The rural hospital stabilization program : a comprehensive report : background of the Rural Hospital Stabilization Program and outcomes of phases one through three

n . GEORGIA DEPARTMENT
~)JI OF COMMUNITY HEALTH
The Rural Hospital Stabilization Program
A Comprehensive Report
Background of the Rural Hospital Stabilization Grant Program and Outcomes of Phases One Through Three
December 2019
0 ,Q!!J:!w. AD~i~on or!he Ge0<glaD1p1rtm1nl ofC0tnm11nlty Hnllh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Ta ble of Contents
l ntroduction .................................... ........................... ...................................................:..............Page 2 Executive Su mmary.....................................................................................................................Page 2 Rura l Hospita l Closures: A Nationa l Concern ...........................................................................Page 3 Hosplta l Closures In Georgia......................................................................................................Page 4 Th e Rural Hospital Stabi lization Committee............................................................................Page 4 Final Report to t he Governor's Office....................................................................................... Page 7 The Ru r al Hosp ital Stabilization Grant Program......................................................................Page 9 Rural Hospital Stabilizatibn Grantees........................................................................................Page 11 Where Are They Now? Retrospective Eva luation....................................................................Page 21 Where Are They Now? Financial Analysis................................................................................. Page 28 Summary...... .................................................................................................................................. Page 47 Sources...........................................................................................................................................Page 48 Appendix........................................................................................................................................ Page SO Acknowledgements......................................................................................................................Page 51

1
0 .Q!!,!!,, ADiYltlonorlh Gorgla Dpar1M..,,ol ComMIN\ily Hullh

Introduction

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

The Georgia Department of Community Hea lth (OCH), St ate Office of Rura l Health (SORH) has the priviledge of administering the Rural Hospital Sta bilization Grant Program (RHSGP) for rural hospital grantees in th e st ate of Georgia. The purpose of this report is to provide a background on th e program as well as an overview of the use and benefit of funding provid ed to grantee hospita ls during the first three fi scal years of this program. This report includes data related to the sustainability of projects after grant funding ended, a synopsis of overa ll impact of individu al grant projects from the perspective of the grantee, and a finan cial comparison of hospitals prior to and aft er t erm ination of grant funding.

Executive Summary

During the 2014 Genera l Assembly, Governor Nathan Deal acknowledged growing concerns regarding the increasing number of rura l hospita l closures in Georgia. The Rura l Hospital Stabilization Committee was appointed to evaluate hospital closures as well as the overall globa l issue of access to hea lth care in rural areas. The fina l recommendations of the Committee led to the creation of t he Rural Hospital Stabilization (RHS) Grant Program.

During the first three years of the RHS Grant Program, it was noted that no rural hospital had been forced to close due to f inancial stress. To determ ine if this may be a re sult of the gra nt, the State Office of Rura l Hea lth elected to conduct a retrospective eva luation of the ben efit and sustainabil ity of programs funded through th e grant, and a comparative financi al analysis of the participating hospitals prior to and after receiving grant fund s.

Specific to benefit and sustainability of grant funded project s, gra ntees reported that carecoordination projects proved the most impactful, and telemedicine projects proved to be the least impactfu l overa ll. Eighty-three percent of th e projects were still on-going as of June 2019, and sixty seven percent of those projects were financia lly sustainable post~grant.

Regarding the financial analysis, overall, the hospitals in phases one through three reflect relatively sta ble results considering the significant changes they have encountered in the past five years. None of these hosp itals have closed during the period under review.

Due to m any variables beyond the scope of th e gra nt program, it would be difficult to draw the definitive conclusion that the Rural Hospital Stabilization Grant Program prevented additional hospital closures. However, specific to the intent to "stabilize" hospitals and communities with this initiative, it is reasonable to conclude that this program appears to have m et its intended goa l.

These hospitals will continue to be evaluated on an annual basis, and future reports will incorporate the result s of phase four and phase five hospitals.
2
0 .Q~Ji,, ADivisionor lht G1orgl1 OoptrlmtnlorCommunlly Htallh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Rural Hospital Closures: A National Concern
Concern for the growing number of rural hospital closures across the country has been a frequ ent topic of national conversations since 2005. Between 2005 and 2017, one hundred eighty five rura l hospita ls closed, with the highest number of hospital closings per year occuring in years 2013, 2014, and 2015.
Wh ile this document primarily focuses on closures between 2005 and 2017, the most recent report from the North Carolina Rural Health Research Program has indicated a record high of nineteen rural hospital closures during the calendar year 2019.
In the 2019 American Hospital Association Rural Report, seven areas were identified as persistent cha llenges encountered by rural hospita ls across the United States. These cha llenges are: 1) Low Volume, 2) Challenging Payer Mix, 3) Challenging Patient M ix, 4) Geographic Isolation, 5) Workforce Shortages, 6) Limited Access to Essential Services, and 7) Aging Infrastructure and Access to Capital.
W ith respect to these seven area s, a post mortem review of circumstances associated with the eventua l closure of rural hospitals across the country would demon strate that most, if not all, of these challenges existed for several years prior to the ultimate decision to shutter the doors.
There is no simple solution to thi s crisis. It is apparent that rura l communities shou ld not be abandoned and left to dea l with the fall -out of rura l hospital closures on an individual basis.
The 2019 American Hospital Association Rural Report su mmarized the need to address this issue as a group, as quoted below from the Conclusion of their report:
Although rural hospitals have long faced unique circumstances that can complicate health improvement efforts, more recent and emergent challenges are exacerbating their financial instability - and by extension, the economic health of their communities. Individually, these are complex, multifaceted challenges. Taken together, they are immense, requiring policymakers, stakeholders and communities to work together, innovate and embrace value-based approaches to improving health in rural communities.
The f ederal government must play a principal role by updating policies and investing new resources in rural communities. A complete listing ofAHA policy priorities and recommendations for America's rural hospitals and communities is available in the 2019 Rural Advocacy Agenda, 2019 Advocacy Agenda and the Task Force on Ensuring Access in Vuln erable Communities Reporti all are available at www.aha.org.
3
0 .Q!!It. ADivisionol u,e Oe~o;aOopartmentofCommunil)i Hellh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Rural Hospital Closures in Georgia

Not able concern abo ut rural hospital closures in Georgia actually began in 2001 when two ru ra l hospitals were forced to close due to fin ancia l stress. As the issue with rural hospital closures began t o gen erat e conversations across t he country, anot her rural hospita l in Georgia was force d to close in 2008.

W hen state level conversations bega n in 2014, the Department of Community Hea lth recognized this issue was not a new problem, but had reached a point of great conce rn . Between 2010 and 2014, Georgia was lead ing the co untry in the number of rural hospital closures as four Criti ca l Access Hospitals closed within a twelve month period.

Hospital Closures in Georgia

Hospital

Location in Georgia

Type

Year Closed

Hancock Memorial Hospital Dooly County Hospita l Taylor Telfair Regiona l Hospital

Sparta Vienna McRae

Rural Rura l CAH

2001 2001 2008

Calhoun Memorial Hospital Stewart Webster Hospital

Arlington Richland

CAH

2013

CAH

2013

*Charlton Memorial Hospital

Folkston

CAH

2013

Lower Oconee Community Hospital

Glenwood

CAH

2014

*Charlt on Memo rial Hospital

Folk sto n

CAH

2014

North Georgia Medical Center

Ellijay

PPS

2016

Chestatee

Da hl onega

PPS

2018

*Charlton Memorial Hospital originally closed in 2013. In an effort to evaluate all possible options for re-opening

the hospital before losing the Certificate of Need, the hospital re-opened for two days In 2014. No viable options

were presented and the hospital was permanently shuttered.

The Rural Hospital Stabilization Committee
Th e Rura l Hospital Stabilization Committee was ultimately formed to evaluat e th e global issue of access to h ea lth care in rural areas.
During the 2014 General Assem bly, Governor Nathan Deal acknowledged t he increasing concern s regarding the financia lly fragi le status of rural hospitals and t he recent closure of fo ur Critica l Access Hospita ls. Leadership w ith the Georgia Departm ent of Com munity Health m et w ith Senat o r David Lucas and Ho use Representative Terry England to discuss substative first steps th at co uld be taken. Towa rd the end of the Legislat ive Session, Governor Dea l presented a three part initiative to the Rural Caucus of the General Assem bly:
4
0 ,Q!!I!u,. AOlvi1lon of th 00tgia Depattmonl ofComnwnify ~oelth

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Part 1 - Delegate to Departme nt of Community Healt h Com m issio ner Clyde Reese t he responsibility of naming a point-person for th e init iative .
Part 2 - Identify t he Ru ra l Hospital Sta bilizat ion Co mmittee M e mbers.
Part 3 - Allow rural hospita ls within certain pa ram eters to st ep down and offer a lower level of s e r vi ces .
Selection of a Point of Contact
In respo nse to t his initi ative, Commissio ner Reese appo int ed Ch arles Owens, Executive Direct or of the State Offi ce o f Rura l Health as the designat ed po int of contact to o rganize Commit t ee meetin gs, as well as coll ect, comp ile, and report infor mation t o and from t h e Comm it t ee as needed.
Identify the Rural Hospital Stabilization Committee M embers
Sixt een very experience d and diverse individu als wer e select ed to participate as th e Rura l Hospital Sta bilizatio n Com mit tee, w it h Representative Terry England and Senator David Lucas serving as Co-Chairs of t he Com mittee.

