicine has a firm footing in cancer treatment. For Third Gen hospitals, personalized health delivered through teambased models is central to their operating model. The results of these efforts – total costs of care,

user experiences, outcomes, and avoidable errors – are the basis for competing against other Third Gen players in their region. Armed with cost and outcome data that’s readily accessible, and powerful tools for self-care navigation, payers and consumers will find “what works best” for their health care far beyond their local communities. • Tighter Access to Capital – Third Gen hospitals need capital to expand their services across a wider array of retail, community,

• Health Insurance Integration – Recent announcements by Aetna and Anthem about their partnerships with reputable health systems like Texas Health Resources, Inova, and others reflect the convergence of financing and delivery of care in our system of care. Consumers and employers trust providers more than insurers, but they have issues with both. Incentives to manage both cost and quality are firmly embedded in the Affordable Care Act’s momentum toward alternative

and building clinically integrated networks around them. Physicians were in the C-suite, but in roles limited to clinical impact – credentialing, care planning, quality and safety surveillance, and so on. Third Gen hospitals will be led by teams of clinicians with acumen in both finance and delivery. And the roles of health coaches, nutritionists, dentists, mental health practitioners, pharmacists, and nurse professionals will also be more directly involved in business and clinical decisions.

payment programs, and they’re unlikely to change. What will change are the activities of Third Gen hospitals to sponsor plans targeting Medicare, Medicaid, employers, and individuals. In some markets, Third Gen hospitals will go it alone; in others they’ll partner with private insurers. And in all, they’ll invest heavily in technology-enabled care management to drive enrollment in their direction. • Clinical Leadership Expansion – First and Second Gen hospitals appropriately focused considerable effort in recruiting physicians

• Operating a Retail Business – For Third Gen hospitals, a sixth force is perhaps the most daunting – operating the enterprise in a retail model. As employers force employees into high deductible plans or exit coverage arrangements altogether, health care spending by Millennials and Boomers will become central to Third Gen hospital finances. Most will integrate alternative health, over-the-counter products, and personalized diagnostics into their clinical operations. All will re-deploy capital from bricks and clicks (integration of

FIGURE 1

and digital services closer to homes, schools, and workplaces. But the capital markets are wary: bond ratings for the acute sector have plummeted, and private investment in health care is betting on other sectors that disrupt the status quo. Third Gen hospitals that operate with scale and scope advantages will be creditworthy; the rest will be starved for capital. And deployment to inpatient programs will be balanced against investments in household services, clinical enterprise developments, and retail services.

ARKANSAS HOSPITALS | SUMMER 2020 39

FIGURE 2

First Gen “Community Hospital”

Second Gen “Medical Center”

Third Gen “Systems of Health”

Era

1947-2000

2000-2015

2015-

Focus

Inpatient Services for the sick and injured patients

Inpatient and Outpatient Services for the sick and injured patients

Health and Well-being Services for individuals, employers, and populations across the full range of their states of health

Scope

Acute

Acute + Physician Services

Primary and Preventive, Acute, Post-Acute + Physician Services + Health Insurance + Homes, Workplaces, Retail Clinics + Digital

Scale

Local

Local Operations with System Affiliations

both an offline and online presence). All will leverage digital health in every program and service so as to connect consumers to their health care organization of choice. And at the core of the organization’s culture is recognition that patients want to be treated as individuals who have choices and want to be actively involved in their care. Branding will matter more than ever.

DISTINCTIONS MATTER

The distinctions between the three generations are significant (see Figure 2). The determination of how best to make the transition to future-thinking a necessary discussion for hospital boards, senior managers, and physician leadership in every hospital, regardless of size, ownership and internal political pressures should be happening now. For Third Gen hospitals, the imperatives for change are market driven. Unlike Second Gen hospitals that necessarily focused on federal regulatory changes, Third Gen hospitals must focus more attention to market forces. New capabilities are required in the Third Gen C-suite, as are new relationships forged with partners who bring capital and competencies not historically central to the operation of the hospital. The key question for Second Gen hospitals is this: How can we successfully transition to become a fully integrated system of health? 40 SUMMER 2020 | ARKANSAS HOSPITALS

Regional/National with Multiple Strategic Partnerships

Some might elect to maintain Second Gen status and take their chances. Others may choose to play a role in a Third Gen system of health. As reflected in Figure 1, managing total population health requires rethinking of how an enterprise is structured, how optimal scale and scope is achieved, and what roles each participant plays.

SHAPING THE FUTURE: CHARTING A COURSE

The key questions Second Gen hospital leaders must answer are: • Can we survive as a Second Gen organization? What are the risks and advantages? How does our cost, quality, and reputation performance compare to systems outside the community? • How fast will conditions in our region shift demand and opportunities from Second Gen to Third Gen? • How will competing systems of health evolve, and what are they? • Do we have the capital and operating expertise to be a system of health on our own, or should we play a key role in another? • Is owning and operating a health plan advantageous? Do market conditions warrant sponsorship of a plan, or is partnering a better option? • How should opportunities in outsourcing, affiliations and thirdparty capital be approached? • And given these challenges and opportunities, is our board prepared

to make appropriate decisions objectively about its use of capital, management, physician relationships, affiliations, etc.? Is the board ready? Answers will vary depending on market circumstances and the starting points for Second Gen hospitals. For rural and critical access hospitals, opportunities abound in primary care and preventive health, emergency services, geriatrics, alternative health, and more. For tertiary hospitals, concentration of specialized programs in high-throughput, high-outcome, high-efficiency centers of excellence is likely. For community hospitals, it’s likely retail health and care coordination will take center stage. All have a role to play. All must necessarily make changes that to some might be uncomfortable. All play a vital role, and none is inconsequential.

FINAL THOUGHT

The ancients in Greece and Rome set the stage for what is undeniably a cornerstone in our society – hospitals that serve as hubs of activity for healers. That will not change, but how and where it’s done will change. For Third Gen hospitals, the forces for change are market driven. Unlike First and Second Gen hospitals that navigated around regulatory changes, Third Gen hospitals adapt to markets. They are not paralyzed by regulatory constraints and shared risk arrangements, nor are they timid about deploying capital outside traditional hospital services. They see the scale and scope of their operations well beyond third-party reimbursement. Third Gen hospitals are systems of health that serve regions. They define health. They treat the sick and the well. They’re the future. Paul H. Keckley, PhD, is Managing Editor of The Keckley Report, and provides independent health care research and policy analysis. Reach him at: pkeckley@ paulkeckley.com. Visit his website at www.paulkeckley.com.

