As the Oktibbeha County Board of Supervisors mulls options of the potential sale or lease of OCH Regional Medical Center, hundreds of concerned residents spoke out overwhelmingly in favor to keep the hospital a county-owned facility at a public hearing on Tuesday evening.
Around 200 concerned residents, hospital staff and community stakeholders gathered for the forum that gave the board-hired consulting firm, Stroudwater, and OCH administrative staff the chance to explain each entity's stance on the contentious issue and field questions from the board regarding the assessment report.
Each side was given 10 minutes to speak, and OCH CEO Richard Hilton confirmed he will present a detailed, 70-page report by the hospital in response to Stroudwater's assessment which stated the county should issue a request for proposals from outside firms interested in acquiring, leasing or affiliating OCH.
"I think it was really good on the county's part to have the public come and express their thoughts, comments and concerns," Hilton said following the meeting.
Hilton will meet with hospital trustees on Thursday in executive session to add the hospital board's input to the final report, and the document will be publicly released after a draft is finalized.
No action was taken following the public hearing, and supervisors will meet again on Dec. 18. Trustees voted last month to unanimously oppose the sale or lease of OCH. Trustees are appointed by supervisors, and the seven member board represents each supervisor's respective district, with two members appointed at-large. Trustees serve five-year terms.
The vote by hospital trustees follows a resolution signed by nearly 40 physicians, over half of the OCH medical staff, in opposition of the sale or lease of the hospital.
During the board comments section of the hearing, District 1 Supervisor John Montgomery and District 3 Supervisor Marvell Howard spoke favorably of OCH and its role in the community as the county's second largest employer behind Mississippi State University. Howard was extremely critical of the final assessment presented by Stroudwater, and stated he would not support the board spending more money on the process.
"I don't think we've been given the necessary information to make a decision," Howard said. "I didn't see anything in the report to hit the panic button."
District 2 Supervisor Orlando Trainer prompted the entire assessment process last spring after the board met with hospital trustees to navigate the legal requirements ahead of the possible sale or lease of OCH. Trainer gave no extended comments Tuesday, but District 5 Supervisor Joe Williams came out vehemently in support of the county exploring options of the sale or lease of OCH. District 4 Supervisor Bricklee Miller did not speak at-length, but asked multiple questions of Stroudwater and OCH during the hearing.
Williams took exception to what he felt was an "unfair representation" of residents and those present at the meeting—a statement that drew major pushback from those at the open forum. Williams also went as far to make generalizations of those in audience, and said he felt those present were "influenced or affiliated" by or with OCH.
Following his input, those at the public hearing continually disputed his comments. Of the multiple residents that spoke, only two spoke in favor of changing OCH's current status as a county-owned hospital.
At the hearing, multiple residents spoke in favor of retaining OCH to ensure job security for those on staff, while maintaining the hospital's financial stability. Those who spoke also contested the reports unbiased nature, and some of the broad language in the 50-slide report.
"Once you make that decision, it's done. You lose all autonomy over that hospital," said MSU Finance Professor Michael Highfield at the hearing. "We teach that options have value."
Department and physician leaders from OCH also took time to speak. Medical staff leaders including Chief of Surgery Will Carter spoke of the potential dangers of selling OCH, thoughts that were continually echoed by other medical staff members. Carter previously said the current assessment process had hurt physician recruitment.
The report claimed a sale could net $20 to $60 million, but the document's financials were disputed regarding the hospital's misrepresented overall operating revenue and bond obligations. The hospital has $71.5 million in operating expenses, with a debt service ratio sitting at 3.25, according to Vizient Gulf States data.
In 2009, the county did not have enough debt capacity to carry a $27.5 million general obligation bond, Hilton said. Bond attorneys developed a plan to send money to OCH to pay on the existing 2002 revenue bonds to free up revenue to send back to the county to pay on the 2009 agreement.