Original M embers of the Rural Hospital Stabilization Committee

Rep. Terry England, Committee Co-chair Georgia House of Representatives

Sen. David Lucas, Committee Co-chair Georgia Senate

Jimmy Lewis

HomeTown Hea lt h

Temple Sellers, Esq.

Georgia Hospital Association

Greg Hearn

Ty Cobb Regional Medica l Center

Scott l<roell

Liberty Regional Med ical Center

Maggie Gill

Memorial Healt h

Wade Johnson

Lincoln County Commission Chairm an

Angela Highbaugh-Battle, MD

Ped ia trician

Charles Owens

Georgia Department of Community Health, State Office of

Rural Health

Molly Howard

Jefferson County Superintendent

Jim my Allen

Business Owner and Tift Regional Hospital Board Member

Thomas Fitzgerald, MD

Tanner Medical Center, Emergency Medicine

Ronnie Rollins

Community Health Systems

David Sanders

Fannin Regional Hospital

Jeffrey Harris, MD

OB-GYN

5
0 ,Q!!J;!,, ADivision of I~ G,or'iJlt Oapit'tmont of Communily Hulth

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Allow a Lower Level of Service

In an effort to provide an alternative for rura l hospitals considering closure (or those that had closed within the last twelve months) the Departm ent of Co mmunity Health began discussions to allow hospitals meeting specific criteria th e option of stepping down and offering a lower level of service to their com munit ies. Currently, two types of authorizat ions are req uired to operate as a hea lt h care faci lity in Georgia:

1. plann ing authorization through the Certificat e of Need program 2. licensure compon ent

Th e Department of Community Hea lth administers both through the Healthcare Facility Regulation Division.

For the purpose of state licensure, all hospita ls are govern ed by Georgia law and Healthca re
Faci lity Regu lation's Ru les and Regulations for Hospit als 111-8-40. Discussion specific to revising
th e rul es began during the Legislative Session and OCH was able to move quickly t hrough the process. This administrative rule was adopted and promulgat ed allowing the option for a hospital to offer a lower level of service referred t o as a Rural Freestanding Emergency
Department. Revised HFR Rule 11-8-40-.02 becam e effective M ay 2014.

Timeline for Revised Hospital Rules March 24, 2014 April 15, 2014 April 29, 2014 May 19, 2014

DCH Board Approved Initial Adoption Public Hearing and Comments DCH Board Approved Final Adoption Rules Became Effective

The Depa rtm ent of Community Health plann ed an aggressive schedule for Com mittee meetings
between Jun e and Decem ber of 2014. M eeting age ndas an d recordi ngs of each of the meetings
in the table below ca n be located o n the SORH page of the OCH website at https://dch.georgia.gov/archive-rural -hospital-stabilization-comm ittee.

Rural Hospital Stabilization Committee Meeting Dates and Locations

Date

Site

June 9, 2014

Department of Community Health

August 25, 2014

State Office of Rural Hea lth

November 20, 2014

Ty Cobb Regional Medical Cent er

December 5, 2014

Depa rtm ent of Community Health

City Atlanta Corde le Lavonia Atlanta

6
0 .Q!!.!!,1, ADivision of!he Giorgi> D111t1m1nl of Communi1y H11llh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Final Report to the Governor's Office
The f ull report from t he Rural Hosp ital Stabilization Comm ittee was presented t o Governor Dea l in the February 23, 2015 Final Report to the Governor.
As quoted in an excerpt from the report:
In April 2014, Gov. Nathan Deal announced his appointments to the Rural Hospital Stabilization Committee, which was created to identify needs of the rural hospital community and provide potential solutions. "In March of this year, I proposed three revisions to the way we approach rural health care, with one being the Rural Hospital Stabilization Committee, 11 Deal said. "I recognize the critical needfor hospital infrastructure in rural Georgia and remain committed to ensuring citizens throughout the state have the ability to receive the care that they need. This committee will work to increase the flow of communication between hospitals and the state and Improve our citizens' access to health care. I am proud to welcome this team and look forward to what we stand to accomplish."
One of the main areas offocus for the Rural Hospital Stabilization Committee was to address Emergency Department (ED) stressors in rural hospitals that can contribute and lead to their closure.
Within the fin al report, the Committee provided a three-part recommendation to the Governor. These recom mendations were:
1. Implementation of a grant fund ed Rural Hospita l St abilization Pilot Program utilizing a " Hub and Spoke" model approach t o four designated hospital recipients
2. Legislative support to maintain and protect t he fragile rura l hosp ital infrastructu re
3. Budgeta ry support of $3,000,000 to be appropriated to t he Georgia Depa rtment of Com munity Healt h, State Offi ce of Rura l Health to grant the fundin g to the four designated hospital recipients and oversee th e Rural Hospital Pilot Program
As a resu lt of th ese recommendations, Governor Dea l allocat ed $3,000,000 in state fundin g for Fisca l Year 2016 to support the Rural Hospital Stabilization Grant Pilot Program.

7
0 ,Q!!J;!,, ADivision of tho Giorgia D1p1rtm1n1 of Community HHlth

~ GEORGIA DEPARTMENT
~ ' OF COMMUNITY HEALTH
A timeline for the Rural Hospital Stabilization Committee progress is noted in the graphic be lo w :

Rural Hospital Stabilization Committee established

Rural Free Standing Emergency Department
Regulations approve

April
2014

May 2014

Rural Hospital Stabilization Committee Final Report "Hub & Spoke" Model
Published
February 2015

Governor signed budget $3,000,000
May 2015

The goa l of the "Hub and Spoke" mod el is to best use existing and new technology to ensure th at patients are being treated in t he most appropriate setting thus relieving some of the cost pressures on the sma llest rural hospitals' emergency departments.

Through the "Hub and Spoke" model, grantee hospitals will function as the " Hub" for the project. The "spokes" would include other local health care partners and stakeholders in each respective com munity, to in clude but not limited to, tertiary hospitals, physicians, nursing homes, pub lic safety agencies, public health departments, home health and behavioral hea lth facilities, educational institutions, loca l busin esses and industry, and faith-based partners.

The Press Release and complete Rural Hospital Stabilization Committee Final Report to the Governor can be located in Appendix A and Appendix 8 of th is document.
8
0 ,Q!!lt. ADivilionol lho Giorgia 01p1nm1nt ofCommunityHu llh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

The Rural Hospital Stablization Grant Program
The State Office of Rural Health was designated as the oversight entity for the proposed pilot program implementation and monitoring. Prior to implementation of the pilot program, the structure and performance metrics had to be determined to ensure thorough and consistent management, documentation and evaluation during the pilot phase.
To ensure adherence to the Hub and Spoke model framework, Grantees wo uld be required to assemble community stakehold er groups to identify the root causes of th eir communities' health issues and develop recommendations for community action.
Projects selected as a result of community engagement efforts had to depict a design that would ensure patients are provided with the appropriate level of ca re in a timely manner, and at the most appropriate facility equipped to meet their medical needs.
Selecting Program Goals and Performance Measures
The four pilot hospitals were brought togeth er on August 14, 2015 to discuss th eir strategies for meeting the goals set forth in the recommendations report (see Rural Hospital Stabilization Grantees section of this report for a listing of the pilot program grant recipients). Using the Hub and Spoke model framework, the hospital leaders started a brainstorming session with the premise, "What are we trying to accomplishr and worked through pertinent data regarding fin ancia l and operational performance, market share, federal penalty program performance, and the patient perception of care.
To support the "Right Care, at the Right Time, and in the Right Setting" philosophy of the program, four overarching goa ls were estab lished:
Increase market share Reduce potentially preventable readmissions Reduce non-emergency care and "super users" served in the Emergency Department Increase access to primary care
During the funding period, grantees would be required to provide quarterly progress reports to the RHSGP Program Manager at SORH. Reporting would include data collected quarterly specific to a pre-determined set of core performance measures. Therefore, the perform ance metrics for the program were decided as follows:
9
0 ,Q!!Jl,. ADivision ol lh1 G1orgi1D1p1nm1n1 of Communiiy H11llh

0

GEORGIA DEPARTMENT OF COMMUNITY HE:AL TH

M e tric Overall Proxy Measure of Financia l Stabilization - Hub Foc us Overall Proxy M easure of Financial St abilization Community Focus Access to Ca re - Inappropriat e Utilizatio n of Emergency Depa rtment Ca re Readmission Reduction - All Cause 30 Day Hospita lWide Read missions Menta l Hea lth -Average Daily Boa rding Hours fo r 1013 Hold Out-Migration Inpatient and Outpatient
Improved Fidelity- Hospital Consumer Assessment of Healt hcare Providers and Systems (HCAHPS)

Source for Data Collection Hospita l Financial Statement
Hospital Financial Statement
Hospital Claims Data
Hospital Claims Data
Hospital Claims/Medica l Record Review
Hospita l Industry Dat a Institute Analytic Advantage Hospita l HCAHPS Vendor Report Question #22 (Willingness to Recommend)

Commitment Funds

The Rural Hosp ital St abilization Program Commitm ent Funds req uirem ent was est ablished as an indicator of each hosp ital's commun ity level commitm ent . This Co m mitm ent was dem onstrat ed through th e collection of funds fro m th e grantee hospital upon grant execution.