ARKANSAS HOSPITALS | SUMMER 2020 41

ARKANSAS

H O S P I TA L S Summer 2017

TELEMEDICINE

Sometimes an article grabs us simply because it highlights the “little guy” doing big things with cutting edge technology and innovation. That’s why we love this story about Piggott Community Hospital and its work with the New York Institute of Technology (NYIT) College of Osteopathic Medicine at Arkansas State University, and with Dr. Darren Sommer, a medical innovator who came up with telemedicine technology so realistic, it feels like you and your remotely located doctor are in the room together. This article first ran in the Summer 2017 edition, which focused on Telemedicine.

arkhospitals.org

From the 2017 Summer Issue

Embracing Telemedicine Piggott Community Hospital Serving as National Model by Nancy Robertson, Senior Editor

That a rural Northeast Arkansas Critical Access Hospital is a national leader in the practice of telemedicine may, on its face, seem surprising. That the hospital is Piggott Community Hospital, long known for its strategy of connecting with a wide variety of partners to increase health care access for its patients, removes the element of surprise. In fact, “Of course!” is a predicted response.

iggott Community Hospital (PCH) is guided by its longtime Executive Director, James Magee, a leader who believes in seeking patient care access through any and all avenues. “As a community-owned hospital, we are not limited to any one system in the partnerships we can generate,” Magee says. “So to benefit our patients, we participate in as many programs as possible – whether conventional or unconventional and across a broad spectrum – to best meet the needs of the patients we serve.” Initial logic for the development of PCH’s Telemedicine Program was that many of the area’s elderly and financially challenged did not have the capability and/or resources to travel to distant locations for physician specialty care. 42 SUMMER 2020 | ARKANSAS HOSPITALS

“Telemedicine was the obvious mechanism to dramatically increase access to specialty care,” Magee says. There are many avenues of telemedicine being employed at PCH. For example, the hospital is a beta site for a Tele-Emergency program with UAMS, whereby an emergency department physician at PCH can connect with a Board-Certified Emergency Medicine physician for a consult on a complex care issue. But it is one program, especially, that moves the hospital into the national limelight. That is the collaboration with Innovator Health and the use of its remarkable telemedicine delivery system, “the Rounder,” which allows patients to build incredibly close relationships with their physicians – even those remotely located.

HOW THE ROUNDER CAME TO BE

Dr. Darren Sommer speaking with a patient via the Rounder. The attending nurse is using an otoscope; Dr. Sommer can “see” inside the ear via the Rounder’s technology.

ANATOMY OF THE ROUNDER

The Rounder is a more than six-foot tall apparatus that looks like a 55inch television, upended to vertical, and made portable by putting it on wheels. It’s the brainchild of Dr. Darren Sommer, DO, MBA, MPH, a true believer in the necessity of building doctor/patient relationships even absent the face-to-face experience. “Our goal is to deliver telemedicine experiences that are so rich and natural that neither the patient nor their caregiver ever sees the distance that separates them,” he says. The Rounder functions as a life-sized connector between physicians and their patients. Besides the screen that brings patient and physician together, the Rounder has a nurse-operated workstation, which includes HIPAA-compliant laptop and video/conversational connections, as well as exam equipment ranging from scopes to cameras, to help

As both a practitioner of telemedicine and a technology executive, Dr. Darren Sommer understands the importance of creating telemedicine systems that exceed expectations. With a focus on reliability and simplicity, Dr. Sommer’s vision is to deploy Innovator Health technologies so that all Americans have access to the highest levels of care. Dr. Sommer received his Doctor of Osteopathic Medicine degree and holds a master’s in Public Health from Nova Southeastern University’s College of Osteopathic Medicine. He also has more than 20 years of military service and two combat deployments in support of the Global War on Terrorism. When he was working with sick and badly injured patients during his time in Afghanistan, he would often call for consults with other military physicians located in Germany or other medical bases. These consults would result in specialists’ interventions on behalf of injured soldiers hundreds of miles from their location. It was through recalling this extreme value to both patient and physician that led him to begin working on his telemedicine breakthrough, the Rounder. Available to serve patients wherever they are, especially in rural or remote locations, the Rounder connects patients with the medical services they need, but that may not be readily available to them locally.

ARKANSAS HOSPITALS | SUMMER 2020 43

the physician with the diagnostic process. Designed by Dr. Sommer, the Rounder employs technology that seems impossible – it provides real eye contact between patient and physician through a 3D experience, which makes the building of the allimportant relationship between patient and caregiver a thoroughly engaging process. It changes the world of the more common small, impersonal, cart-based telemedicine communications – once

the epitome of high-tech telemedicine – to a truly life-sized and personal, immediate doctor-patient experience.

A “ROUNDER” COLLABORATIVE IS BORN

Magee was an early adopter and betatester of the Rounder on behalf of PCH’s patients. He was also, cooperating with Dr. Shane Speights and St. Bernards Health System, instrumental in bringing the technology to the new osteopathic

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school of medicine located on the campus of Arkansas State University in Jonesboro. “Dr. Speights, who is now the dean of the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) at Arkansas State, has a long practicing history at St. Bernards,” Sommer says. “St. Bernards helped purchase the Rounder in use at PCH and is using its physicians to staff it.” The cooperation between the three entities (PCH, St. Bernards and NYITCOM at Arkansas State) is integral to northeast Arkansas’s becoming a national leader in this leap forward in telemedicine utilization. “It would be hard to find a rural hospital more innovative and aggressive in the adoption of telemedicine than PCH,” says Dr. Sommer. “We are grateful to Mr. Magee for working with St. Bernards and Dr. Speights as we explore a connection for helping today’s medical students become comfortable with the practice of telemedicine.” Dr. Sommer works with NYITCOMASU students, beginning in their very first year of medical school, in building the all-important physician/patient relationship through and by use of telemedicine technologies. His title? Professor of Telemedicine.

“Telemedicine is an extension of faceto-face medical practice,” Magee says. “At PCH and in our rural health clinics in Rector and Campbell, we also advocate for our patients to see their telemedicine physicians in person when the doctors make their regularly scheduled trips to our various locations.” What are some of the other many telemedicine opportunities for patients in the Northeast Arkansas/Southeast Missouri region served by PCH? • Cardiology/Heart Clinic visits through St. Bernards telemedicine. • Dermatology visits through a physician located in Searcy/Jonesboro. • Sleep Study services through pulmonologists at St. Bernards.

• Gastroenterology consults through a physician located in Cape Girardeau, Missouri. • AR SAVES stroke consults through UAMS. • Tele-ICU (e-ICU) consults through Baptist Health. • Mental health consults through the Mid-South Health System. • And coming soon: ear, nose and throat services through St. Bernards. “One of our goals is to make telemedicine services available in our rural health clinics,” Magee says. “We are also in discussion with our large home health, assisted living and skilled nursing care locations on ways to employ telehealth – and the Rounder – for the care of these patients.” Ben Bloom, principle with Affinity Healthcare, Inc., a health care management firm that has worked with PCH for more than 15 years, is helping Magee continue expanding the hospital’s telemedicine reach. “There are a lot of health care venues that talk about a commitment to telemedicine,” he says, “but Piggott Community Hospital demonstrates its commitment. Both from the top down (leadership commitment) and the bottom up (professional staff buyin at all levels), PCH is dedicated to providing telemedicine excellence for its patients.” A perhaps unanticipated challenge faced by PCH in its desire to increase its telemedicine outreach is not in the areas of technology or patient satisfaction; the challenge is often in getting physicians comfortable with the practice. “If we can get our specialty physicians (located in other locations who travel to Piggott for outpatient services) to try telemedicine, they most often report liking and appreciating it,” Magee says. “We will never eliminate the needed face-to-face physician visits, but we find we can reduce the number of in-person encounters greatly when our specialists embrace telemedicine.” Physicians typically agree to use telemedicine when they see the positive impact it has on their patients.

It’s easy to see how telemedicine can be a boon to rural health care, bringing specialists into reach for patients in remotely located and underserved areas. And PCH’s examples of how to utilize and encourage participation in telemedicine are already bearing fruit in neighboring states. Besides the use of PCH telemedicine programs by patients located over the state line in Missouri, two hospitals in Mississippi are replicating PCH’s extensive and

wide-ranging telemedicine practices after visiting the hospital for a closeup view of how the programs are woven together. PCH is also in discussion with long-term care facilities in the Northeast Arkansas region to see how the Rounder could be employed to better serve individual patients in these organizations. “We can see how patients can benefit from having the Rounder brought to their rooms and having a

ARKANSAS HOSPITALS | SUMMER 2020 45

telemedical physician visit and a diagnosis be made on the spot, without having to bring these fragile patients out into the weather or having them endure waits in the ER or clinic,” Magee says. “The most important thing telemedicine, in all its forms, brings to our patients is increased access to health care and local access to specialists they would otherwise only see by traveling long distances,” Magee adds. “We’re proud that PCH is seen as being far ahead of the curve in its multi-disciplinary approach to telemedicine, and for setting the bar for what’s possible for rural and Critical Access Hospitals across the nation.” “To benefit our patients, we participate in as many programs as possible – whether conventional or unconventional and across a broad spectrum – to best meet the needs of the patients we serve.” “There are a lot of health care venues that talk about a commitment to telemedicine, but Piggott Community Hospital demonstrates its commitment… to providing telemedicine excellence for its patients.”

