← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Shelby Brown, Chief Administrative Officer of Southwest Arkansas Regional Medical Center
00:20:00
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- [00:02]
A
@ Athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom Practicing medicine is complex, but running a practice can be that much simpler. With Athenahealth, see how simpler is healthier at athenahealth.com.
- [00:44]
B
This is Madeline Ashley with the Becker's Healthcare Podcast and I'm excited to be joined today by Shelby Brown, Chief Administrative Officer of Southwest Arkansas Regional Medical center in Hope. Shelby, thanks so much for joining me today.
- [00:58]
C
Oh, thank you for the invitation. I always look for opportunities to share information about rural healthcare.
- [01:04]
B
Wonderful. I'm so excited to dive into our very important discussion today. But before we do so, do you mind sharing just a little bit about yourself, your background, and more about Southwest Arkansas Regional with our listeners?
- [01:17]
C
Sure. I have been in healthcare for 35 years actually am in the southwest corner of Arkansas, worked for a larger hospital in Texarkana. Both of these hospitals that I've been associated with in the last 35 years were part of the Steward Health Group and so I'm sure everyone remembers that as it is still probably going on. But they filed bankruptcy back in May of 2024. But at any rate I have gone from marketing to business development to running a foundation, being over volunteers, doing government relations, then to the suite, the C suite and I have learned a lot. I think healthcare is one of those things, it gets in your blood and I can't see myself doing anything any differently.
- [02:15]
B
Wonderful. I really appreciate you sharing that background there. And just for like a little bit more on Southwest Arkansas Regional, I want to make sure I have this correct. So please again correct me if anything sounds inaccurate to you, but as you mentioned, it was purchased by Pafford Health Systems I believe in early September of 2024 for about $200,000 from Steward Healthcare. Like you mentioned, could you share just a little bit more about the hospital itself?
- [02:47]
C
So the hospital in Hope, Arkansas is the only hospital in Hempstead County. It is the county seat and started in the 50s as a county hospital. Again, regretfully this is the second bankruptcy that it has gone through. It's had a couple of owners that really didn't do right by this community, but the workforce Here in southwest Arkansas is phenomenal because they have really given their heart and soul to make sure that this hospital stays open and pampered. Health system never. They are in national organization. That's what they do and that's what they love. But this is their home office in Hope, Arkansas, and they did not want to see this hospital close for the community, so that's why they stepped in. It has not been an easy road, and I know we'll get a little bit more into those details, but this community is very fortunate to have an organization and a family that had the passion and the means to help save this hospital.
- [03:59]
B
Yeah, no, to your point. That is great to hear. Just the passion around keeping it afloat for the community. Back in late September, you and I connected and we covered here at Becker's that the hospital was Planning to request 3 million from the state to kind of help provide some financial support, stabilize its operations, and essentially keep it open. And you also had mentioned that the hospital received approval in mid September from CMS to transition to a critical access hospital. All of this in mind, can you share some updates just on how things are going at the hospital just before we dive a little bit deeper into our discussion today?
- [04:36]
C
Sure. Actually, the Packards took over at midnight on September 19. The request for critical access hospital designation did not happen until February. That's when the first it was requested through cms.
- [04:51]
B
Okay.
- [04:52]
C
Because originally they thought about making this hospital an rh, which is a rural emergency hospital. Right after thought and you know, really digging into it, number one, the volume was higher than most. Number two, being the only hospital serving four counties really felt like that the, the way to go was to be a critical access hospital with a reh. You lose your inpatient services. And we do feel very driven that we needed to continue to serve our community and if they needed to be put in the hospital, that there would be a local hospital to. To do that.
- [05:37]
B
Right.
- [05:37]
C
So February, the we requested designation as a critical access hospital. We did finally receive it in August, and I guess we're notified actually in September. But they backdated it until August 9, which is when we had our successful survey.
- [05:57]
B
Wonderful. So now you are a critical access hospital. Officially.
- [06:00]
C
We are officially as of about three weeks ago, we are still waiting for our interim rate that has to be handed down from ems.
- [06:10]
B
Yeah. So it's been obviously, as you mentioned, like a long road to go to this hospital. Lots of ups and downs. But of course the goal is to keep it, you know, open to the public. So, you know, could you share with me? Obviously, as we kind of touched on at the beginning of this podcast, rural hospitals across the country are facing significant financial pressures. Many are closing or cutting services. So from your perspective, what do you feel is the largest financial challenge many rural facilities are facing, similar to southwest Arkansas regional? And how does state funding factor into survival? What just what are your thoughts here?