A rest rict ed fu nd source was est ablished so t hat t he communit y com m it m ent proceeds ar e dedicat ed t o th e Rura l Health St abilizat ion proj ect. This restrict ed fun d source is not subject to lapse and surp lus f unds are protect ed from being return ed t o t he treasury.

The commitment amo unt fo r the Pilot Program was set at $100,000.00 per co mmun it y. Au tho rity for th e co ll ection of fund s fro m each of the grantees was estab lished o n the signature page of t he executed Notice of Grant Award Agreement.

Rural Hospital Stabilization Program Continuation of Funding
As annu al fund ing fo r the progra m continued each fisca l yea r beyond the intial pi lot effo rt, the Department of Com m unity Health elect ed t o cont in ue using t he o ri ginal goa ls and perfo rm ance m easures identified for the pilot project fo r each subsequ ent phase of the program .
Commit m ent f unds in the amount of t en percent of grant award cont inued to be collected from each grantee upo n execut ion of t he grant fo r each new fun ding cycle.
10
0 .Q!!J;!,,, AOivilion of!he Georgia 01p1r1mtnl of Communlly Hnlih

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Rural Hospital Stabilization Grantees

Hospitals se lected to participate each year in t he Rural Hospital Stabilization (RHS) Program are det ermin ed at t he legislative leve l. The Departm ent of Community Health is notified of the selected participants and the Executive Director of the State Offi ce of Rural Health communicates with the Chief Executive Officer (CEO) of each hospital to determin e interest in participation in the program. Hospitals m ay choose to participate or decline the offer.

Particip ating hospitals for phases one through three of the Rural Hospital St abilization Grant Program are described below, indicating the phase of participation, funding amount, and th e fundin g period. A description of the hospital and services offered, as well as description of the county in which t he hospita l is located is also included. A color-coded map denoting the location of each site ca n be locat ed in Appendix C of this document.

Rural Hospital Stabilization Grant Program Sites: Phase 1 {Pilot)

Four Sites Selected

Fiscal Year Funding: 2016

Appling Healthcare System

$3,000,000 (annual) award

Crisp Regional Hospital Emanuel Medical Center

$750,000 award to each site Project Period: July 2015 - December 2016

Union General Hospital

Appling HealthCare System 163 East Tollison Street Baxley, Georgia 31513
Opened in 1951, Appling Hea lthCare Syst em is a non-profit acute care medical facility which continually dedicates its purpose of providing patients with the highest quality of medica l care. Appling Healt hCare System is licensed for 64 beds (of which 30 are ded icated t o the Geri atric Behavioral Health Unit) and offers a vari ety of technologica lly advanced and high-quality impatient and outpatient hea lth care services to Appling Co un ty.

Appling Hea lt hCare System is located in the city of Baxley, which is the county seat of Appling County. As of the 2010 census, t he county's population stood at 18,236 resid ents, comprised of 8,512 housing units and 4,894 families residing in the county. Appling County has a total of 5 12 square miles w it h 507 square miles of land and five square miles of water.

11
0 ,Q!!IL. AOivi,lonollho Gt"'9io DDJ)WMIII orCommuni1Y Hallh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Crisp Regional Hospital 902 7th Street North Cordele, Georgia 31015
Esta blished in 1952, Crisp Regiona l Hospital offers Crisp Cou nty and surrounding areas high-q uality hospital and outpatient care fo r fam ily and emergency medicin e, obstetrics/gynecology and over 20 other specialties. With a Level Ill t rauma center and more t han 50 physicians who practice in a high-tech hospitalist environment, Crisp Regional offers a comprehensive network of facilities t hat incl ude a 143-bed nursing home, retirement home, dialysis faci lity, home hea lt h program, hospice and home care program and rural hea lth clinic.
Crisp Regional Hospital is in th e city of Cordele, which is t he county seat of Cri sp County. According to the 2010 census, t he co unty's pop ulation stood at 23,439 residents, comprised of 10,734 housing units and 6,295 families residi ng in the cou nty. Crisp Cou nty has a total of 281 sq uare miles with 273 square mil es of land and approximately eight sq uare miles of water.
Emanuel Medical Center 117 Kite Road Swainsboro, Georgia 30401
Emanuel Med ical Center feature s a hea lt hca re team of over 450 employees, over 40 physicians and provides quality care, close to home, for fam ilies in Emanuel County and surrounding communities. The hospital is eq uipped with 18 patient rooms, all furnished w ith full bathrooms, tel ephones and televisions, 15 Senior Behaviora l Health private room s, 49 nursing home beds and eight Critica l Care rooms.
Ema nuel Medical Center is located in the city of Swainsboro, w hich is the county seat of Emanuel County. As of the 2010 census, the county's population stood at 22,598 residents, which is comprised of 9,968 housing units and 5,833 families residing in the county. Emanuel County has a total of 690 sq uare miles with 681 square miles of land and approximately nine sq uare miles of water.
Union General Hospital
35 Hospital Road Blairsville, Georgia 30512
Located in North Georgia, Union General Hospita l serves all commu nit ies in t he North Georgia area with high-qu ality ca re. Due to its location, Union General Hosp ital is in t he
12
0 ,Q!!Ji!,m AOMslon of iht Gtotgla OeptrlmtntofCommunlly H11lth

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

unique position of providing a plethora of healthca re needs to citizens in Blairsvill e and Gainesville, as we ll as Murphy, North Carolina, Greenville, South Carolina and Chattanooga, Tennessee. From its humble beginnings as a small outpatient clinic that opened in 1959, Union General Hospital has advanced into one of Georgia's most stateof-the-art and technologically advanced hospitals.
Union Genera l Hospita l is located in the city of Blairsville, which is the county seat of Union County. As of the 2010 census, the county's popu lat ion stood at 21,356 resid ents, comprised of 14,052 housing units and 5,833 families residing in the county. Union County has a total of 329 sq uare miles with 322 square miles of land and seven square miles of water.

Rural Hospital Stabilization Grant Program Sites: Phase 2

Four sites selected; one declined Habersham Medical Center Miller County Hospital Upson Regional Medical Center

Fiscal Year Funding: 2017 $3,000,000 (annual) award $1,000,000 award to each site Project Period: September 2016 - June 2018

Habersham Medical Center 541 Historic Highway 441 North Demorest, Georgia 30535
Habersham Medical Cente r is a 53-bed not-for-profit acute care medical faci lity that prides itself in offering award-winning health care to more t han 80,000 residents in Habersham and surrounding counties. Habersham Medical Center employs more than 600 healthcare workers who strive daily to meet and exceed patient expectations.

Habersham Medical Center is located in the city of Demorest. Per the 2010 census, the county's population stood at 43,041 residents with 18,146 housing units and 11,307 families residing in the county. Habersham County has a total of 279 square miles with 277 square miles of land and two square miles of water.

Miller County Hospital 209 North Cuthbert Street Colquitt, Georgia 39837
Open ed in 1957, Miller County Hospital is a 25-bed critical access not-for-profit hospital named by HomeTown Health as "The Hospital of the Year" in both 2000 and 2015.
13
0 .Q!!IL AOiv~lonof 1h, (l0()19la Oepa'1tntnl ofCommuniiy Health

n~ J J ' GEORGIA DEPARTMENT OF COMMUNITY _H E ALTH
Miller County Hospital delivers a spectrum of inpat ient and outpatient services to th e resid ents of Co lquitt and surrounding areas and is dedicated to deliverin g high-quality hea lth care for Sout hwest Georgia residents.
Miller County Hospita l is located in th e city of Colq uitt, which is th e county seat of Mill er County. As of t he 2010 census, t he county's population stood at 6,125 resid ents, m ade up of 2,426 housing units w it h 1,674 families residing in t he county. M iller County has a total of 284 square miles, w it h 282 sq uare miles of land and t wo square miles of wat er.
Upson Regional Medical Center 801 West Gordon Street Thomaston, Georgia 30286
Upson Regional M edical Center is an acute care hospital t hat is home t o more t han 500 employees w ho daily strive to ma intain "the cleanest hospital in the stat e" by listening to th eir customers and cont inually improving based on feedback. Upson Regional M edical Center is const ant ly adding new services, includ ing cardiology, new t echno logy and new physicians, w ho st rive t o offer t he highest quality care on a daily basis.
Upson Regional M ed ica l Center is locat ed in t he city of Thomaston, w hich is th e co unty seat of Upson County. As of t he 2010 census, t he county's population stood at 27,153 residents made up of 12,161 housing units and 7,382 fa milies residing in th e count y. Upson County has a tota l of 328 square miles, w ith 323 square miles of land and approximately fi ve sq uare miles of water.

