Ripley County Memorial Hospital will not reopen, board reports

Add Ripley County Memorial Hospital to the growing list of more than 100 rural hospitals across the nation ceasing to exist since 2010.

During a special meeting Friday, the five-member hospital board unanimously agreed to notify state authorities the public hospital in Doniphan, closed since Oct. 15, will be dissolved as expiration of the hospital certificate of need approaches on June 28.

The board has received the maximum two 90-day suspensions of the certificate since late December.

The decision ends a desperate 13-month effort by the hospital board to find a health care provider to replace SoutheastHEALTH of Cape Girardeau.

During that period, the board has pursued all leads and worked with Missouri Department of Health and Senior Services director Dr. Randall Williams and staff to reopen a 24-hour emergency room and in-patient services.

Board president Freddie Leroux polled each board member at the table before agreeing to begin dissolving the hospital as a county entity.

Board members Carol Wilhelmy, David Snyder, Dennis Meyers and Riley March joined Leroux in expressing regret but agreed there were no other options available.

Earlier in the meeting, the board agreed to reject a last-minute proposal from Dr. Bob Jackson of Columbia, Missouri. Jackson was part of a hospital management corporation known as Tornare LLC that approached the board last summer about operating the hospital.

Tornare's original proposal was declined by the board due to financial concerns about the company after it requested the board put up the county-owned hospital as collateral for financing.

Leroux, Wilhelmy and March met with Jackson early last week in Doniphan to hear a second proposal.

Wilhelmy said the board was asked by Jackson to provide $50,000 for another study of hospital costs and revenue.

More questions about the company's financial capabilities were raised by Leroux and March. After further discussion, the board rejected Jackson's proposal.

A feasibility study provided by Missouri Highlands Health Care last fall through a Springfield accounting firm showed the hospital could expect to lose about $500,000 a year. Although with critical access status, which brings additional Medicare and Medicaid funding, that figure could possibly be reduced to around $200,000.

(When announcing Southeast Health's plans to leave Ripley County in April 2018, CEO Ken Bateman told the board SoutheastHEALTH expected to lose $2 million locally in 2018.)

However, obtaining critical access care status for Ripley County Memorial Hospital ran into a roadblock.

Under federal regulations, critical access status cannot be granted to a hospital located less than 35 miles from another with the same status. In this case, the Doniphan hospital is about 5 miles too close to Poplar Bluff Regional Medical Center.

Also attending Friday's special meeting was Karen White, CEO for Missouri Highlands Health Care (MHHC.)

Earlier this year, White contacted the Centers For Medicare and Medicaid Services requesting a waiver of the 35-mile rule.

On April 12, the waiver request was denied by CMS chief medical officer Kate Goodrich.

White said she is hopeful a solution will be found at the federal level to balance the reimbursements paid to rural hospitals compared to what urban hospitals receive.

"They seem to think it costs a lot less (to provide health care) in rural areas than urban. When in fact that's not true," she said.

"A lot of senators and representatives are working on our behalf but change is slow in coming," White said. "I think they will find a solution, but it's too late for Doniphan and several other providers in our area. We hear every week about another rural hospital closing ,and it's at a crisis. CMS has to realize significant changes need to be made."

Missouri Highlands began operating the Doniphan Family Clinic in December following the departure of SoutheastHEALTH.

Last June, MHHC was one of two health care providers to submit a letter of intent to SoutheastHEALTH to take over local operations after SoutheastHEALTH made it known it was leaving the county.

MHHC's proposal involved assuming operation of the Doniphan Family Clinic, possibly setting up an Urgent Care type facility and working with any potential provider in operating the emergency room and hospital.

After Friday's meeting, White said MHHC is ready to begin work on the proposed Urgent Care facility to be operated in the former hospital building. Missouri Highlands will lease the property from the county.

"We would really like to be up and running within 3-6 months," White said.

White said MHHC also has applied for a $300,000 grant to assist with bringing a dental clinic to the former hospital. Currently there are no dental services in the county.

White said plans are to keep an Urgent Care facility open seven days a week 'but it has to be feasible and sustainable.'

White said MHHC is aware that services provided since it took over the clinic are below Ripley County's needs.

"The clinic is having to be the only provider for a community and county used to having a hospital, emergency room and a couple of clinics," she said.

MHHC is attempting to recruit a doctor for the clinic and find more solutions to improve services locally.

"We're not going to have what we had before, but we're going to have better than we have now," said presiding commissioner Jesse Roy, who also attended the special meeting.

A final topic of discussion for the board was the one-cent sales tax still being collected for hospital operation. Eliminating it may be a long procedure. Special legislation was required to be passed in 2009 in Jefferson City specifically to allow the sales tax to be placed on the ballot in Ripley County. It also is specific in how the tax may be repealed, possibly requiring a ballot proposal for voter approval.

With no elections upcoming in 2019, a ballot issue wouldn't be possible until April 2020.

Acting on advice from attorneys, the board agreed to send a letter to the Missouri Department of Revenue requesting the tax be repealed. Meanwhile, the sales tax money will be kept in a trust fund until the issue can be resolved.

One problem that had plagued the hospital for many years was resolved during Southeast Health's eight-year stay.

Leroux said that when Southeast Health first began operating the hospital in 2010, the hospital was $3 million in debt. With help from Southeast Health and through lease payments, the hospital is now debt-free as work begins to dissolve it as a county entity.