46 SUMMER 2020 | ARKANSAS HOSPITALS

PCH Executive Director James Magee in Piggott, Arkansas, consults with Dr. Darren Sommer, physician-inventor of the Rounder, in Englewood, Ohio, using Dr. Sommer's invention. (Photos by Alex Gookin, AG Video Services)

ARKANSAS HOSPITALS | SUMMER 2020 47

H O S P I TA L S Fall 2017

Innovation arkhospitals.org

From the 2017 Fall Issue

With the COVID-19 pandemic revealing sharp social disparities between white neighborhoods and communities of color in America, a movement to correct injustices is stirring. We loved this article about the fight Arkansas Children's is waging against food insecurity, unlivable housing and educational deficiencies. This article first ran in the fall of 2017. Today, the fight continues: 1 in 4 children in Arkansas still struggle with hunger, while 1 in 6 Arkansans find themselves without enough food. Arkansas ranks second behind New Mexico with the highest rate of child hunger. Arkansas Children’s President & CEO Marcy Doderer said June 3: “The recent anti-black racism publicly displayed in Minneapolis has rightfully shaken our nation, our local community and many team members at Arkansas Children’s. More troubling, this is only one instance in a pattern of discrimination that is dehumanizing and terrifying. Arkansas Children’s leadership wishes to be clear – we are watching, listening and want every single member of our team and community to know we remain vigilant in standing against racism and discrimination wherever it exists. Today, we make a renewed commitment to actively create an anti-racist environment across the entirety of our health system and set an example for the communities we serve. Racism is firmly in the way of attaining unprecedented child health in Arkansas...We promise to do more listening, more asking and more advocating. Please join us in doing more to stand against discrimination. Our children are watching.” [For more on racial disparities and social determinants of health, see Dr. Melinda Estes’s article on page 10.] 48 SUMMER 2020 | ARKANSAS HOSPITALS

Can a Bag of Food Improve Health?

Arkansas Children’s Hospital Initiative Addresses Food Insecurity and Other Social Determinants of Health

By Anna Strong, MPH, MPS, former Executive Director of Child Advocacy and Public Health, Arkansas Children’s Hospital

ospitals and health care providers work diligently to treat illness and promote health for their patients. Population health research shows, though, that 80% of the factors that determine health outcomes are outside of clinical care: education, employment, income, health behaviors, community safety and housing. As payment models evolve to add value-based components that depend on these health outcomes, health care providers are exploring innovative, systematic ways to bridge the gap between medical and social needs to improve outcomes for patients. We at Arkansas Children’s Hospital (ACH) are no exception. In an effort to ensure our patients are better today and healthier tomorrow, over the past 15 months, we have been screening patients in a primary care clinic for social needs and providing associated resources, including a medical-legal partnership and programs to address food insecurity.

A COMMUNITY-DRIVEN STRATEGY

To determine what social needs the hospital should address, a multidisciplinary team looked to ACH’s 2016 Community Health Needs Assessment. The team noted the shocking fact that one-quarter of children in Arkansas are food insecure, while 18% of the overall population lacks, at times, enough food for all family members to lead a healthy, active life. Adding to the problem of food insecurity, Arkansas is one of two states in the nation lacking an implied warranty of habitability for tenants that would require landlords to maintain livable homes for tenants, and almost 22,000 children in Arkansas are homeless. The team also observed that just 31% of fourth graders read proficiently, with significant disparities by race and ethnicity.

Through a partnership with the USDA, ACH distributes summer and after-school meals to children.

Community members echoed the need to address these three issues: food insecurity, housing and educational attainment. As ACH developed its social needs screening form, one principle guided the work: The team would not ask questions that couldn’t be answered. The hospital’s cross-departmental team sought a way to quantify social needs, but it was equally important to give clinicians the tools to address a problem and focus on clinical care. The team selected validated questions that were written at appropriate reading levels for patients’ families. ACH’s initial screener included 14 yes-or-no questions written at the 6th grade level, and it was printed double-sided in English and Spanish, on bright green paper. Any “yes” response was a positive screen. To address food insecurity, housing and educational attainment, ACH worked with existing community partners through the Natural Wonders Partnership Council to develop solutions. Within the hospital, ACH’s Food Insecurity Workgroup and Medical-Legal Partnership team coordinated hospital resources.

TO ADDRESS FOOD INSECURITY

• Helping Hand food bags: A neighborhood food pantry, which is a member of the Arkansas Food Bank, provides bags of healthy, nonperishable food to the clinic, which distributes them to families that identify an immediate need for food. • Helping Hand mobile pantry: A retired school bus, retrofitted by a local church to be a grocery store on wheels, stops at the hospital weekly and distributes fresh and nonperishable food to patients’ families. • Summer and after-school meals: Through a partnership with the USDA, ACH distributes summer and after-school meals to children – more than 60,000 have been given out since the program began in 2013. The lunches are prepared by students from local high schools’ communitybased instruction classes. • SNAP applications: ACH financial counselors assist qualified families in applying for the Supplemental Nutrition Assistance Program. • On-Campus WIC clinic: ACH partners with the Arkansas Department of Health to offer a Women, Infants, and Children enrollment clinic each week.

• Pantry resource list: ACH maintains a list of neighborhood food pantries that families can access when they return home.

FOR HOUSING NEEDS

• Medical-Legal Partnership: ACH partners with Legal Aid of Arkansas to address patients’ health-harming legal needs, including housing issues such as evictions or housing quality. • Shelter resource guide: Families at risk of homelessness are referred to community programs that help prevent homelessness and are given a guide to local shelters if they currently lack a safe, stable home. • Utilities Assistance guide: ACH provides a handout regarding utility assistance if a family is concerned about electricity, gas or water being turned off, and the clinic provides letters of medical necessity to families.

TO ASSIST WITH EDUCATION

• Medical-Legal Partnership (MLP): ACH partners with Legal Aid of Arkansas, which employs one of the only special education attorneys in the state. The MLP addresses issues ARKANSAS HOSPITALS | SUMMER 2020 49

such as individual education plans or special education services that are not being implemented properly.

PILOTING THE PROCESS

Once the screening tool (the “screener”) was developed and resources were identified, the screening and referral process was piloted in a busy primary care clinic with a volume of around 20,000 visits each year. The clinic’s payer mix was about 80% Medicaid. The multi-disciplinary screener team trained staff on social determinants of health and the screening process. Front desk staff distributed the paper screener, and families filled it out as they waited. During triage, nurses reviewed the positive results with the families, providing resources and referrals with the help of a “cheat sheet” posted at the nurses’ station that outlined resources for each question. The nurses documented interventions on the screener and shared the results with

50 SUMMER 2020 | ARKANSAS HOSPITALS

physicians, who aimed to document the needs and interventions in the electronic medical record (EMR). Screeners were then placed in a green screener basket for collection by staff. The screening team ensured that support staff were in the clinic during the first couple of months of the screening to help with the transition. After the screener was piloted and moved to implementation, process improvement projects helped to streamline and simplify the clinic flow, improve accuracy of data tracking and guard against abuse of the program.