Rural Hospital Stabilization Grant Program Sites: Phase 3

Twelve sites selected; One declined

Fiscal Year Funding: 2018

Bacon County Hospital Chatuge Regional Hospital Cool< Medical Center

$3,000,000 (annual) award $250,000 award t o each site Project Period: July 2017 - June 2018

Effingham Health System

Irwin County Hospital

Jasp er M emorial Hospital

Liberty Regional M edical Center

M emorial Hospital & Manor

Mitchell County Hospital

14
0 .Q!!J:L. A Divilion of tho G101gi1 01p1itm1n1 of Communil)' Htellh

n

GEORGIA DEPARTMENT

~)JI OF COMMUNITY HEALTH

South Georgia M edical Center-Lanier Campus
Washington County Regional Medical Center

Bacon County Hospital 302 South Wayne Street Alma, Georgia 31510
Bacon County Hospital is a 25- bed, acute care general medica l-surgical hospital which is part of a medical complex that comprises 11 acres and over 25,000 square feet. Bacon County Hospita l prides itself on providing compassionate ca r e mat ched w ith up-to-date technology and services to th e community of Bacon and surrounding counties.

Bacon County Hospital is located in the city of Alma, which is t he county seat of Bacon County. As of the 2010 census, the co unty's population stood at 11,096 residents, comprised of 4,801 housing units and 2,960 families residing in the county. Bacon County has a total area of 286 squ are miles, w ith 259 square miles of land and 27 sq uare miles of wat er.

Chatuge Regional Hospital 110 South Main Street Hiawassee, Georgia 30546
Chatuge Regional Hospital is located along Highway 76 North, tucked into the beautiful North Georgia Mountains. An affiliat e of Union General Health System, Chatuge Region al Hospital features a state-of-the-art Emergency Center with an air ambulance service providing access to m ajor trauma and ca rd iac facilities. First named Lee M . Happ Jr. M emori al Hospital, the hospita l changed its nam e to Chatuge Regional Hospital in 1994.

Chatuge Regional Hospital is locat ed in the city of Hiawassee, t he county seat for Towns Cou nty. Accordin g to the 2010 census, Towns County has a population of 10,471 r esidents w ith 7,731 housing units and 2,981 families residing in th e county. Towns County has a total of 172 square miles, w ith 167 squ are miles of land and approximately five square miles of water.

15
0 ,Q!!It. ADivision of!ht Gtorgl1 Otpa~m,nt of Cammuniiy H..lth

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Cook Medical Center 706 North Parrish Avenue Adel, Georgia 31620
Cook Medical Center, now renamed Southwell Medical, recently moved to a new location as part of t he new Cook Med ical Plaza. The new 120,000-square-foot facility is fu lly operational w ith a rehabi litation department, sleep center, and a fu ll-service laboratory with outpatient surgica l se rvices to be offered soon in a variety of specia lti es. Southwell Medical now also offers an extensive medica l imagi ng department as well.
The hospital is located in the city of Adel, which is the county seat of Cook County. As of the 2010 census, the popu lation stood at 17,212 resid ents, with 7,287 housing units and 4,594 fami lies residing in the county. Cook County has a total area of 233 square miles w ith 227 square miles of land and six square miles of water.
Effingham Health System 459 Georgia Highway 119 Springfield, Georgia 31329
Effingham Health System is a Level IV Trauma Center, with state-of-t he-art treatment roo ms for trauma, stroke, and cardiac patients with a proven track record of providing high-quality advanced trauma life support. Effingham Hospital prides itself on having an entire team of resid ency-trained, boa rd certified Emergency Medicine Specialists prepared to treat all patients, from newborn through geriatric. The nursi ng staff of Effingham Hospital is Trauma Nursing Core Certified, all with training in the rapid discovery of life-threatening injuries and comprehensive patient assessment.
Effingham Health System is located in the city of Springfield, w hich is the county seat of Effingham County, As of the 2010 census, t he county's population stood at 52,250, with 19,884 housing units and 14,139 fami lies residing in the cou nty. Effingham County has a tota l area of 483 squa re miles, w ith 478 sq uare miles of land and five square miles of water.
Irwin County Hospital 710 North Irwin Avenue Ocilla, Georgia 31774
Irwin County Hospital is a 34-bed acute care facility offering a wide range of medical services to Irwin and surrounding counties. Governed by a seven-member Board of Directors, Irwin County Hospital is a non-profit corporation backed by a 66 member staff
16
0 .Q!!I!,,. AOMiionollho Gto,gla Otpat1men1olComrnunily Htollh

n~ Y..' GEORGIA DEPARTMENT OFCOMMUNITYHEALTH
who is committed to promoting healthier lives for patients by emphasizing core va lues such as quality, teamwork and a patient-centered perspective. Irwin County Hosp ita l's emergency department hand les more than 5,000 visits annually while its Birthing Place delivers over 400 babies a year. Additionally, th e on-site nursing hom e mai ntains fu ll capac i t y .
Irwin County Hospita l is located in the city of Ocilla, which is the county seat of Irwin County. As of the 2010 ce nsus, the county's population stood at 9,538 residents, with 4,033 housing units and 2,475 families r esiding in the county. Irwin County has a total of 363 square miles with 354 miles of land and eight sq uare miles of water.
Jasper Memorial Hospital 898 College Street Monticello, Georgia 31064
Designated in Janu ary 2000 as a Critical Access Hospital, Jasper Memorial Hospital is a licensed, 17-acute-care bed facility, with a 24-hour emergency room that offers highqua lity care provided by contract physicians staffing through Schumacher Clinical Partners. Equipped with advanced cardiac monitoring, Jasper Memorial Hospital offers outpatient and ambu latory ca re services and prides itself on having an average wait time of less than 30 minutes for all emergency room services.
Jasper Memorial Hospital is located in the city of Monticello which is the county seat of Jasper County. As of the 2010 census, the county's population stoo d at 13,900 residents, w ith 6,153 housing units and 3,779 families residing in the county. Jasper County has a total of 373 square miles, with 368 square miles of land and approximately five sq uare miles of water.
Liberty Regional Medical Center 462 Elma G. Miles Parkway Hinesville, Georgia 31313
Opened in 1961 as Liberty M emorial Hospital, Liberty Regiona l Medica l Center is a 28bed acute care hospital serving over 50,000 patients a year in Liberty County and surrounding areas. Liberty Regional Medical Center prides itself in its use of advanced technology and teams of top-notch physicians and nurses backed by a caring staff of other clinica l and non-clinical personnel.
17
0 .Q!!lt. AOMw nol \ht Go1gia Opat11,,en1 ol Comn1unity Health

0 ~

GEORGIA D EPARTMENT OF COMMUNITY HEALTH

Liberty Regional M edical Center is located in the cit y of Hin esville, w hich is the county seat of Liberty County. As of the 2010 census, t he county's population stood at 63,453 residents, w it h 26,731 housing units and 16,566 fa milies res iding in the county. Lib erty County has a total of 603 sq uare miles w it h 490 sq uare mil es of land and 113 squa re m iles of water.
Memorial Hospital & Manor 1500 East Shotwell Street Bainbridge, Georgia 39819
Open ed in 1960, M emoria l Hospital & M anor employs over 450 hea lth care personnel and offers a w id e range of hea lth ca re services to Bain bri dge and the surrounding areas. An 80-bed acute care hospital, M emori al Hospital & M anor has expa nded its faciliti es t hroughout t he years t o accommodat e needs of a growing com m unity, including opening M emori al M anor, a 67-b ed Long-Term Care Facility, in 1972 followed by M anor II in 1979 which added another 40 beds to t he nursing hom e. M emorial Hospita l & M anor also offers an intensive care unit and m aintains continuous renovations of patient rooms in the hosp ital as well as resident rooms in th e Manor. Plans are current ly underway for a Sa me Day Surgery center at th e hospital, w hich w ill expand t he faci lit ies for Radiology, Laboratory and other va ri ous departm ents.
M emorial Hospita l & M anor is located in th e city of Bainb ridge, w hich is t he county seat of Decatur County. As of t he 2010 census, the county's populatio n st ood at 27,842, w hich is made up of 12,125 housing units and 7,255 families residing in the co unty. Decatur County has a t otal of 623 sq uare miles w ith 597 sq uare miles of land and 26 squar e miles of water.
Mitchell County Hospital 90 East Stephens Street Camilla, Georgia 31730
Mitch ell County Hospital is a 25-bed critica l access hospital t hat offers personalized inpatient and outpati ent services t o M itchell County residents and surrounding areas. As part ofthe Archbold network, Mitchell County Hospital is a critical part of a syst em w it h a ded icated staff r egarded for high-quality, co mpassionat e medical care.
Mitchell County Hospital is located in the city of Camilla, which is th e count y seat of Mitchell County. As of th e 2010 census, t he cou nty's population stood at 23,498
18
0 ,Q!!,!!u,, ADivision of Ut, G10rgi1 01p1rtm1nl of Community H11ltt1