- [06:44]
C
Well, I want to say that you hit it on the head. Rural healthcare in America is in a crisis mode. And for many of us, I'll throw ourselves into it. You know, that time is a factor and we're running out of time. It has to be addressed and we are not sitting still. We are going after funding in different areas. Part of our strategic plan was to be critical access. So we've taken that step. Our next step is to put in skilled nursing beds. So we have recently accepted skilled nursing patients, or they're called swing beds, meaning they go from an acute care bed, then you can swing a patient over into a skilled bed, which is another revenue stream for rural hospitals. We are now waiting for our survey because yet again, they have to come in and survey you to give you that approval. So that's part of our strategic plan as well. But I think every rural hospital, it comes down to reimbursement.
- [07:53]
B
Yeah.
- [07:53]
C
And in, in the state of Arkansas, I can just tell you that our Medicare reimbursement is probably the lowest in the United States. And I know we have brought that up, not just us, but across the state are Arkansas Hospital association talking to our elected officials that that needs to be changed. And nothing has changed thus far. But I will say as a critical access, it won't be as impactive because now as a critical access hospital, you get paid the cost plus 1%.
- [08:33]
B
Right.
- [08:34]
C
And. But that's only for traditional Medicare, your Medicare Advantage, which is another struggle for most hospitals. Medicare Advantage plans, I'm not sure, you know, if the listeners know a whole lot about it, but that is offered by private insurance companies. Okay. So they negotiate their own rates. Right. If you're a traditional Medicare patient, then it is paid by the federal government and you pretty much know what you're going to get if you're a PPS hospital because they're paid on DRGs, means set fees. But for the state of Arkansas, those set fees are lower than other places in the United States. Wow.
- [09:18]
B
I appreciate you breaking that down for our listeners. And you know, we touched on it. There's a few more, like you said, a few more little loopholes just in terms of really becoming that Critical access hospital. Everything's in the works. You just have a few more things to do. How do you see this designation changing your ability to sustain operations, continue serving your community? How important is this for you? You have touched on it a little bit, but just to dive a little deeper.
- [09:43]
C
Yeah, I think it's important because it helps us with getting at least back from those traditional Medicare patients what it cost us to provide that care. Then I'll say misnomer or the misconception sometimes can be, okay, well, your critical access things are going to be a lot better. But that still comes over time. So at least six months. You know, we have got to prove ourselves saying this is what our costs are. We have to. We can ask for a renegotiated or to look at our rate and see if they would raise it because it's costing us more to take care of those patients. And the cost in patient care depends on how sick that patient is.
- [10:30]
B
Right.
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C
And more than half the people in the state of Arkansas live in rural communities.
- [10:34]
B
Right.
- [10:35]
C
Typically, they don't seek care, you know, at the drop of a hat. I mean, sometimes in larger cities it's very accessible. You can run over here, run to a clinic. That's not how it is in small towns in Arkansas. And so typically we see sicker patients when they get to the emergency room. They really need us. But that increase, once we can get that, that rate from cms, that we have proven this is what it costs us to take care of Medicare patients, that will be helpful. So that's part of a strategic plan of any rural hospital. It just doesn't happen overnight. So this is our first step in our strategic plan. And again, with skilled nursing beds, because as a rural hospital or a critical access hospital, you can only keep patients in beds in an acute bed for an average of 96 hours.
- [11:32]
B
Okay.
- [11:32]
C
So that's an average. So you bring your mom in and she stays for 24 hours. I bring my dad in and he, he stayed for five days. It's still an average. So you're okay. You know, you give and take. Being a critical access hospital. If we feel like someone comes to our emergency room having an acute stroke, an acute heart attack, we will stabilize them. That's what a rural hospital is supposed to do. And then we are going to transfer them to a higher level of care. But our job is to save that life and to get them stable and to do those early interventions and then get them to a hospital that has the specialist is in a cardiologist or a neurosurgeon or neurologist. Now we do participate in Arkansas has our saves, which is a stroke program. So we do telemedicine with University of Arkansas for Medical Science in Little Rock. We get someone in, we do a CAT scan. They're able to look at the scan, tell us, okay, it's not a bleed. So you go ahead and give that thrombolytic or that clot busting drug because you've got to a window where you can give that. If you're outside of the window, you can't give it. And so you may not die of a stroke, but if you don't get that early intervention, you could have debilitating, you know, effects from the stroke, meaning you may not talk or you may not be able to walk. So early interventions for stroke and heart attacks are extremely important. And we have a 24, 7 emergency room and that's our job to do. And without those, people are on the road traveling for long hours to get somewhere, to get emergency care. I'm very proud of what we do here.
