Memorial Healthcare, a 161-bed rural hospital in Owosso, Mich., faced a critical decision several years ago.
The Affordable Care Act was kicking in and other small hospitals were being advised to join larger health systems for survival.
The board of trustees of not-for-profit Memorial was warned by its former CEO and a consultant that its future was either to financially struggle and potentially face bankruptcy, or link up with one of a number of larger health systems in Michigan vying for the hospital's acquisition or affiliation.
CEO Brian Long, who was brought in as CFO in 2011 and became CEO in early 2013, said Memorial and its board, which heatedly debated the issue for nearly five years, eventually chose door No. 3: Stay independent and expand its reach beyond Shiawassee County in central Michigan with its population of 68,000 to neighboring counties of Saginaw, Clinton, Bay Ingham and Genesee.
Besides covering more territory, the evolving plan, described by board Chair Greg Bontrager and vice chair Tony Young, was that Memorial should also hire more staff doctors, recruit other specialists, add satellite clinic offices and focus on improving quality of care across its 34 specialties and service lines.
But the key component of the survival strategy — and now a major area of investment — was to focus heavily on neurology as a profitable clinical area and integrate neurologic specialties with orthopedics and an expanded community wellness program. Long said the three service lines complement each other for patient benefits and improved outcomes.
"What we chose to do was to pick a service line or two that we could be world-class in and provide services not only to our community" but to a larger market that could attract patients from hundreds of miles away, Long said.
"Not every hospital can be excellent in everything," he said. "Even the larger organizations, like the Cleveland Clinic, they've got comprehensive services but they're known for heart. ... Memorial Hermann Cancer Center in Texas, a very large facility, they're known for cancer."
Young, who is president of Young Chevrolet Cadillac in Owosso, said when he joined the board in 2013 the debate to sell or affiliate with a larger health system had split the board with several resigning. He favored the hospital remaining independent, building up existing services, improving quality and patient and employee satisfaction.
"I started pushing the (question), what would the community gain from a merger?" Young said. "The hospital was losing a little money, but had money in the bank."
Bontrager, the former president and COO of the American Cancer Society, joined the board in 2015 when members were still considering offers to sell. One was an equity sale of Memorial to a partnership between the University of Michigan and Sparrow Health System. He said all major health systems offered to buy or affiliate, including McLaren Health Care and Ascension Health.
"(Sale) didn't make sense to us business leaders on the board," Bontrager said. "Every community tal is challenged financially. Our balance sheet was strong. Some of the offers were for less money that we had in the bank. Under Brian's leadership, we thought we could make a profit on our core business and also build up two or three clinical services."
Besides building up neurology and orthopedics, Long said over a 10-year period Memorial increased the number of its employed doctors to 80 from about 18 in a range of primary care and specialties, including internal medicine, pediatrics, obstetrics and gynecology, general surgery, gastroenterology and endocrinology.
Memorial, with its 1,200 employees and 200 physicians on its medical staff, also expanded outward into at least 25 satellite clinics that includes nearby Chesaning, Durand, Perry, Laingsburg, Ovid, Elsie, Corunna and Auburn. "We needed to expand our market" share to increase patient volume and revenue, Long said.
But Young said the board knew patients wouldn't come or tell their friends about their experiences if quality wasn't as good or better than the larger hospitals, so at every meeting trustees asked questions how the quality improvement program was going.
"The quality of services that we offer, based on all those indicators, have seen significant increases from prior years" in all areas, Long said. "We are focused on providing the very best care that we can to the community that we're charged to serve."
As a result, Memorial scored a B grade this year in The Leapfrog Group patient safety scores, three stars (of five) in patient satisfaction as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems, and three stars (of five) in the Medicare Hospital Compare quality ratings. It also rates above average in employee satisfaction, and care of patients for sepsis care, colonoscopy and preventive measures, Medicare data shows.