n

GEORGIA DEPARTMENT

~)JI OF COMMUNITY HEALTH

r esidents wit h 8,996 ho using units and 5,761 families residing in th e cou nty. Mitch ell County has a total of 514 square miles, w ith 512 sq uare mi les of land and approximately two square miles of water.
South Georgia Medical Center Lanier Campus 116 West Thigpen Avenue Lakeland, Georgia 31635
Sout h Georgia Medical Center (SGMC)-Lanier Campus, form ally the Louis Smit h M emorial Hospital, operates as a 25-bed critical access hospital w hi ch provid es acute and sub-acute ca re to Lakeland and surrounding communities. W it h the distinction of being the largest employer and economic generat or in the Lakeland community, SG M C Lanier Campus is proud to offer a variety of quality services w ith the personal touch of a small community hospital including program s for preventive and wellness m edicine, acute and chronic disease management, immunizations, healt h coaching and minor emergencies.
South Georgia M edical Center- Lanier Ca mpus is located in the city of Lakeland, which is
the co unty seat fo,: Lanier County. As of the 2010 census, the county's populat ion st ood
at 10,078, which consist ed of 4,249 housing units and 2,626 families residin g in the county. Lanier County has a total of 200 square miles w ith 185 square mil es of land and 15 square miles of water.
Washington County Regional Medical Center 610 Sparta Road Sandersville, Georgia 31082
Opened in 1961, Washington County Regional M ed ical Cent er (WCR MC) is a licensed genera l acute ca re 56-bed hospital which provides a scope of services including comprehensive inpatient and outpatient surgery, a 24-hour physician staffed emergency room as well as an Imaging Center, Rehabilitation Se rvices and Ambulance Services. WCRMC serves patients from five counties and it committed to providing their patients w ith the highest quality care and play an instrum ental role in the community' s hea lth and happiness.
Washington County Region al M edica l Center is located in th e city of Sandersville, which is the county seat of Washingt o n County. As of the 2010 census, t he county's population stood at 21,187 w ith 9,047 housing units and 5,269 fa milies residing in the county.
19
0 .Q!!J;!/t/, AOiv~ionol!ht Geo,gia01p1rtm1n1 of CommuMy Health

~ GEORGIA DEPARTMENT
~ ' OF COMMUNITY HEALTH
Washingt on Cou nty has a t otal of 684 square miles w ith 678 squ are miles of land and six square miles of water.
Phase Four and Phase Five of the Rural Hospital Stabilization Grant Program Tw o addit ional phases of the Rural Hospital Grant Program have been fund ed in fi sca l yea r 2019 and fi sca l yea r 2020.

Rural Hospital Stabilization Grant Program Sites: Phase Four

Four Sites Selected

Fiscal Year Funding: 2019

Burke Medical Center Clinch County Hospital Elbert Memorial Hospital

$3,000,000 (annual} award $750,000 award to each site Project Period: July 2018 - June 2019

Evans Memorial Hospital

Rural Hospital Stabilization Grant Program Sites: Phase Five

Ten Sites Selected; Two Declined

Fiscal Year Funding: 2020

Candler County Hospital

$3,000,000 (annual} award

Dodge County Hospital

$300,000 award to each site

Dorminy Medical Center

Project Period: September 2019 - August 2020

JeffDavis Hospital

Jefferson Hospital

Stephens County Hospital

Wayne Memorial Hospital

Wills Memorial Hospital

A det ailed evaluat ion using t he same methodology describ ed in th e next section of this report w ill be completed for Phase Four and Ph ase Five Grantees and will be provided as an add end um to this document in December 2021.

20
0 ,Q!tt!"" ADivisionorlh Gtoigla 01p1rtm1nlolCommunity Health

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Where Are They Now? A Retrospective Evaluation of Outcomes for the Rural Hospital Stabilization Grant Program Phases One Through Three
The " Hub and Spoke" model, described previously il'.1 this report, is the foundation for th e Rural Hospital Stabilization Grant. Grant deliverables require Hospita l Grantees to select projects that
will support the "Right Care, at the Right Time, and in the Right Setting" philosophy of the
program. Grantees are also expected to design the projects with input from the commun ity obtained through community engagement meetings, and develop budgets appropriate for project needs.
Eighteen hospita ls participated in phases one through three the RHS Grant Program. The number of projects per site was left to the descretion of the gra ntee and guided by the amount of the fundin g award.
In April 2019, the Stat e Office of Rura l Health began compilation of a comprehensive report to eva luate the RHS Grant Program outcomes for grantee hospitals that had pa rticipated in phases one through three.
Th e purpose of the eva luation was to determine the overall benefit of the gra nt to each hospital and the surrounding community, and the sustainabi lity of the projects funded through the program.
As a requirement of the grant, each site had designated a Project Manager r esponsible for oversight of the grant and providing quarterly and fina l reports and invoices to the State Office of Rura l Hea lth. The Chief Executive Officer, the Chief Financia l Officer, and the Project Manager at each site were asked to partner togeth er to provide the requested information for the report.
Methodology
A comprehensive questionnaire was designed to collect qualitative and quantitative data specific to:
benefit, outcomes, and sustainability of the proje~ts select ed by each grantee hospital financial, operational, and statistical data prior to and after funding period
The questionnaire, referred to as the "Rural Hospital Stabilization Grant Program: Where Are They Now?" document, provided instructions for completion of the survey an d a deadline for
submission of the completed docum ent to SORH.
21
0 ,Q!tt!,1, ADivision ol lh, G101gl Otpanm,ntolCommunity Heollh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

The questionnaire was divid ed into four sect ions:
1. General Grantee Information 2. Project Specifi c Details 3. Overall Impression and Benefit of RHSGP 4. Financial Data Collectio n

The questionnaire was distributed t o th e CEO at each Grantee Hospital by way of electronic m ail commun ication.

Section Two of the questionnaire required th e Grantee to respond to a serie s of questions specific to each project that had been selected and fund ed through the RHS Grant. The number of projects chosen by each Grantee varied, however the qu estionnaire was not considered to be properly complet ed without including t he req uested information specific t o each project funded.

Specific to Section Four of the questionnaire, SORH obtained written permission from the Chief Executive Officer or t he Chief Financial Officer at each Grantee Hospital to allow Draffin Tucker, LLP, to utilize and summ arize the hospit al's fin ancial data from audited fin ancial statements and other grant-specific financial information provided for this report.

A copy of the questionnaire temp late used for th e collection of this information ca n be locat ed in Appendix D of this document.

Findings: Proj ect M anager

Th e RHS Grant allowed Grantee Hospitals to select a Project Manager from within or hire from outside the organization. Grant fund s cou ld be used as sa lary support for a current ly existing employee or fun d a portion, or all, of a new emp loyee's sa lary.

Questions specific to the status of the Project Manager

Question

Findings/ Results

Was th e Proj ect Manager selected from

72% of Project Managers were already employed by

staff already employed with your faci lity or t he Grantee Hospital

hired from outside of your orga nization?

28% of Project Managers were hired specifica lly to

manage the grant

Is the Project Manager still an employee of 78% of Project Managers were still employed by t he

your organization? If so, in what capacity? hospital as of June 2019

22
0 ,Q!!.!!,, ADivisoo of lh1 Georgie D1p111tn1n1ofCcmmun;cy H11llh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Specific to the Project Managers' employment status after termination of the grant, those Project Managers who were em ployed with the organization prior to receiving the grant continued in their sa m e ro le after grant termination. Those Project Managers who were hi red from outside the organization were either placed into an open position with in the organization, or a position was created/modified, most often in a community outreach or marketing rol e.

Findings: Specific Projects Funded

Section Two of the questionnaire required that each respondent complete an "Attachment A" document (see Appendix D) for each individual project that had been selected by the Hospital Grantee and funded through the RHS Grant. The number of projects selected by each site varied with some hosp itals se lecting only one project and some hospitals selecting as many as six projects.

For the purpose of data collection, the following information is specific to the com bined number of project s for all eighteen sites. Collectively, the projects were grouped based on similarity of design allowing an opportunity to evaluate the most common ly select ed project s as well as the most unique.

