Thursday, April 2, 2020
To My Constituents,
By now most of you have heard that our local hospital, Decatur County General, will be closing its doors at the end of business on April 14th. This could not come at a worse time for the people of our county, yet we have no choice at this point.
I’m sure that many of you have kept up with the continuing saga of the facility and know the underlying situation, but for those that have not here is a comprehensive look at this situation: (forgive me for the length, but it is necessary to fully understand the situation).
The hospital has been in a financial downfall for more than a two decades, however it was not widely known until it became a critical issue. Since that time several valid attempts were made to correct the problems and bring the facility into a profitable status. In fact, it is my understanding that the hospital was within $600,000 of being able to break even when politics took over and made bad decisions that only worsened the financial stability year after year.
Several factors led to the crisis. The three most important were: 1) the lack of practicing doctors, 2) the failing insurance system, and 3) the rigid mandates and policies dictated from federal and state government.
The business model of the traditional community hospital has become obsolete. Doctors no longer come back to their hometowns to practice. The necessary malpractice insurance is so expensive (thanks to an out-of-control legal system), that doctors must generate significant amounts of income to simply stay in business.
Insurance reimbursements have become so complicated that it is often impossible to predict revenues. Small hospitals submit claims and hold their breath until they see what costs will actually be paid. Larger hospitals operate on such massive volumes that each individual claim does not have the same impact. The many issues with insurance reimbursements have created a system that is ripe for corruption; every level seems to have opportunity for exploitation. Loopholes and clouded reimbursement policy have led to an influx of scams that have left small hospitals destitute. Decatur County General has seen this firsthand.
Our small community hospital is expected to adhere to every regulation that is expected from larger facilities such as Vanderbilt or Baptist hospitals. (For example: we must have a certain number of employees on hand at any given time, whether we have 10 patients or none; we are required to maintain certain technologies locally rather than be able to transfer those cases to larger facilities.) Because there has been no major effort in government to differentiate these regulations, the cost of operations is unproportionate to revenues for small hospitals. Meeting regulations may cost us 50-70% of our revenues, while it only costs a large facility 10-20%.
The common denominator in all three of these factors is money. We do not have enough money to operate our hospital. A MINIMUM cost for operations at Decatur County General is just over $300,000 per month. PER MONTH.
The revenue from the additional wheel tax generated approximately $600,000 per year. When the wheel tax was instituted, the $600,000 could address shortfalls. However, that was only 1 part of a comprehensive plan that never saw fruition. Rather than continue with a plan to become part of a larger system, the Commission at that time chose a cheaper – but unproven - alternative.
It is difficult to fully understand the mechanisms of economic planning. This commissioner certainly does not as it is not my area of expertise. However, success is gained by understanding that you cannot know everything, and you must seek guidance from those who know the particular pieces with which you are dealing. This is where we as a County have failed. We have refused to listen to expert advice and made decisions based on our limited understandings.
The most critical point of our failures is that we continue with this same mindset. We look for the easiest, cheapest way out; never realizing that its cheap price is due to its inability to be successful. We have gone down this road 4 times and it has only increased our debt from $600,000 to $6 Million.
This is unacceptable and must be addressed.
The collapse of our hospital can only be attributed to one group of people – us, the citizens of this county. We were not paying attention and allowed bad decisions to be made without any uprising from the public. We have failed to demand accountability from those in leadership positions; and we have failed to recognize our responsibilities of civic duty – our service to our community.
We have not stood up and been a participant in our city and county governance; leaving these positions to be filled with folks who have not had significant business and financial experience. However, you must applaud those people who have tried to make a difference and volunteered to run for offices; it is indeed a thankless job. We cannot simply point fingers at those who have made mistakes, when we have not been willing to stand in their shoes.
A perfect example of this scenario is the story of the talents in the Bible: God expected more from those to whom more was given. That story is applicable to us in our modern age as well. Those who have skills must – for the sake of the financial future of their own community – MUST stand up and lead at some point in their lives. We are each a part of the community and do not live in isolation. No matter how far out in the county you may reside, you rely on services provided by the collective of the people – the county (or city, or town) to which you belong.
Our county is at a critical point. Not only is our hospital unable to continue, our county operations, in general, will be right behind if we do not act now.
The hospital closure is not the end of healthcare in our county. While the public hospital is incapable of continuing operations, its closure allows for private companies to open facilities. Decatur County General’s continued operations has been an obstruction for any other private group to act. This may seem irrational, but it is based in financial analysis and government regulation.
While there is movement on the state level to rethink the hospital and emergency healthcare regulations, Tennessee has not yet changed its laws. A hospital can only open in an area based on population and distance to the next emergency facility. (This is another reason why our census is so important.) If we were any closer to Lexington, Camden or Savannah, we could not legally operate a hospital. (I believe the limit is 30 miles, so our proximity to Lexington is already a sticky issue. We have been lucky that DCGH was chartered prior to these regulations).
Additionally, a corporation looks at its potential profitability in any area before it decides to invest in opening in that area. With DCGH open, the potential profitability was too small for any larger hospital group to even consider investing in our county. The closure will now open this opportunity.
It is also important to note that large reputable hospital companies do not want to invest in or purchase our old, outdated facility. The cost of refurbishing the current facility is not worth the investment when building a newer facility would be better use of their funds. Plus, these large companies (especially those that are publicly traded) must maintain a specific identity – a brand. When a patient enters one of their facilities, it must look and function to enhance their brand (thus their stock value).
We may be without a hospital for a time while other opportunities are being sought, but this closure is not the end of healthcare for our area. We likely will need to invest more in our EMT services to pick up the burden of additional emergency transports.
The timing of this disaster at the same time as the worst medical pandemic in more than 100 years is simply unimaginable; but we have no option but to deal with it. I encourage you to call your Commissioners and the Mayor to relay your opinion.
What Decatur County needs now is attention from our public. We need you take an interest in your governance and demand answers. With the damning report from the investigators of the Comptroller’s office, (click here) we need to make changes. Please read the report from the Comptroller. Only with your input, can we – as your elected officials – know what you want and expect for the future of Decatur County.
April Watkins Barrett
County offices are closed to public. Please call the office if you need assistance.
All courts are closed until further notice.
Decatur Co. Schools will be closed through the month of April.
All City Parks are closed until further notice.
Check Facebook for closures of Church Services, City Offices, Parks and other facilities.
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