MAKING AN IMPACT

The team used grant and donor funding to support data entry and analysis of the screener data. This was the only new staff employed for this project. The results were kept in an Excel spreadsheet that allowed the team to monitor trends and project resource needs. Over the first 15 months of the program, staff distributed

screeners at more than 20,000 visits. Approximately 56% of these were completed and had a positive consent. Of those completed, 43% had at least one positive screen. Of the patients who completed the screener: • 29% screened positive for food insecurity. • 15% said they “need food today.” • 15% had at least one housing need. • 4% were concerned about rats or pests in their home. • 10% were concerned about their utilities being turned off. • 7% had at least one educational service need. Families welcomed the resources. The clinic made more than 800 referrals to the medical-legal partnership. They distributed more than 1,200 bags of food and more than 2,500 food pantry packets to clinic patients. Financial counselors supported more than 900 families who wanted to apply for WIC or SNAP.

ACH’s community garden provided more than 3,000 pounds of produce for Helping Hand food pantry during the summer of 2017.

After the pilot, ACH wanted to share this success with other clinics. Through the Natural Wonders Partnership Council’s Innovation Fund, four successful community clinic pilots were conducted in southeast, southwest, northeast and central Arkansas, proving that with the right supports, any clinic can work to address social needs.

CHANGING CULTURE

ACH’s efforts to improve awareness of social needs extend beyond the social needs screener and into the community. A vibrant community garden on the corner of ACH’s campus grows fruits and vegetables that are donated to Helping Hand and often come back to ACH families. During the summer of 2017, the GardenCorps service member who manages the garden oversaw harvesting of more than 3,000 pounds of produce. The hospital’s Community Outreach team teaches Cooking Matters classes to help families plan, budget, shop and cook healthful food. Pop-Up Cooking Matters offers a portable version of the shopping curriculum to high school students across Arkansas. These evidence-based programs are the result of a partnership with the Arkansas Hunger Relief Alliance and the national No Kid Hungry Campaign. Going forward, hospital staff members hope to embed the screener and resource provision into the EMR and expand the program to new clinics to reach more families. As ACH works to further its mission of bringing care close to home for families across Arkansas, it's hard to imagine anything closer to home than a healthy dinner served at a family's own kitchen table.

ARKANSAS HOSPITALS | SUMMER 2020 51

ARKANSAS’S MEDICAL-LEGAL PARTNERSHIPS By Kesia Morrison, Legal Aid of Arkansas According to the National Center for MedicalLegal Partnership, only 20% of an individual’s health is determined by genetics, medical care and personal choices. The remaining 80% is Unresolved social and economic problems can perpetuate poverty and determined by where an individual lives, works, its effects on health. Many of these problems have legal solutions, and learns and plays. Factors include income, access to addressing them with legal help can provide a path out of poverty. care, education, housing, access to healthy food, stable employment and personal safety. Individuals living in poverty face many barriers to good health outcomes that cannot be treated in an exam room. How can Legal Services, partners with the Central Arkansas VA Health health care professionals ensure good health outcomes for Care System Day Treatment Center. their patients when so much is beyond reach? MLP is an important part of Legal Aid’s service delivery A medical-legal partnership (MLP) embeds attorneys in the model because we understand that poverty and health are health care team to “treat” legal problems that are affecting connected. Poverty is the single most defining factor in health. It helps to think of the attorney like another specialist. a person’s life. Poverty is the best predictor of whether a When the medical partner knows it is a medical issue, she person will have good health, live in a safe environment, refers to the appropriate medical specialist. If the patient has a get a good education and have employment opportunities. shattered bone, he is referred to an orthopedic surgeon. If the Unresolved social and economic problems can perpetuate patient has grand mal seizures, she is referred to a neurologist. poverty and its effects. Many of these problems have legal If it’s a mystery rash, refer the patient to a dermatologist. solutions, and addressing them with legal help can provide When the medical partner identifies or suspects a healtha path out of poverty and a path toward a healthier future. harming legal need, the patient is referred to the legal partner. Legal Aid hopes to create a statewide network of medical For example, if the patient cannot get well because of the and legal partners. Such a network could bring together conditions in her apartment, that problem could have a legal stakeholders to facilitate research collaboration, systemic solution. A patient who cannot get a medical device because advocacy and other opportunities. Working together, Medicaid will not cover the cost can be referred to MLP for help medical and legal partners can identify solutions to the most getting Medicaid to pay for the device. A victim of domestic pressing health-harming legal needs facing Arkansans. violence can be referred to MLP for help securing an order of protection and a divorce so that she can live in a safe and healthy environment. A student can get help asking her school for educational services that meet her individual needs. Legal Aid of Arkansas is a nonprofit law firm that provides free legal services to low-income Arkansans. Legal Aid operates six medical-legal partnerships in Arkansas: Anna Strong now works closely with Arkansas Mid-Delta Health Systems, with Friday, Eldridge & Clark; Children's in her new role as Executive Director at Arkansas Children’s Hospital, with Walmart Legal; Midthe Arkansas Chapter of the American Academy South Health Systems; Veterans Healthcare Systems of the of Pediatrics. Kesia Morrison is Staff Attorney with Ozarks; Lee County Cooperative Clinic; and CHI St. Vincent. Legal Aid's Medical-Legal Partnership with Arkansas Additionally, our sister organization, the Center for Arkansas Children's. 52 SUMMER 2020 | ARKANSAS HOSPITALS

ARKANSAS HOSPITALS | SUMMER 2020 53

At Central Arkansas Veterans Healthcare System, staff members refer to their patients as Veterans, always with a capital V. They revere their patients, and they respect all Veteransâ&#x20AC;&#x2122; service to our country. In many cases, caregivers are, themselves, Veterans. This story warmed our hearts when we first ran it in the Winter of 2017; it continues to do so today.

Heroes Caring For Heroes

By Salena Wright-Brown, Shauna Haynes and Sandee Foster, Central Arkansas Veterans Healthcare System

he mission of the Department of Veterans Affairs is to fulfill President Abraham Lincoln's promise "to care for him who shall have borne the battle, and for his widow, and his orphan" by serving and honoring the men and women who are America's Veterans. The VA 's four primary missions are Health Care for Veterans, Educating Health Care Professionals, Research, and Providing Support in Times of Emergency. The Central Arkansas Veterans Healthcare System (CAVHS) is a large, busy VA health system. Its two hospitals, located in Little Rock and North Little Rock, and eight community-based outpatient clinics serve an average of 65,000 Veterans from Arkansas and surrounding states. The organization provides a wide range of inpatient and outpatient health care services, including disease prevention, primary care, surgical procedures, extensive mental health programs, rehabilitative care and other specialties. Staff at CAVHS use multiple modalities, including traditional face-to-face visits, home-based services, integrative medicine, telehealth services and other techniques to connect with patients. At the core of the organization are the nurses that call CAVHS home! There are over three million registered nurses in America; with more than 80,000 RNs, APRNs, LPNs/LVNs and nursing assistants, the VA is the nation's largest employer of nurses. More than 1,000 nurses work at CAVHS. These nurses are recognized and honored with local, regional and national awards throughout the country, including 12 of the "40 Great Nurses 54 SUMMER 2020 | ARKANSAS HOSPITALS

Under 40" and seven of the "Great 100 Nurses in Arkansas." Dr. Salena Wright-Brown, Associate Director for Patient Care Services for CAVHS, emphasizes the impact that CAVHS nurses play in meeting the VA 's core ICARE values of Integrity, Commitment, Advocacy, Respect, and Excellence. "CAVHS nurses fulfill the mission by serving Veterans and understand as an organization we only exist to serve America's heroes." Thirty percent of employees at CAVHS are Veterans themselves. They make an impact in the lives of the Veterans and are valuable members of the many multidisciplinary teams dedicated to the four missions of the VA.