A combined total of 52 projects were funded through the grant during thi s evaluation period. The categories in which the projects were grouped are listed below:

Grouping of Projects Telehea lth/Telemed icine Community Paramed icine Emergency Department Renovations Upgrades New Service Lines New Designations Mental/Behavioral Hea lth Chronic Condition/Care Coordination Unique/Miscellaneous

Number of Projects 13 5 3 2 9 4 5 7 4

The top four most commonly selected group s of projects are detailed below:
1. Telehea/th/Telemedicine
The most commonly selected projects were those involving telemedicine as a primary component. These projects included telemedicine utilized w ithin school-based clinics, behavioral health facilities and nursing homes. Two projects included telemedicine
23
0 ,Q!!J;,t , ADivision of the Gtorgl 01p1rtm1nl olCommunity Hnllh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

utilization in the field to enhance triage and destination selection for patients presenting with signs of a stroke, and one project w as specific to consultation with a Nephrologist, allowing patients to report to their local hospital for follow up evaluation and treatment inst ead of t raveling several hours to a faci lity in an urban area.
2. Community Paramedicine and Chronic Condition/Care Coordination
Care coordin ation projects were the seco nd most commonly selected. For the purpose of the data collected for this report, "ca re coordination" included a variety of methods in w hich patient care was m anaged in an effort to ensure the "right care, at the right time, and in the right setting". Therefore, two groupin gs have been combined for this report.
Five of the proj ects were provided through an arrangement with the loca l Emergency M edical Service t o provide care to the patient in their hom e environm ent to reduce unnecessary 9-1-1 calls and emergency department visits, as well as reduce th e number of hospital readm issions w ith in a 30-day period. Other types of car e coordination projects includ ed Patient Care Coordinat ors, in w hich hospital staff worked w ith patients after discharge to ensure discharge instructions were followed and follow-up appointments were met. Other projects included hospital emergency department triage to re-direct nonurgent/non-emergency patients to walk-in clinics, Nursing Home roun_ds provid ed by advanced practice providers to prevent unnecessa ry transports to the emergency department, and th e utilization of Commun ity Hea lth Workers and Community Hea lth Coaches.
3. New Services
Funding from th e grant program was used t o create new services offered by Hospital Grantees. These new services included the co nstruction of new facilities such as wa lkin/non-em ergency and charity ca re clinics (som e in cluded expanded hours of operation), remodeling existing structures to offer Geriatric Psychiatric in-patient facilities, occupationa l medicine, and weight loss/wellness progra ms. One Hospita l Grantee used fund ing to reopen the Intensive Ca re Unit w ithin the hospital, w hich had been closed for several years.
4. M ental/Behavioral Health
The fourth m ost commonly select ed type of projects were those designed to provide o r enhance mental and behaviora l health ca re w ithin the community. All Grantee Hospita ls acknow ledged these projects led to a strengthened relationship w ith the local Com munity Service Board during the design of the proj ect. Project s included t he provisio n of both outpatient and in-patient services (in som e cases where non e had exist ed previously). Projects
24
o ~.Q!!Jt. ADivitblof!ht ~14 Depeltnlot ofCemmuftify Hullh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

w it h a specifi c patient-popu lation focus included servi ces for se nior ad ults (age 55 and older), adolescent/youth programs, or programs d esigned specifically to address opioid addiction.

The questionnaire also included questions specific to the benefit and sustainability of the proj ects.

Project Specific Details Question Is this project still on-going?
Was/ls t his project financially sustainable after t ermination of the gra nt? Would your hospital have selected/fund ed this project if the RHSGP had not been ava il ab le? Did t his project lead to relationship development w ith other partners and subsequent addit ional projects?

Findings/ Results 83% of original projects were still on-going as of June 2019 67% of original proj ects were conside red fin ancially sustainable post-grant 20% of th e projects would have been done at some (later) point 75% of the projects led to project-specific new relationships

As indicated above, th e RHS Grant Program allowed twenty percent of Gra ntee Hospit als the opportunity to implem ent programs wh ich had been ident ifi ed for future efforts, as w ell as allowing eighty percent of Hospital Grantees the opportunity to explore new ideas and initiatives.
With Hospital Grantees reporting that eighty-three percent of th e project s were still on-going, and sixty seven percent of those projects were fin ancially sustainable post ~grant, it is evident that communities have benefited from the effort to design programs to address specific community need s.

Overall Impression and Benefit of the Rural Hospital Stabilization Grant Program
Section three of the questionnaire was designed to collect information specific to the RHS Grant Program as a w hole and det ermin e which projects Hospital Grantees f elt had the most and least impact.

25

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Specific to the overall benefit of the program, the following question s were asked:

Question Based on your experi ence with the RHSGP, do you fee l this program
met its intended objective to ensure patients receive the "right care at the right time in the right setting"?
Did your facility seek other grants/funding so urces to expand or sustain any work begun through the RHSGP?
Based on your experience w ith the RHSGP, if given the opportunity to start your project over, would you have made the same decisions, choices, done anything differently, etc.?

Findings/Resu lt s 100% (18/18) of recipients felt the RHSG Program did meet the objectives. 44% (8/18) of recipients did choose to seek additional f unding to continue or strengthen projects begun with RHSGP funds. 83% (15/18) of recipients would have made different decisions or choices about some aspect of their projects or selected an entirely different project all together.

Based on your experi ence with the RHSGP, what suggestions or advice would you offer to a new RHS grant recipient?

17% (3/18) of recipients would have made no changes at all to decisions or projects.
See Appendix Efor a
complete list of responses

Hospital Grantees who indicated they wou ld have made different decisions or choices about projects exp lained their positions in a commentary format. Most respondents felt they chose too many, or too ambitious projects specific to the time constraints of the funding period. Other comments refl ected a desire to have been more selective when choosing vendors for the projects. Clarification for this question is reflected in many of the suggestions or advice that was
collected and reported in Appendix.
Specific to the overall impact of th e program, two questions were asked :
Question #1. "Overall, what do you feel was the most beneficial or impactful component of your projects? Please explain."

26
0 .QJ!J;!,, ADivi~onollht Gto,via Dtptruntol olCommunily H11llh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Specific to the most beneficial or impactful component, overwhelmingly, re spondents indicated that community engagement and sta keholder collaboration was the most beneficial result of the program. Hospital Grantees indicated that, due to the " Hub and Spoke" model design, new and improved relationships with their co mmunities had resulted in an increase in utilization of services, improved perception and reputation of the hospital, and a rebuilding of "faith and trust" in the providers and system in general.
Specific to the most beneficial group of projects funded through the grant, respondents cited Commu nity Paramedicine/Care Coordination projects as having the most positive impact for patients. Commentary provided with the responses indicated that working directly with patients in a one-on-one capacity resulted in improved patient comp liance with discharge instructions, increased follow up with primary care providers, improved ab ility for self-ca re, increased utilization of other re sources avai lable to the patient, and decreased dependency on emergency services, both fixed and mobile.

Question #2: "Overall, what do you feel was the least beneficial or impactful component of your projects? Please explain."
Interestingly, while Tel emedicine/Telehealth projects were the most commonly se lect ed, Telemedicine was also identified as the least beneficial or impactful project funded through the program.
Commentary provided by respondents indicated that, while t elemedicine had been identified as one of the most promising servi ces for the provision of health care in rural areas, provid ers and patients were slow to embrace th e concept. Also, estab lishing relationships with specialist s could be time consuming and costly in the initial phases of building telehealth programs between rural and urban providers.
Another barrier was described as the "failu re of a 360-degree commitment". Telemedicine requires a two-party agreement between those who w ill present patients to the provid er, and the provider who treats the patients presented. For both sides of the relationship to work effectively, guidelines and processes must be estab lished, equipment must be purchased and maintained, and presenters and providers must be trained and proficient in the use of the
equipment. Some respondents indicated that a less-than-enthusiastic attitude demonstrated by
either one of the required parties resu lted in failure of the program. Other challenges were described as frequent turn-over by trained staff participating in the program without proper training for new staff, and a lack of overal l understanding of the technology.
27
0 .Q!!JI". ADivi>lon of11,e G.o111la D1p1r1m1n1 ol Commun;,y H11llh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Findings: Financial Analysis
Section Four of t he questionnaire was comp leted by Draffin Tucker, LLP. As previously deta iled in this report, permi ssion to access hospital financia l records was obtained from each Grantee Hospital prior to beginning th e analysis.
Methodology
Financial, operational, and statistica l data was gathered from all of the hospitals in phases one through three. This data was obtained from audited finan cial statem ents, cost reports, and other sources provid ed by the hospitals. The individu al hospital data was su mmarized to ca lculate and present finan cial ratios, indicat o rs, and other information .
The most recent five years of available data is presented with reporting to the closest corresponding fisca l year. All hosp ital data was presented w it hout consideration for the va riou s start dates of the three phases. For reference, st art dates and number of hosp itals for the va riou s ph ases are as follows:
Ph ase One - July 2015 - four hospitals Phase Two - Sept ember 2016 - three hospitals Phase Three - Oct o ber 2017 - eleven hospitals
The most recent fiscal year dat a was utilized if any of th e years were incomplete for an individu al hospital. For example, if Hospital X's 2018 audited financial st at ements were not completed, then Hospital X's 2017 audited financial statements wou ld be used for 2017 and 2018 without any adjustments.
Certain individual hospital data elements were excl uded if the data element was not consistently prepared. This reflects t he practice where some hospitals are report ed as departm ents and do not prepare individual stand-alone balance sheets separate from th e overall multi-hospital syst em consolid ated ba lance sheets. Cert ain data elem ents from two individual hosp itals was excluded as a result.
Compar ative ratios are presented w here app licable and are from t he 2019 Almanac of Hospital Fin ancial and Operating Indicators (the Almanac) published by Optum360. The ratios refl ected in this report prim arily reflect s 2017 data from Medicare Cost Report fi lings as published in the Almanac. Almanac ratios for specific cat egories includ e:
Georgia - average of all Georgia hospitals National Rural - average of rural hospitals with revenues less than $90 million
28
0 ,Q!!It. ADi\ltslon orthe Giorgia D1p1rtm1nt ofCommunlly Health

n

GEORGIA DEPARTMENT

~J)I OF COMMUNITY HEALTH

As applicable, each ratio presented w ill includ e several key pieces of inform ation:
Ratio Type Desired Trend Definition Formula

Overall Summar y Findings
Over the past five yea rs, the hospitals in these first three phases have faced a vari ety of fa ctors including changing or declining demographics, varyin g patient pref erences, shifts in service pattern s from inpati ent to outpati ent, introduction of new reimbursement m echanisms and models, increasing salary and other cost s, and adjusting regulat ory or pol icy impact s. The hospitals are working to address th ese challenges and adapt to this changing healt h ca re environment. Hospitals are compelled to grow revenue to offset in cr easing expenses, develop new service lines, reduce cost s, and implement other operat ional and fin ancial actions to keep the hospitals' doors open and continue to serve the community.
Overall, t he hospitals in Ph ases One through Three refl ect rel atively st able result s considerin g the significa nt changes they have encountered in the past five years. None of th ese hospitals have closed during th e period under review . These hospitals w ill continu e t o be evaluat ed on an annual basis, and future reports wi ll incorporat e the results of Ph ase Four and Ph ase Five hospitals.

