Ozarks Community Hospital in Gravette is hosting a town hall meeting tomorrow morning to welcome new emergency room physicians. The 11 a.m. meeting will feature complimentary food and refreshments and a chance to meet with Dr. Andy Wilson, the president of ACPHealth. I spoke with Wilson yesterday over Zoom. He says this is a great opportunity to learn about some changes at the hospital.
Wilson: And we don’t mean just some new paint or new flooring, but some really transformational changes that the hospital’s decided to make to ensure that every patient in Gravette when they need emergency care are seen by a Level I trauma center-trained ER physician every single time.
Which is, after Nov. 1, when it all starts, they will be one of the only rural hospitals in the entire state of Arkansas that has that. And in fact, probably the only one. I don’t have exact numbers, but it’s pretty impressive what the hospital leadership’s decided to do for their community.
Moore: When we think of hospitals in Northwest Arkansas, a few big ones come to mind. We think of Washington Regional in Fayetteville, Mercy in Rogers, Freeman Health in Bentonville. What sets apart a rural hospital like in Gravette compared to one of the bigger three hospitals in the region?
Wilson: Yeah, it’s a good question. And one that is sometimes difficult to understand. But if you think about a big Level I trauma center, they have hundreds of beds in their ER, they have hundreds and hundreds of inpatient beds and they have a lot of different services and specialties that they can provide for the whole state really. And large regions of the state.
So the difference in rural ER is it’s smaller, there’s less space, less beds. But an interesting distinction that a lot of folks may not understand is if you went to, because I trained in a Level I trauma center, I’ve worked in three Level I trauma centers, worked in Level II trauma centers, Level III and Level IV trauma centers. So we’ve covered the gamut.
But what was interesting that I learned through my career is if the hospital is willing to put the right resources in place, and even a small Level IV trauma center, which most rural hospitals are under that qualification or that status, it’s really like going to that big Level I trauma center and some of the large centers that you talked about, and just taking a big old chainsaw, cutting off the ER from that Level I trauma center and moving that ER with inpatient beds, some inpatient beds to that rural community.
So in fact, in any given encounter, it might even be better in some cases because whereas at the Level I trauma center where I trained in Temple, Texas, you might not get seen by a board-certified ER doctor every time you come in. You get seen by whoever’s available. Maybe it’s a really great physician’s assistant, but it’s not that trained physician. Maybe it’s an intern that’s learning how to practice medicine with some oversight.
But in Gravette, you get the actual attending physician, you get the person who’s teaching the residents in the Level I trauma centers every single time after Nov. 1. So it’s pretty exciting.
But obviously we need the large centers. They’re not the exact same as the rural centers, but there’s nothing that I could do fully within just the ER of a Level I trauma center that we can’t do right there in Gravette. So being able to stabilize people, heart attacks, strokes, significant trauma, being able to do what we need to do to take care of them. In many cases, we’ll be able to keep them right there. But in some cases we’ll have to transfer.
But the community members and their loved ones in Gravette will just know that, hey, if we want to see the best doctors, we don’t have to drive an hour away. They’re right here anyway. So it’s the same doctors in both places.
Moore: So what’s recruitment look like at a rural hospital?
Wilson: Just in general? It’s harder. Yeah. It’s harder for rural hospitals, as you know, any rural hospital that. I saw a LinkedIn article recently that said being a rural hospital CEO is the hardest job in health care. And I think that’s absolutely true. It’s tough.
And Gravette specifically, the recruiting is complete for the doctors. They’re all there. The schedule is made out well into 2027. Every hour of every day is covered. We have really outstanding physicians, which I hope the community will come out and get to meet some of them and virtually meet some of the other ones.
But it’s generally, it’s tough to get folks to see that type of environment as somewhere that maybe they want to go work. But what we have seen is when you build the program, like the leadership at Gravette has decided to do, it sort of is a self-replicating, self-feeding recruitment pathway because people want to work in a place where they can provide really exceptional care to patients.