- [13:27]
B
No, and you can hear the passion in your voice, which is so great. And truthfully, it sums up the next question I was going to ask you. Because when we talk about closures, it is easy to focus on dollars and regulations, but what's truly at stake is, is the patient care if a hospital closes and just the community's care that they receive. Anything else you'd like to add just to that point?
- [13:48]
C
Well, I mean, you have to look at the economic decline of the region because you can look at any community, any county that loses their hospital. We served Nevada county, who lost their hospital in the 80s, I believe, and Lafayette county, which lost their hospital, I think it was probably in the 70s. But their population has declined over the years. And a spot selector that's coming in to put manufacturing, you know, they, one of the top two things they look at is your schools. Do you have a good workforce and do you have health care? You know, they're also going to ask about transportation, whether you have airport or Railroad or I30. I, I say I30 because we sit on Interstate 30.
- [14:38]
B
Okay.
- [14:39]
C
But it's important for the vitality of this area to keep a hospital for these large manufacturers. We have a Tyson Chicken plant, we have a large steel industry here. And well, it used to be Firestone, but a tire manufacturer. And it's important for the existing businesses to also have in case there's an accident at their place of employment.
- [15:10]
B
Right. It's all connected. It all plays, you know, it all.
- [15:14]
C
Is so for growth is important, but it's also for your existing employers.
- [15:21]
B
Yeah, and we could talk about this, this the topic of rural health care and just the importance around it all day. But, but to wrap us up, you know, as you mentioned, Arkansas is, is not alone in facing rural healthcare crisis. So could you share some lessons or strategies that you think other rural hospitals across the US might draw from your experience or any just lessons learned just in terms of keeping essential services available.
- [15:49]
C
I think it's important not to do what you've always done and that's hard for some people to get out of that mindset. You have to make hard decisions. You need to right size what you're offering. You can't be everything to everyone. So if you want to concentrate on having a skilled emergency room and inpatients as you need it, I mean we used to deliver babies, we used to have surgery. At this point in time, that's not something we can offer. And so we want to be good at what we do and we know that we can't do everything. And so. Right. Sizing your operation is important. You always have to look at your staffing model to make sure that you're efficient in what you do. You never want to compromise quality. But again, sometimes you have to think outside the box and make sure that you're being efficient with your monies that you have. When I go and ask the state for money, and we did ask for $3 million, but I feel like it's incumbent on us to make sure that they know that we're not just sitting back looking for a handout. We are making necessary changes to be sustainable. But we need help and we need attention as all small rural hospitals do. But I know we need to be accountable and everybody else should be accountable.
- [17:09]
B
So just before, just to close us off, could you just give us your hope for the hospital right now? Moving forward, just any forward thinking thoughts?
- [17:19]
C
We are actually trying to work and collaborate with about six other small rural hospitals in southwest Arkansas and early in our discussions. But how do we share services? Like I'll give an example, another hospital about 45 minutes from us wants to do the skilled nursing beds as well. You're required to have occupational therapy and speech therapy. Neither one of us can afford to hire them full time, so can we share that position and they travel between our hospitals. And I think it's important that we find ways to work together again to make all of us more efficient. And so shared services I think are important and I think it's important that we continue to. To communicate with our elected officials to not forget about rural health care.
- [18:09]
B
Yeah. And you're still continuing to push for that 3 million, right?
- [18:12]
C
Oh, yeah. Y.
- [18:14]
B
So it's not been provided just yet?
- [18:16]
C
Yes. It has not come through. We have written several grants.
- [18:21]
B
Yeah.
- [18:22]
C
And that will continue to look for other revenue sources. We, our city and county are great. They are supporting us and, and supporting us financially. So that's good. Not every community has that either.
- [18:37]
B
Right. A strong community is always important. Shelby, again, it's so great to hear the passion in your voice and support that you have for real health care just in general at your hospital, and just the topic overall, such an important one. So I truly thank you for coming on the podcast and connecting with me, and I'm so excited to connect with you again down the line to hear how well the hospital's doing. All right.
- [18:59]
C
Thank you so much for the invitation. Thank you, Shelby.
- [19:05]
A
At athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams, and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions. Reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom lines. Practicing medicine is complex, but running a practice can be that much simpler with athenahealth. See how simpler is healthier at athenahealth. Do.
- [19:51]
B
Sam.