29
0 ,Q!!J;!,1, ADiv~lonof lhoGoo,vla D1p111mon1 of Ccmmuney Htallh

Detailed Analysis

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Average Daily Census

Ratio Type - Volume Desired Trend - Increasing
Definition - Measures the average number of adu lt and pediatric inpatient days over a
fisca l year. Excludes swingbed and nursery days. Formula - Total Adu lts and Pediatrics Inpatient Days/ 365

Average Daily Census

25
20
l? 15
C
Q)
.-1 10
&. 5
0
- - - - - A.ll Phase-s
Phase 1
Ph~se-f
cl>iiasef

- - - 2014 11 18
. 19
6

- 2015 -
11

18 22

---

6

- - - - 2016

2017

11

- 10

2-018- - -
10

17 - 22
6

-

-

-17 18

5

-- - --

----

17 18
5

~Draffin Tucker

As reflected in the data, the number of patients reported as inpatient is not a large number for all phases or the individual phases on average for the year. These numbers will fluctuate based on surgica l cases, flu season, or other reasons, and the hospital wi ll have to adjust its staffing, medical supplies, and other items to meet the varying demand for services. Th e trend for these five years reflect an overall decrease in average daily census from 2014 to 2018.

30
0 ,Q!!J;!,, AOlvis<>n of the Georgia Otp1rtmen1 of ~muniiy Hetlth

n~ Y J G EORGIA DEPARTMENT OF COMMUNITY HEALTH Patient Mix - Inpatient Days - Payer Percent age and Days

Patient Mix - 1/P Days - Medicare %

50.0% . 45.0% 40,0% 35.0% ~0.0%

2014
42.3% 43.7 % 42.7% 41.7%

2015
__ - ... 42,..2__%_
4 2.4 %
4Q:!'!b
42.8%

-it!- --- !i -r~ itii -- 2016
- 4ti:'0%-..

201 7 4 2.3%

1

201a

i

44.1 %

-")Draffin Tucker

Patient Mix - 1/P Days - Medicare Days

12,0,00
I 10,000
8,000
~co 6,000
0
4,000
2,000 ,
I
0-

.. 9,009.
9,006____ _
8,471

<5.Droffin Tucker

For M edicare, t he inpat ient days m ix is increasing from 42% to 44%, but the actual patient days declined 6% fo r Phase One, 7% for Phase Two, and 14% for Phase Three.
31
0 .Q!!J!,, AO~i,ion of the Georgia Otptltn1tnl of Community Hnllh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Patient Mix - 1/P Days - Medicaid %
20.0% 15.0%

.5.0%
0.0%
All Phases Phase 1 Phase 2 Phase 3

2014 'jo1o 11.4%
8.4%

2015
9:6io"
12.8%
11.2%
-w--- - --
7.9%

2016
. _9...9..%........ ... 15.3% 12.0% 7.3%

2017

2018

8.8% 9.5%

- ...

-1-0-.9--%--
10.6%

13.2%

18.5%

7.3%- -. ,.... 8.8%

")Draffin Tucker

Patient Mix - 1/P Days - Medicaid Days

3,500 3,000
2,500 ~ 2,000
~ 1,500
1,000
500
O 2014

2015

2016

-----~

2,607 - _ _ 3,138 ----

. 2, 243 _ - - - ~376--- - -

2,330

1,904

2017

2018

2,077

2,137

., - - - 1973---

.2,485 ,_.,_,

1,808

1,959

<5Draffin Tucker

For M edica id, the overall inpatient days mix is increasing from 9% to 11%. However, in patient days mix stayed relatively consistent for Ph ase One and Three. Phase Two M edica id inpatient days mix went from 10% to almost 19%. Actual M edi ca id patient days declined 26% for Phase One and 24% for Phase Three w hile Ph ase Two increased 36%.
32
0 .Q!!IL ADivisionof lht Gtotgla Ooptrtmantof Community H11lth

n~ y , GEORGIA DEPARTMENT OF COMMUNITY HEAL TH

Patient Mix - 1/P Days - Other %

55.0%

50.0%

45.0%

40.0%

35.0%

30.0%

25.0% 2 01 4

Alf Phases --- ~-~~. --- ..

Prase l ...
Phase 2 a Phase 3

44.8%
17-.~~~-
49.8%

< ' 5 o r o f f i n Tucker

Patient Mix - 1/P Days - Other Days

1Moo
14,000 12,000 V> 10,000
r>o- a,ooo
Cl 6,000
4,000 2,900
0 .
aPhase 1/
i5iiase2[ a Phase 3:

12/315 . ~Q(2J_!!' 14,103

.. 12,751 _ _12,951,_ 12,998

} 1,02 ~~~62_~ 12,442

12,157
10,061 . ii,892 -

_9,'141 .- 10,640

<ioroffin Tucker

Other payers fo r inpatient mix is decreasing from 48% to 45%. Actu al patient days for other payers st ayed relatively t he sam e fo r Phase One. Phase Two refl ects an 8% decrease, and Ph ase Th ree refl ect s a 25% decrease .

33
0 ,Q!!Ji/1, AOiviltOl'l or th, G,orgi D1partm1nt ol Community Hnllh

~ GEORGIA DEPARTMENT
~ ' OF COMMUNITY H EAL TH

Average Daily Census - Adjusted for Outpatient Eguivalency
Ratio Type - Volume Desired Trend - Increa sing Def init ion - Measures the average number of adjusted patient days over a fisca l year.
Num er ato r consist s of in pat ient adult and ped iatric days plus outpatient equ ivalent days. Unit measure of volum e incorporating out patient services. Formula
o Out patient Equiva lent Days = Outpatient Revenue / Average Inpat ient Revenue per Day
o Adjust ed Patient Days= Inpatient Days + Outpatient Equiva lent Days o Tota l Adu lt s and Pediatrics Inpatient Days / 365

Average Daily C~nsus - Adjusted for O/P Equivalency

70 60
so
~ 40
&(1) 30 20 10 0
All Phases Phase 1 Phase 2 DPhasej

2014

2015

2016

2017

2018

34

36

35

34

35

53 50

-6~3-

- - - - -6~1

~

~

- - ,- - -5-3 - - - i - - -55_ __

. -~---1--------1----- ------ - - --- - -

22

22

21

21

21

<5Draffin Tucker

This rat io converts outpatient services t o in corporate into an adjust ed average da ily census. It helps to better reflect t he volume, work effort, and activit ies of the hospita l. As noted earlier in th e r eport, average daily census was an overall average of 10 to 11 patients. Including outpatient activity, average daily census is now averaging 34 to 35 pat ient s. Approxim ately two-t hirds of t he hospital act ivity is attributable to outpat ient services.

34
0 ,Q!!IL. ADivision ol lhe GtorgleD1p1rtmentolCommuni1Y Heellh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Salary per Full Time Equivalent
Ratio Type - Unit Cost of Inputs Desired Trend - Depends Definition - Measures the average sa lary per full t ime equivalent (FTE). Full time
equivalent determined by dividing total fisca l year paid hours by 2,080 hours (40 hours times 52 weeks). Salaries are typically the largest resource item used in the provision of healthcare services. Formula - Total Salary Expense/ FTEs

Salary per FTE

Georgia - $59,685 Nat'I Rural $50,970

$60

$55
~ $50
m C $45
5 $40
~ $35

$30
I All Phases _
Phase 1
l -Pi:hifaisa9ea-32

2014
- 1~(.~~? 4_?/}27 49,021 40,576

2015
i~~~-2
. 52,128 51,361 43,343

2016
~~i?J:l __,.
54,_~~~
. 5-?,.~~o ..
45,361

2017
4_81t6'1 ~,417
.?~,7?!
44,830

2018
.?-q,~-_2-q .. ~s..~_7~
52,749
48,565

<")Draffin Tucker
Salary per FTE helps to analyze the cost of the employed labor providin g the services at the hospital. This cost does not include benefits, recruitment and retention costs, and ext ernal contractors. There is an overa ll 17% increase since 2014 or an average sa lary increase of 4% per year.