CARING FOR VETERANS

When you ask CAVHS nurses what the best things are about caring for Veterans, the answer is often "the stories!" Veteran nurses share a connection with their patients that facilitate conversations about military service. Sometimes, these conversations may not even have been shared with the patient's family. Dawn Moore, Associate Nurse Executive for Surgery Service and an Air Force and Navy Veteran of over 35 years, says the narratives that her comrades share are "living history." She recalls her most memorable patient, a Veteran who served in the Navy alongside President John F. Kennedy. The Veteran shared his story of "taking care" of the Navy Lieutenant Kennedy, ensuring that his PT boat guns were in operational order. (He also kept the Lieutenant out of "hot water," at times.)

Years after the war, this Veteran and his wife were traveling through Texas and ran into the Navy Lieutenant and his wife while they were campaigning for the presidency. The Veteran approached Kennedy, and he immediately recalled the Veteran and the help he had provided, then leaned toward Jackie, whispered in her ear, removed the campaign button from her jacket and presented it to the Veteran. While taking care of this Veteran one evening, Moore says the patient leaned toward his nightstand and removed a handkerchief. Wrapped inside was the campaign button he had received from President Kennedy. Stories like this are a frequent occurrence at CAVHS, as staff are caring for those who helped write America's history. The camaraderie and relationships that form between Veteran patients and Veteran nurses are very moving to witness. Jessica Fulbright, Army Veteran and 6D medical-surgical unit RN, puts it well, "I enjoy the solidarity I have with every Veteran!" Fulbright explains that her mission in the Army as a Medic was to help soldiers through illness or injury. When her obligation to the military was over, she set out to continue to help past and present comrades in the same way.

EDUCATING HEALTH CARE PROFESSIONALS

After World War II, the VA set out to help meet the changing needs of America's health care delivery system by educating future health care professionals. Since that time, the VA has conducted and continues to conduct the largest education and training effort for health professionals in the United States. Amelia (Amy) Dawson, a nationally certified oncology nurse at CAVHS, followed in her father's footsteps and joined the Arkansas Army National Guard at 17, serving as a Blackhawk helicopter pilot and warrant officer. Dawson, an Operation Iraqi Freedom Veteran, obtained her nursing degree upon return from Iraq with the goal of caring for her fellow brethren and living her life in a manner that honors those who sacrificed for our country. She specifically mentions her friends and members of the Blackhawk crew, with call sign "Easy 40." These heroes were lost to enemy fire while in Iraq.

Dawson believes she serves their memory while serving Veterans as a nurse. She began her career at CAVHS in 2011, after graduating and serving a deployment to Kosovo. She credits her desire to work on the oncology unit to her time as a student nurse at the facility. She is one of the more than 127,000 health care professionals each year who receive at least part of their training at a VA facility. Observing the day-to-day interactions between Dawson and her patients can only be described as intriguing. She can be seen sitting down beside her patients and listening to their concerns and fears while providing the reassuring presence and touch that are important parts of nursing. Dawson feels strongly that oncology nursing is a "calling." This is evident in the compassion she shows in all situations, but especially when a Veteran's battle is nearing its end. Family members who have lost loved ones to this horrible disease remember Amy Dawson by name and the comfort that she provides during their grief.

From the 2017 Winter Issue

RESEARCH

The VA has been on the forefront of groundbreaking research for decades. CAVHS continues the VA tradition of research and innovation that began long ago with the first liver transplant, and the development of computerized medical records and barcode medication administration. These research efforts continue today with advances such as the hydraulic self-leveling walker for use on stairs or inclines. CAVHS is one of just 32 facilities (out of the 150 VA facilities) selected as a national innovation site. At the forefront of CAVHS's Innovation Squad is Perry Maclaird, Patient Safety Manager and Air Force Veteran. Maclaird's distinctive experiences in the military as a meteorologist helped grow an attitude of assuming responsibility for the surrounding environment and avoiding complacency. When he noticed a nurse struggling to push a patient in a bed while pulling an IV pole, he said, "There has got to be a better way." This led to his partnering with other members of the VA Innovators Network and designing an IV hitch. The device, which attaches the IV pole to the bed, frees up the health care worker's hands for patient transport. There is ARKANSAS HOSPITALS | SUMMER 2020 55

currently a patent pending on this device developed by Maclaird and nursing staff at CAVHS. Research takes another form at the Community Living Center (CLC) at CAVHS, which is an example of an innovative environment providing quality care in a homelike setting. With programs and practices in place like the Snoozelen multi-sensory room for dementia patients, a research-driven fall prevention program spearheaded by staff nurses, and an

in-depth recreational therapy program that includes woodworking and other therapeutic creative arts activities, it is no surprise that CAVHS's CLC holds an overall quality rating in the first quintile, meaning it performs better than 90% of other VA sites in the nation. Dara Penn, RN, works in the CLC and is a 3rd generation Veteran whose grandfather served in World War II, father in The Gulf War and husband in Operation Enduring Freedom. After serving in the Air

Force for four years, she knew she wanted to continue serving her country through caring for her fellow Veterans. Penn, whose leadership on her unit is a significant reason why Veteran care in the CLC ranks so highly, is also a member of the Innovation Squad and strives to improve Veteran care daily. She says she loves the unique environment of the CLC because the Veterans are there for an extended period, which enables her to form lasting, meaningful relationships with them and their families.

SUPPORT IN TIMES OF EMERGENCY

When Hurricane Harvey brought devastation and flooding to our neighbors in Houston, scores of CAVHS employees stepped up to assist in many ways, including answering the phone lines when CAVHS assumed responsibility of the regional helpline and volunteering to travel to Houston to work. One of those who answered the call was David Hathcock, a Registered Nurse in the Medical Intensive Care Unit/ Coronary Care Unit. Hathcock is an Army Veteran who served from 1989-1992 as a Personnel Administration Specialist with the Artillery Battalion. He has a unique and extraordinary career path and provides a real example of perseverance and determination. In 2003, Hathcock was homeless and living in a local transitional housing shelter when he enrolled in the Compensated Work Therapy program at CAVHS and was hired as a bed washer. He graduated from the program and was offered a housekeeper position in the Environmental Management Service in 2004. Working closely with nursing staff as a housekeeper cleaning rooms, the nurses began encouraging him to consider nursing school. He used online tutorials for three months to self-teach the math skills he needed to pass the pre-requisites for the LPN program at Pulaski Tech. Hathcock then entered the LPN program in 2006, graduated in 2007, and was the first male to be awarded the "Outstanding Student Award." He continued his career with CAVHS as an LPN on a medical-surgical unit and Perry MacLaird, Patient Safety Manager, inventor, and Air Force Veteran. 56 SUMMER 2020 | ARKANSAS HOSPITALS

was well-known for his compassion and connection with Veterans, as well as his excellent clinical skills. This is evidenced by his selection as the 2010 Secretary's Excellence Awardee in the LPN category for CAVHS. Hathcock was not only the facility winner, but was also selected to represent the region (Arkansas, Oklahoma, Mississippi, Texas) in the LPN category. He continued his professional development and graduated in 2014 with his Associates Degree in Nursing from the University of Arkansas at Little Rock. During Hurricane Harvey, the Michael E. DeBakey VA Medical Center in Houston needed nursing support. Hathcock volunteered, without hesitation, to drive a van with five other staff to Houston to provide support. With only a day's notice, he and his colleagues left Little Rock and drove all night to arrive in Houston the following morning. Hathcock was assigned to work in the step-down unit and for two weeks served alongside the Houston staff taking care of Veterans. One Veteran's family was so appreciative of the excellent care he provided that, on his last day, they

surprised him with a balloon bouquet. Hathcock not only cared for the Veterans, but also for the staff. When he arrived, the staff mentioned that the grocery stores were running out of food in their neighborhood and they had minimal food to support their families stuck at home. Soon after hearing this, Hathcock selflessly brought all the snacks sent from Little Rock and prepared bags for the employees to take to their families. When asked, he will tell you that what he does best is "serve his fellow Vets."