That’s why they went into health care in the first place, and they want to be in a place that has a shared mission and shared values and practices standards of care, even above standards of care, to care for the community, for the folks that entrust them with that care. So we see that as something that is going to be much easier at Gravette as opposed to just your normal rural hospital.
Moore: When we think about a hospital as a business, a thing that has to make money, volume certainly helps in these situations. And when we look at a rural hospital with the climate of health care costs, where they are with reimbursements, where they are with insurance and public insurance being where it is, how sustainable is it to run a rural hospital like in Gravette?
Wilson: So rural hospitals fall into, at this point, really three categories. And it’s based on how they get paid. So one is the rural, they call PPS. The designation doesn’t matter, but it’s more like a old, the most original style, right? The prospective payment system.
Then there’s critical access hospitals, a designation that started many years ago to try and help rural hospitals that are struggling financially. And it’s cost-based compensation from CMS. And then there’s a new designation, this rural emergency hospital.
The only reason those are important is just to understand that one of the big challenges for these rural hospitals is the programs and the policies of the federal government, particularly, they change and they change often. And so just as the leadership of the hospital figures out, OK, because these hospitals are, they’re not-for-profit hospitals typically. Right. And even if they operate under a tax designation as for-profit, they don’t make any profit. So it’s a challenge.
And so just as these leaders figure out how they have to run the financial side of the hospital, the care is the care, but the financial side of the hospital, then the next week, month or year, the government changes how they pay them.
So it’s really tough under the two models that we really have now, critical access and rural emergency hospital, to make sure you’re tracking those and doing the crossing the T’s and dotting the I’s that the federal government requires you to do. It’s also very expensive to administer those programs. You have to pay outside auditors. And it’s just the bureaucracy that goes along with it.
What we’re seeing, though, is the critical access hospital designation is getting harder and harder to maintain because of a lot of things we don’t have time to go into, which is putting a huge squeeze on these hospitals. And you’re absolutely right. You hit the nail on the head. You spoke of volume. If we can just provide the service that the community desires, then the community will stop leaving the community to get their care.
And so it’s really back to the fundamentals and the basics of what rural hospitals did many years ago. They assessed the need in the community, which the leadership at Gravette has done an exceptional job of evaluating and assessing that need. They then decide what does the community need from us as their community hospital? Let’s make sure that we’re providing that to the community so that they know it’s not only safe, it’s exceptional to receive your care here.
And once they know that, then they stay. And then those dollars stay in that community. Right. The care provision stays in that community. These are often the biggest employer in the town that they’re in. And so that’s jobs for that community.
And if you have good schools and you have great hospitals in rural communities, those communities thrive. If you lose either the schools or the hospital, they don’t do well. So it’s in everyone’s interest to build the model that the community needs and desires and to provide it with excellence.
And that’s what Gravette is doing. And it’s really fun to watch. And I think you’re going to see over the next year, year and a half, just a lot of changes, a lot of really positive changes.
Moore: So when you look at a hospital like this, is this an outlier in the world of rural hospitals?
Wilson: Yeah. So depending on the metric you use, there’s anywhere between, and what designation you use, maybe 1,500 to 1,800 rural hospitals in the United States.
And if you consider that likely in Arkansas, I can’t say with 100% certainty, but likely in Arkansas, Gravette will be the only rural hospital, the only critical access hospital where you’ll be seen every single time by a physician who’s completely and fully trained in emergency, trauma and critical care so that you can feel safe when you go there. You’re going to get Level I trauma center ER doctors.
So yeah, it’s a huge outlier. It’s a big deal what they’re doing. And I think what you’re going to see is the outcomes of their decision are also going to be a big outlier.
Dr. Andy Wilson is the president of ACPHealth. That town hall meeting is happening tomorrow morning at 11 a.m. at Ozarks Community Hospital in Gravette.
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