PINEVILLE, Ky. — Stace Holland started hunting for ways to slash unnecessary costs the minute he took over an endangered rural hospital that was losing $6 million a year. It didn't take long for him to find plenty.
He persuaded the dietary contractor to reduce fees by $15,000 a month. He switched emergency medicine contractors to save $200,000 a year. And he persuaded some full-time employees to drop to 32 hours a week, yielding cost savings equal to cutting 15 FTEs.
Now, eight months after taking over as CEO of the 120-bed Pineville Community Hospital in an economically depressed town of about 1,800 in scenic southeastern Kentucky, Holland is well on the way to turning around a struggling not-for-profit facility that still expects to lose $3 million this year. With support from the Plano, Texas-based Community Hospital Corp., which took over management of the hospital in 2014, Holland already has made significant progress toward stabilizing its finances.
“I was afraid we would just have to lay people off, and how would that help the economy of this city if people can't buy groceries?” Holland said. “But we have satisfied the needs of the hospital without hurting anyone.”
Holland faced a challenge that is all too familiar to rural hospital leaders around the country: declining patient volumes; a preponderance of low-paying Medicare, Medicaid and uninsured patients; public and private rate squeezes; high incidence of chronic disease and drug abuse; difficulty in recruiting physicians; and a shortage of funds to invest in new equipment and services. Kentucky's successful expansion of Medicaid and private insurance under the Affordable Care Act eased those financial pressures, but didn't eliminate them.
To save the hospital, whose previous CEO served nearly 40 years, Holland, Chief Nursing Officer Dinah Jarvis, and CHC knew they had to take tough steps that would unsettle physicians, staffers and local residents accustomed to the old comfortable ways. They trimmed costs, established a partnership with a larger hospital to offer new services, implemented clinical protocols to improve quality of care and reduce readmissions, and obtained a federal rural health facility license that significantly boosted Medicare and Medicaid payments.
Holland never expected to land in this poor Appalachian community. Early last year, the veteran rural hospital administrator heard Community Hospital Corp. CEO Mike Williams speak about his not-for-profit organization's mission to preserve access to healthcare in rural America. Impressed, Holland told Williams he wanted to work for his company, which advises and manages rural hospitals.
A gregarious man with shrewd eyes who retains his native Oklahoma twang, Holland inherited a staff of 338 he calls dedicated but often stuck in outdated practices. To encourage open communication, he launched a daily all-staff CEO briefing at 8 a.m. to share news, tamp down gossip and cheerlead for change. “What motivates me,” he said, “is when people want to learn new ways and say, 'Let's make more changes today.' ”
With a willingness to make tough changes, many but not all rural hospitals can survive to continue serving their communities, said CHC's Williams, whose organization offers strategic assessments, consulting and management services to rural facilities. CHC advises some facilities they can achieve financial solvency through fine-tuning operations. For others, it may recommend shifting to an urgent-care and outpatient model.
CHC often urges collaborations with larger systems. But Williams and his team sometimes have to deliver the bad news that there's no alternative to closing a hospital.