HEROES

Staff members at CAVHS are dedicated to our Veterans, each of whom has earned the right to receive high-quality health care through their service to our country. VA nurses help fulfill that debt every day through their service to Veterans. But there are special nurses â&#x20AC;&#x201C; Veterans themselves â&#x20AC;&#x201C; who continue to serve through their personal commitment and dedication to the VA mission. Nursing has long been recognized as the most trusted profession; nursing at CAVHS is truly filled with Heroes Caring for Heroes.

Since this article's first publication, CAVHS nurses have continued to receive accolades for their dedication to Veterans. An additional 87 nurses have been recognized as Great 100 Nurses of Arkansas, five of whom are featured in the original article. During these trying times, CAVHS nurses are united on the frontlines against the COVID-19 pandemic, supporting each other and going to amazing lengths to support, heal, and celebrate with Veteran patients, both local and throughout the nation. This article was authored by proud staff members at CAVHS: Salena Wright-Brown, PhD, MNSc, APRN, RN, Associate Director, Patient Care Services; Shauna Haynes, MSN/ED, RN, OCN, Associate Nurse Executive/ Nursing Excellence; and Sandee Foster, DNP, RN, Chief Nurse Executive/ Nursing Service. You may reach this team at Shauna.Haynes@va.gov.

ARKANSAS HOSPITALS | SUMMER 2020 57

When we first introduced our readers to Sutter Health’s T3 Program in the spring of 2017, it was well into years of successful work with the medically vulnerable who frequent the ED for primary health care. We were impressed with their year-overyear success rate three years ago, but today’s figures are even more remarkable. Today, 60% of T3 clients have been placed in permanent housing (many were previously homeless), and 80% stopped or significantly reduced substance use. Inappropriate ED visits are down 60% in the T3 client group, and every client who enters the program without health insurance leaves with some kind of health coverage. T3 is just one of many partnership programs between Sutter Health and WellSpace Health; in 2020 the number of clients referred by Sutter Health ED navigators continues to grow and the program to expand. From the 2017 Spring Issue

Linking The Underserved

Sutter Health’s T3 Program Changing Lives and Hospital Usage By Kelly Brenk

16 . SPRING 2017

Like most innovative partnerships, our story started with a need and a conversation. THE NEED:

A large number of medically vulnerable, underinsured people were presenting in California's Sutter Medical Center, Sacramento Emergency Department (ED) for non-urgent needs. It became apparent that an integrated health care delivery model was needed to minimize inappropriate ED visits and maximize long-term outcomes.

THE CONVERSATION:

In 2005, the Sutter Health Valley Area began a collaborative relationship with WellSpace Health, a local Federally Qualified Health Center (FQHC) based in Sacramento, California. Sutter Health and WellSpace started talking, and the conversation led to collaborative first steps. What evolved is a trusted partnership that has yielded multiple innovative and unique Community Benefit programs to serve some of the most at-risk populations in our community. We hope our ideas may lead your community and hospital system to begin similar strategies. 58 SUMMER 2020 | ARKANSAS HOSPITALS

THE TRIAGE, TRANSPORT, AND TREAT PROGRAM

More than a decade after those first talks, WellSpace Health is one of Sutter Health's most prominent and dedicated partners. While the many programs and efforts developing from this partnership are specific and distinctive, one of the most impactful is the Triage, Transport and Treat (T3) program. The T3 Program skillfully creates a seamless, interconnected network of resources that seek to treat the whole person and link patients with the right care, in the right place, at the right time. A T3 patient is likely to have a multitude of ailments, and a quick fix in the ED is a non-sustainable solution. These patients are often unemployed, indigent, homeless and navigating life on the streets, while battling a complex blend of deteriorating health issues and complications resulting from things like untreated diabetes, hypertension, vascular disease and chronic pain, as well as mental and behavioral health issues and substance abuse.

THE CASE MANAGER

Enter the T3 Case Managers, who are employees of WellSpace Health. They seek to connect underserved patients to vital resources through long-term and community-based case management. They address a patient's immediate needs and shift their care from the emergency department to more appropriate care settings. The T3 case manager helps patients with everyday issues such as obtaining an ID, a social security card, securing an income, finding a primary care doctor to manage multiple health challenges (including pain management) and eventually, even locating permanent housing. With a T3 case manager, stability is more likely and patient health improves.

need, we see a drastic improvement in the health and overall quality of life for this often-underserved patient population. Baby steps lead to bigger steps, self-esteem and resiliency continue to play larger roles, and incredible progress can happen. Year after year, we see countless stories of success, with patients who once felt hopeless now feeling empowered to take the steps necessary to improve their health and overall lives. When an underserved patient walks

through the doors of our hospital, this provides us with an unmatched opportunity to connect with this patient and help them understand what resources are available and why linking to a medical home and primary care provider is a better way to access care. In most cases, by focusing holistically on the vast needs of the T3 population, Sutter Health is able to have a more significant and positive impact. Over time, we've learned that partnering with patients facing

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IMPACT

The payoff is improved patient health and reduced wait times for those seeking care in the ED for true medical emergencies. Most importantly, by connecting these patients to the health and social services they so desperately ARKANSAS HOSPITALS | SUMMER 2020 59

major life challenges on all levels of their care can be highly successful. A comprehensive plan that includes support for needs beyond health care and integrates partnership and accountability ultimately creates a healthier patient and community.

REFERRAL PROCESS AND FOLLOW UP

While the T3 program serves a very complex patient population, the referral process is fairly simple. Hospital staff identifies patients who could benefit from long-term, outpatient support and explains the T3 program and the services provided to enrolled clients. After gaining patient consent, hospital staff then refers the patient to the T3 program and contacts the T3 Case Manager. When the referral is made, the T3 Case Manager meets the patient at bedside, conducts an assessment and talks to the patient about what is going on in his or her life. It is at this time that the T3 Case Manager makes a personal connection to each T3 client, explaining to them the purpose of the program and encouraging the patient â&#x20AC;&#x201C; who is often scared, skeptical or distrustful â&#x20AC;&#x201C; to take control of their health and their life by enrolling in the T3 program. The personal connection is key. Once enrolled, patients are provided with months of outpatient case

management services. T3 Case Managers work tirelessly to help individuals establish a primary care home and provide linkages to wrap-around services like behavioral health treatment, insurance, substance abuse treatment, transportation, public assistance, community resources and housing. Patients are consistently followed through telephonic and inperson contact, driven to medical appointments, assisted with tasks and supported throughout this period of stabilization. During a patient's time as a T3 patient, they are provided with countless warm handoffs and the consistent encouragement needed to get on their feet, once and for all.

