Good news in healthcare can be hard to come by in Mississippi, which for years has ranked at or near the bottom among all states in most public health indicators.
In one recent survey measuring the health of residents in all 50 states, Mississippi again ranked dead last-at or near the bottom in 10 of 17 indicators ranging from the prevalence of smoking to the risk of heart disease. It was the nation's most medically underserved state and the third-poorest overall, with nearly 17% of the population living in poverty, according to the U.S. Census Bureau.
Against this grim backdrop, a sharp contrast is emerging in the town of Tupelo, birthplace of Elvis Presley and home to North Mississippi Health Services. The sprawling system is pumping nearly $40 million into a series of new capital-improvement projects in and around the northeast corner of the state.
The bulk of the recent bond issue-part of a five-year capital plan calling for about $160 million in construction and equipment purchases-will finance expansion and renovation of the system's 650-bed flagship North Mississippi Medical Center. Reflecting the system's strong financial performance in recent years, the bonds have been rated AA- by Fitch.
Jeffrey Barber, the system's president and chief executive officer, said North Mississippi is continuing to build on its classic hub-and-spoke feeder system to combat the perennially poor overall health of the residents it serves. With North Mississippi Medical Center at its core, the system includes 42 clinics and five other hospitals over a vast area that stretches across 19 counties in Mississippi and three others in Alabama.
Barber freely acknowledges that NMHS continues to face a tough challenge providing medical services to a "population of people who are prone to high blood pressure and diabetes and . . . generally poor health habits."
"As far as states go, we're usually ranked right at the bottom-49th or 50th," he said. "It has a lot to do with heart-disease rates, low high school graduation rates, high infant mortality and premature death."
With a focus on primary care through its extensive network of clinics, Barber said, the health system "has chosen to attack the problems head-on" with preventive-care programs aimed at heart disease, substance abuse and other major public health concerns. He said the system is also using its network to improve access to nutritional information, among many other such programs.
"We're providing more access," Barber said, "and ending up with a healthier community. But it's a tall order."
The good news, in Barber's view, is that northeast Mississippi is better off than other sections of the state, with lower unemployment and a slightly higher per-capita income. Tupelo (population 35,100), once one of Mississippi's poorest areas, is now a well-established regional manufacturing and retail center with several innovative economic development programs in place. Last year, the National Civic League named it an "All-American City."
The system's flagship hospital is the largest in the state-and the biggest nonmetropolitan hospital in America. Covering an area with about 650,000 residents, North Mississippi ranks as the nation's third-largest rural healthcare system in America, local officials said, based on a recent American Hospital Association study that charted the number of hospitals, clinics, beds and other facilities.
The private not-for-profit healthcare system drew praise in the Fitch report for posting strong operating margins despite the impact of the Balanced Budget Act of 1997. One key to the system's success: All of the hospitals are sole providers, and every clinic feeds patients into the hospitals.
From 1998 to 2000, the report said, the system has posted an average operating margin of 6.1%. In 1999, the median operating profit margin for Fitch's portfolio of 180 hospitals was 1%, said analyst Craig Kornett.
"They've been extraordinarily profitable," Kornett said.
On the negative side, according to Fitch, North Mississippi has a high Medicaid load and a heavy bad-debt expense because of its role as the only tertiary-care medical center within a 60-mile radius. Still, the system posted its impressive operating profits despite writing off $19.5 million in charity care for 2,000 patients in fiscal 2000.
Operating returns notwithstanding, Barber said, the system must cope with the state's largely negative national image. That perception developed during the civil-rights protests of the 1960s and has been reinforced through the years by the bad news contained in surveys such as the annual ReliaStar State Health Rankings, which placed Mississippi 50th in 1998.
What's more, Barber said, Mississippi has only about half the national average of 280 physicians per 100,000 population, according to American Medical Association data. And a study conducted by the University of Mississippi found that 14% of the primary-care physicians in northern Mississippi plan to retire in the next few years, a trend that complicates Barber's job in recruitment.
"We're the birthplace of the King-but that's not enough," Barber said jokingly. "We have to get physicians over the preconceived ideas of what Mississippi is all about. We have to get them down here to the facilities, and the hard sell becomes an easy sell."