Since 2009, audits show an incoming transaction of $1.1 million to OCH and an outgoing transaction back to the county worth $1.1 million. The difference is sent to OCH by the county in ad valorem tax revenues as collected. The difference equates to around $98,000 per month, Hilton said. Regardless of a potential sale or lease, OCH would still maintain its general obligation bond requirements through 2025.
Stroudwater stated OCH needed to improve its operating revenue by $3 to $4 million annually to keep up with its current level of services provided to the area. The hospital also needed $1 to $2 million annually in the future for strategic capital for new equipment and related operating needs.
Between 2013 to 2015, OCH's market share in the Golden Triangle area has decreased—to which OCH disputed its zip code analysis data with some areas outside of the hospital's service area being included in the calculated market share.
"OCH lacks the financial scale, clinical scale and operating scale of hospitals that surround you," said Stroudwater principal Doug Johnson in reference to facilities in Columbus and Tupelo.
"There's no way for us to evaluate what the stand alone risk and benefits look like as the organization exists right now as a community-owned facility versus one that may be owned or leased by [a private firm]," added Stroudwater Director Jeff Sommer.
OCH officials took issue with the assessment's emphasis on "out-migration" of patients to other facilities in the hospital's north Mississippi outpatient service area, due to varying services provided at each facility.
In the last five years, OCH's inpatient revenues have increased by over 6 percent, and the hospital's outpatient revenues increased by over 39 percent, according to data presented by Hilton on Tuesday evening. In 2015, OCH staff performed 6,000 surgeries and around 4,000 endoscopy procedures. Emergency room visits have increased from 25,000 in 2011, to 30,000 last year. The hospital's maternity ward helped deliver around 900 infants in 2015, according to hospital data. Recently the facility added a new wound care center for treating outpatient wounds.
"We can make decisions going forward whether we need to tighten up or reduce expenses," Hilton said. "That's within the hospital board's discretion of what they would direct the administration to execute."
Hilton acknowledged admissions at OCH were down, and bed occupancy was declining—something hospitals were experiencing nationally due to previous policy changes. Hilton claimed Stroudwater's assertion that outpatient surgery numbers were on a downward trend was untrue.
"From a zip code analysis, you can't tell why patients are leaving the market," Hilton said. "You can only tell that by getting down to looking at outpatient numbers. [These other facilities] are five to six times the size of OCH. Yes, they have higher volume and higher scale. We don't deny that. But we know, we do not have the population base that will support those specialty services (cardiac surgery and neurosurgery) and there are associated population base requirements to justify those super speciality services."
Hilton presented data defining more closely the information related to patients leaving OCH for outside services, and hospital statistics found 60 percent of those who sought inpatient care at a facility other than OCH did so to access specially care that can only be supported by a larger facility.
OCH was given an "A" rating for its Leapfrog Safety Grade, along with a 3-star Medicare rating. OCH ranked in the top 32 percent of hospitals nationally with an "A" rating from the Leapfrog National Ratings.
Former alderman Frank Davis has led a grassroots campaign to garner signatures needed from registered Oktibbeha County voters to push the decision to sell or lease OCH to a popular vote. Davis said he was nearing the required 1,500 signatures to present the formal position to supervisors. Davis previously led efforts to petition in 2013 following a similar sale or lease scenario. Davis said he hopes to get 2,000 signatures.
In 2013, Capella Healthcare approached a previous board with an offer to discuss a 50-year lease proposal for OCH—but no action was taken.
"We came out of 2013 knowing a little bit about what we could do…We are right now doing the same thing just three years later," Davis said. "We want to be the ones to decide whether or not we keep it or to sell or lease it. We the people of Oktibbeha County, those of us who are registered voters, will look to make that decision."
At the meeting, Ward 1 Alderman Ben Carver, who attended the meeting in self-proclaimed civic capacity, warned supervisors of the potential ramifications of voting to sell OCH.
"Voting to sell this hospital would be political suicide," Carver said.
To view the Stroudwater report, visit oktibbehacountyms.org/?q=node/694.