THE RESULTS SPEAK

Since the T3 program began in 2007, the program has served more than 4,200 patients, and year after year, the program continues to yield successful outcomes. At Sutter Medical Center Sacramento in 2016, patients showed a 51% reduction in emergency department visits post-T3 program intervention. In addition, the same patient population showed a 57% reduction in inpatient stays, a 62% reduction in bed days used and a 52% reduction in overall hospital usage, post-T3 intervention. In Sacramento, the T3 program currently meets the needs of an average 170 active patients each month

Caption: T3 clients work with their Case Managers, who help them establish primary care medical homes and link to other needed services including behavioral health treatment, transportation, public assistance, community resources, and housing.

60 SUMMER 2020 | ARKANSAS HOSPITALS

by ensuring that they are engaged in comprehensive health, behavioral health, and ancillary services in the community. Last year, nearly 140 new patients were enrolled in T3, with 344 patients served overall. T3 Case Managers linked 136 patients to a medical home, 37 patients to a mental health provider and provided nearly 600 medical transports to primary care and mental and behavioral health appointments. In addition, 60 patients were placed in temporary shelter and 18 patients were placed in permanent housing. Due to the success of the program, the T3 program was used as a best practice and duplicated to serve patients in Placer County seeking care at Sutter Roseville Medical Center and Sutter Auburn Faith Hospital. In 2016, 120 new patients were enrolled in the Placer County T3 program and a total of 174 patients were served, overall.

T3+, BEYOND THE ED

In 2014, the foundation of T3 was used as the basis of a new program, T3+, which is similar to T3, except patients are identified in an inpatient

setting, rather than in the emergency department. The T3+ navigator also follows the patients after discharge and works with staff to provide a follow-up health plan, telehealth, pain management and other health services. All of this is while the T3+ navigators ensure the success of the patients' other needs by connecting them to things like housing, transportation, community resources and a medical home. In 2016, T3+ patients showed a 39% reduction in ED visits, a 62% reduction in inpatient stays, a 49% reduction in overall hospital usage and a 71% reduction in bed days used, post-T3+ intervention.

COMMITMENT TO CONTINUE

The evolution and growth of the Sutter Health Valley Area Community Benefit programs â&#x20AC;&#x201C; both new and old â&#x20AC;&#x201C; is incredibly exciting, as we're on a constant quest to elevate programming and expand the depth and breadth of our outreach. At Sutter Health, a commitment to the greater community is at the heart of our mission, which is why we work hard to ensure our reach extends far beyond the walls of our hospital. The T3 program is a prime example of Sutter Health's steadfast pledge to increase access to care for the underserved and is the epitome of the incredible work that can be accomplished through collaboration, innovation and partnership. This program would not exist without the collaborative teamwork between our FQHC partner, WellSpace Health, and the multiple departments within the Sutter Health Valley Area. Our combined focus on compassion and caring for all those who walk through our doors and a tireless commitment to making our community a healthier, happier place unites us in this successful collaboration. We hope our model can be of help to Arkansas hospitals reaching beyond their hospital walls to serve specific patient populations. Kelly Brenk is the Manager of Community Health, Sutter Health Valley Area. Her work with Sutter Health community programs focuses on the Sacramento, California area. ARKANSAS HOSPITALS | SUMMER 2020 61

Answering the Call:

A Rural Physician’s Story By Lawrence F. Braden, MD, Ouachita Valley Family Clinic

da (a pseudonym) was 63 years old and dying with pancreatic cancer. She lived alone. She was in terrible pain. There was nothing more that the medical institution could do for her, so she was discharged from the hospital with no plan for continued care. She was, by the time of her call to us, unable to get out of the house. “Please,” she asked, “is there someone who can come see me? I need help and have none.” As a young resident, I was charged with making an assessment and bringing her story back to the residency. The year was 1982, and I was midway through my family medicine training. Her need was overwhelming, and at the time, there were no clear answers. There were no procedures or medicines that could reverse her disease. There were too few hands, ears and minds that were comfortable embracing death; few were willing to stand with someone like Ida, working actively and quietly to raise the experience of dying to a level of significance on par with birth and our lifelong struggle against disease. There was little or no place in the work of the physician for the care of the dying. Much of what we did was awkward, unstudied and, occasionally, harmful. My residency director, Kenneth Goss, M.D., helped me. “So long as you pursue the science of your involvement and do nothing of questionable ethic, I will stand with you. Take the

time you need. Chronicle the experience, and share it with all of us. Let’s see where this goes.” Dr. Goss was a wonderful man and teacher, always affirming, guiding and encouraging. There were few products that could help Ida’s pain. Only immediate release morphine held any promise, but she eventually could not swallow the pills. We sat and talked as I crushed pills and mixed the resultant powder with petroleum jelly to build rectal suppositories. They had to be given at regular intervals, so my other work, my life at home and sleep were too often interrupted. But she died with little pain and with someone at her bedside. She was thankful and at peace. It was a good death. I spent many hours with Ida, in the study of dying and the use of narcotics. I learned from her as she spoke of social disenfranchisement and regular disappointment. She demonstrated the power of faith in mitigating the sufferings of transition. I learned of kindness and depth, often missed in the superficial interactions of daily living. I learned of her life and then of her dying. Though she had very little, she was rich indeed.

SEARCHING FOR MY PLACE

My work with Ida shaped the way I wanted to practice medicine. This was good work, but it clearly required an organization of caregivers. No one individual could do it alone. The thenyouthful hospice movement was beginning to catch people’s attention, yet it was still considered countercultural within the medical world of my place and my time. When the idea of establishing such an organization in central Arkansas was brought to hospitals, it was dismissed as unneeded or outside the scope of missions. Doors were regularly closed. It was disappointing at best, disheartening at worst. It was much the same as I looked for the would-be home of my medical practice. In that search, I was seen by colleagues not as a source for assistance or partnership, but as competition. I questioned my parents and other individuals and heard repeatedly that there was no real need for additional physicians in primary care. Everyone seemed to already have a medical home, and most practices did not share my vision.

AN INVITATION TO SERVE

Then, I spoke with Dr. William (Bill) Dedman, a fellow resident who was not only an outstanding physician but also a strong leader and powerful advocate for his patients. I appreciated the quality and intensity of his work very much. We fought together to ensure the best experience possible as we prepared for our life’s work. He recognized my discouragement and suggested what I had never considered. “Come to Camden with me,” he encouraged. “There is a remarkable need for new physicians, and you will be 62 SUMMER 2020 | ARKANSAS HOSPITALS

This is the personal story of Dr. Lawrence Braden and his lifetime rural family medicine practice in Camden, Arkansas. It's a vivid illustration of how one physician, joined by others of like mind, can help meet the health needs of generations of patients and fellow citizens with whom his life is tightly woven. Since this article first appeared in the spring of 2016, Dr. Braden reports that the Hope Health Commission, in studying health deficits in Ouachita County, boiled needs down to two overarching factors: helping people relieve social and health disparities and providing resources to help them climb out of poverty. Creation of The HUB, a place where citizens can connect with services and resources, was an outgrowth of the Christian Health Center mentioned in his article. New and exciting for the county is a repeating 16-week program based on Ruby Payne, PhD's, work in poverty reduction. Already yielding stories of success, this course brings clients and leaders together to learn from one another. It stresses re-thinking ways of reducing poverty while preserving worth and dignity for all. welcomed with open arms. And hospice? If that is something you want to develop, I am sure you will find willingness from the hospital to help and to support you.” Soon it became time for making the decision to stay in Little Rock or to seek a heightened adventure. Again, Dr. Goss was a trusted counselor. He did more to encourage my wife, Dyan, and me than he could ever know. “You will likely not have all the stuff of Little Rock, but you can travel here,” he said. “When you come, you will appreciate being here more than you ever would if this were home. Your children will do well in any school they attend, as they have grown seeing how you and Dyan embrace education and achievement. In the end, you will miss nothing, and the opportunities afforded you will be countless.” So, we went south. Originally from Hawaii, I along with my wife, who is originally from western Canada, and our children moved to Camden, a city on the Ouachita River about 50 miles north of the Louisiana state line, in 1983. In Camden, I found my personal and professional home. Within weeks, Bill Dedman and I filled our practices. A small community of people, supported by our hospital and its administrator, C.C. McAllister, began building a hospice program, the second in Arkansas. The program remains a vital organization serving our county even today, 33 years later. Through the years, there have been many other initiatives as well. We established new on-call systems which resulted in

arkansas

hospitals www.arkhospitals.org

SPRing 2016

Bringing Healthcare Home

Answering the Call: A Rural Physician’s Story A MAgAzine foR ARkAnSAS heAlthCARe PRofeSSionAlS ArkAnsAs HospitAls I Spring 2016

From the 2016 Spring Issue

improvement to our personal health and our lives at home. A clinic supported by our community brings primary care to the uninsured and the poor. We also have an organization now committed to improving the public health of the community of Camden and the county as a whole. I tell you this to show that practicing in a rural community affords opportunities that too many urban practices cannot. There is room in rural communities to grow programs for our patients, serving the needs of our patients and bringing them to fruition with our patients’ assistance, as we work together for the good of all.

JOINING THE COMMUNITY

In preparing to write this article, I asked most of the physicians I work with what they thought distinguished our work in rural southern Arkansas from that of our colleagues in urban areas. Without hesitation, every one of them responded, “relationships.” It is true that the work of a primary care physician in any setting offers the opportunity to know, deeply, the people they serve. There is a difference, I would offer, in the rural setting. The neighborhood of the urban center is often defined by its demographic. We migrate to areas where people are “like us.” We can go days on end without ever seeing the desperately poor or the overwhelmingly rich. In urban centers, I suspect, there is less trust – and perhaps even distrust – in the safety of areas filled with groups “different from us.” In Camden, I live, work, shop, sup, worship, play with and serve every demographic, every day. I truly find myself at home with the whole array of structure and people that make up the diverse community of Ouachita County. When I do a good job, I feel I have done so for an entire community. When I fail, I feel that I have failed that community. When I can improve access to care, I feel that I have helped an entire Dr. Lawrence Braden (right) poses for a snapshot with his son, Dr. Chad Braden (center), and Dr. Bill Dedman (left) at an event in 2000. 2020 update: Chad is Associate Medical Director at Oschner, where he has served as a family practice physician for nearly 20 years. The Bradens' daughter, Erin Goss, is a family medicine physician serving the El Dorado area. Their son, Eric, is a Simulation Specialist at Arkansas Children's. Dr. Dedman and Dr. Braden still practice together in Camden.

ARKANSAS HOSPITALS | SUMMER 2020 63

community. When I am in any way responsible for a denial of care, I feel I have injured that same community. For when you choose a rural practice, it is always about community. Not only the “community” in which you live, but the community of individuals you have chosen to serve, whose lives are interwoven with yours at every turn.

INNOVATIONS IN CARE

The challenges have been many. When I began my work, the resources for continuous learning were very limited. I kept a file of any interesting articles from many professional journals in my office. They were filed using the indices of textbooks in obstetrics, pediatrics, surgery and internal medicine. I would keep lists of questions that came up, then one day a month trek north to the University of Arkansas for Medical Sciences (UAMS) library in Little Rock seeking answers. I was eventually able to call upon staffers at our nearest UAMS-affiliated Area Health Education Center for assistance. They consented to do literature searches for me. These days, I have medical resources that I call upon via computer while with a patient in the examining room. To be current in my practice, with only a fraction of my original effort, is a reality I relish! Another challenge led to the new oncall system I mentioned earlier. Being on call had been murderous. Bill and I alternated call, during which we could count on 10 to 15 calls from patients every night, along with travel after hours to the hospital for emergencies and for delivering babies. We were exhausted. We sought alternatives and found a work by the University of Colorado that included hiring nurses to take phone calls, after developing protocols for them to ensure they would tell patients what the doctors would have told them. Bill and I felt that our patients would complain, detecting a lack of personal commitment to them. But the Colorado experience suggested otherwise. We nervously launched the idea, and our patients loved it! The advice and comfort given was right on target and deeply appreciated. The long wait for call-backs that was an accepted part of our work was replaced by the promise of response within five minutes by people who were rested and alert. Our care for our patients was better because we 64 SUMMER 2020 | ARKANSAS HOSPITALS

were no longer working to the point of exhaustion. The system was a success. As our practices became more corporate 20 years ago (when large organizations bought up our work), it became more difficult, with rising overhead and more disciplined administrations, to care for those who were uninsured. Under the corporate structure, we were too often forced to turn the uninsured away. That we would be altruistic in medicine is an opportunity but not a mandate. Yet, we remained true to our natures and in 1996 took on this problem in earnest. We sought to build an organization that was supported by our wider community. Therein lay the mandate. The new organization, the Christian Health Center, was built on the expectation that individuals are themselves responsible for the costs of their care. When they cannot afford their care, they should look next to their family, then friends, then churches, and only then, to their wider community. Our role as doctors would be to volunteer our services. The cost to patients began at $8.00 per visit and has grown to $20.00 per visit. Our community has continued its monetary and volunteer support of this work, now in its 18th year. The Center is housed in a renovated bank. It is a beautiful clinic and a star within the county. You may wonder whether demand for the work of the Christian Health Center diminished with the launch of the Affordable Care Act. We chose to remain open, but to add to our mission. Clinical care is now taking a back seat to direct work with our poor, from food to emergency funds to pathways from poverty. Again, our rural setting and the close-knit nature of our relationships with fellow citizens allows us to be flexible in meeting direct needs. A new work has begun. Our county has been at or near the bottom of the “County Health Rankings” for the last several years. We have established a County Health Commission that represents the leadership of the city of Camden and of Ouachita County. The commission is charged with choosing public health problems and defining strategies to combat them. The commission began its work in January of this year. There is a growing excitement

within our community for their work. Perhaps we can again find new ways to truly make a difference.

THE CONTINUING JOURNEY

I have watched the economic and business health of my community decline over the last 33 years. We have seen a changing demographic, with poverty levels reaching alarming levels. This morning at the gym, I heard the town gossip. Our only remaining hardware store is closing. It makes me sad that struggles will continue for our small town on the Ouachita River. Then, through the morning’s work, I visited with a mom and her 3-year-old daughter. The little girl had perfect skin and wore a beautiful black-and-white polka dot, freshly ironed dress. Her hair was tightly platted with white plastic balls surrounding her head and face, making cracking sounds as they bounced, one upon the other. Her eyes were bright, her teeth and smile sparkling, untouched by any coming social pressures and injustice. This mom was obviously both proud and committed. I was filled with joy that was immediately juxtaposed with the realization that these two may be hurt in the years ahead. I love this place and its people. The relationships, the ability to serve others, and the opportunity to innovate, create and work with your fellow citizens on improving the health of your community… these are the precious realities of a rural practice. I am so glad that my wife and I decided to take a chance!

Dr. Lawrence Braden is board certified in Family Medicine and practices at Ouachita Valley Family Clinic in Camden, Arkansas. He graduated from the University of Arkansas for Medical Sciences College of Medicine in 1980 and has been in practice for 39 years. Dr. Braden offers his perspective as a physician practicing in a rural community to show the remarkable opportunities that exist for those who choose such a life. You may reach Dr. Braden at lfbraden@practice-plus.com.

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