35
0 ,Q!!,!!,1, ADivision of lllo Gtornli Dopartmonl ofCommunily Hoallll

n~ Y J GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Net Days in Net Patient Accounts Receivable
Ratio Type - Liquidity Desired Trend - Decreasing Definition - Measures the average time that receivables are outstanding, or the
average collection period. High values imply longer collection period and thus a need for the hospital to finance its investment in accounts receivable. Formu la - Net Patient Accounts Receivable/ (Net Patient Service Revenue/ 365)

Net Days in Net Patient Accounts Receivable

60

55

50
ti)
m>- 45
Q 40

35

2014

2015

2016

2017

All Phases

50

49

47

49

Phase 1

49

55

55

53

Phase 2

40

41

44

43

CPhase 3

53

48

45

50

Georgla-53 Nat'I Rural - 58
2018 49 49 41 52

-,Draffin Tucker
Net days i~ net patient accounts receivab le stayed relatively consistent on an overall basis with some variations w ithin the phases during the five year period. The data indicates it takes an average of 49 days for hospitals to receive payment for se rvices for the most recent year.

36
0 ~,Q!!,t!,,, AOivi1lon of l/10 GtorglaDop,rtmont of Community Ht1llh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Average Payment Period
Ratio Type - Liquidity Desired Trend - Decreasing Defin ition - Measures the average time that elapses before current liabilities are paid.
The denominator is an estimate of the hospital's average dai ly cash expenses minus depreciation. Creditors regard high values for this ratio as an indication of potentia l liquidity problems. Formul a - Current Liabilities/ [(Total Expenses - Depreciation)/ 365]

Average Payment Period

.Georgia - 50 Nat'I Rural - 54

90

80

70

6P
~ so .
~ 40 30

20

10

O ...

2014

2015

60

61

--8531 ,,. -

47 62

si

"57

2016

2017

2018

58

66

68

52

- - 49 _.,

50

50

48

46

64

79

84

<5Draffin Tucker

Average payment period is a liquidity measure which shows the average time it takes the hospital to pay its vendors. The trend for this ratio should be decreasing; however, the data reflects the ratio at an average of 68 days in 2018 w hich is a 13% increase from 2014. In 2018, the in dividual phases range from a low of 46 days for Phase Two to a high of 84 days for Phase Three. Phase One is at 50 days for 2018.

37
O ~.Q!!lt. AOlviolon ol 1h Gtorgl Oapartmtnl ol Commun/I}' Healih

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Average Age of Plant
Ratio Type - Asset Effici ency Desired Trend - Decreasing Definiti on - Measures the average age of the hospital's fixed assets in yea rs. Lower
va lues indicate a newer fixed asset base and thus less need for near term replacement. Form ul a -Accumulated Depreciation/ Depreciation Expense

Average Age of Plant

Georgla- 13 Nat'I Rural - 13

22

20

18

~ m

16 14

~ 12

10

8

6 -

2014

AfPhases

13

Phase 1 ... ----- 13


o

Phase
fihase

2
I

"

.

-



- -1i40

- -

--2-015-
14

- 2016

2017

--- 16 '"

- - -18---H





-

-

-



-

-1-3- - - - 1i60 _ _ _

-

---

15
, 4oh
11

16 -
- - -12--

18

20

_... .._
-

_____ 2.0...1...8
18
1-7- - - -
12
2i

<5Dfaffin Tucker

Average age of plant is an indicator for how old th e equipm ent, building, and other fixed asset s of t he hospit al are and shows the potential need for replacement or updating. From 2014 to 2018, there was an overa ll agi ng of fixed assets from 13 to 18 - an increase of 5 yea rs or 39% increase in th e average age of plant.

38
0 ,Q!!,!,t, AOivi1lon of lht Georol Otpttlmtnl ofCO(llmunlly Hnllh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Total Operating Revenues

Total Operating Revenues

$350,000
$300,000
$250,000
1$200,000
$150,000
$100,000
$50,000
$0 -
Phase 1 II Phase 2 CPhase 3

2014
$200,052 - -$139,139 $267,384

-

<')Draffin Tucker

Total operating revenues includes revenue from patient services and reflects the gross charges of the hospital adjusted down to the amounts actual ly expected to be collected from payers and patients. There is an increase in all phases from 2014 to 2018. Phases One and Two report a 26% increase or approximately 5% per year over this time period. Phase Three reflects an 11% increase or less than 3% increase per year over the t ime period under review.

39
0 ,QJ!JI,. AOivislO!Iof1/lt Georgia Oepar1menl of Communlly H11llh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Operating Margin
Ratio Type - Profitability Desired Trend - Increasing Defin ition - Reflects the proportion of operating revenue retain ed as income and is a
measure of a hospital's profitab ility from the provision of patient car e services and other hospita l operations. Formula - (Operating Revenue -Total Expenses)/ Operating Revenue

Operating Margin

Georgia - Positive 0.2%
Nat'I Rural - Negative 3.3%

4.0% -
2 .0 %
0.0%
-2.0% 4.0o/o
-6.0%
-8.0%
All Phases Phase 1 Phase 2 Phase 3

2018
--- __ 4.0% ,,__
-1.3%
2.9% -5.3%

=-)Draffin Tucker

Operating margin is a profitab ility measure focused on t he provided hospital services and generally does not include investment income, donations, nonoperating amounts, or unusual adjustments. Overa ll operating margin hovered around a loss from 3% to 4% with mixed r esults by individua l phases with all phases ending up at t he same or decreased margins in 2018 as compared to 2014.

40
O ~,Q!!IL. ADivision ol lhe Gtorgle Oep1r1men1 ol Community Hnllh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Total Margin
Ratio Type - Profitability Desired Trend - Increasing Definition - Defin es the percentage of total revenue that has been realized in the form
of net income or excess revenu es over expenses. Used by many as a primary m easure of hospita l profitability. Formu la - Excess of Revenues (Expen ses)/ Total Revenue

Total Margin

Georgia - Positive 1.8% Nat'I Rural - Negative 1.9%

6.0%
4.0% 2.0%
0.0%
-2.0o/o
-"4.0%
-6.0o/o
All Phases Phase 1 Phase 2 Phase 3

2014
-0.9% 2 .5% '1.5% -3.6%

io1s
-0.3% 4.5% 5.1% -3.5%

2016

2017

2018

---0.9%--" -o--.3--o/-a- -- - - -0.5-%- - -

2 .0%

2.5%

- - ---210-..-.876%%%- -

<-5Draffin Tucker

Total margin includes all revenue and expenses, in cluding donations and investment in com e. Overall result s for all phases went from -0.9% (negative margin) in 2014 to 0.5% (positive margin) in 2018. Positive margins are reflected in Phases One and Two and an improving m argin in Phase Three .

41
0 .Q!!I!,1, AOivi1lon orlho Goorglo Oop1<1monlofCommunil)' HHIU1

0

GEORGIA DEPARTMENT 'OF COMMUNITY HEALTH

Current Ratio
Ratio Type - Liquidity Desired Trend - Increasing Definition - Measures the number of dollars held in current assets per dollar of current
li abilities. Most widely used measure of liquidity. High values imply a good ability to pay short term obligations and thus a low probability of technical inso lvency. Formu la - Current Assets/ Current Li abilities

Current Ratio

3.5

3.0 2.5 .

2.0

1.5

1.0

0.5

0.0

-=-- An P;h~l~els
Phase 1

2014 -2-.s- - - 2.1

i --PP-hhaassee 3

- - -12-..99- ---

2015
2.3 - 2.s
- 2.0 -
2.4

2016
21""'"
2,0 2.3 2.0

Georgia - 2.1
Nat'I Rural - 1,.5

2017

2018

2.1

1.8- - -

2!~

_ _2,!.~. .

-- -- 2.3 --
1.8

...

-2.3-
1.5

...

:')Draffin Tucker
Current ratio reflects liquidity of the hospital w ith two times current assets over current liabilities. Phases One and Two hovered around 2 between 2014 and 2018 whi le Phase Three dropped from approximately 3 to 1.5.

42
0 .Q!!J:t, ADivl1lonor lht Gto,glaDep1run1nt orCo,nmunity H11l1h

n

GEORGIA DEPARTMENT

~)JI OF COMMUNITY HEALTH

Days Cash on Hand - Short-Term Sources
Ratio Type - Liquidity Desired Trend - Increasing Definiti on - M easures the number of days of average cash expenses that the hospital
m aintains in cash and market able securities which ar e cl assifi ed as cur rent asset s. The denominat or m easures the average da ily cash expenses less depreciation. High va lu es usually imply a great er ability to meet short-t erm obligations and are viewed favor ably by cr editors. Formula - (Cash + Short-Term Investments) / [(Total Expenses- Depreciation) / 365]

Georgla-9
Days Cash on Hand - Short-Term Sources Nat'I Rural - 15

60 50 40
r~o 30
0 20
10

0 -
-AllPhases -
Phase 1 Phase 2 OPhase 3

2014
35 20 42 39

2015

38

22
53

- "'u-

41

- 2016
32

-

-

-2017 34

-

-

2.01-8 - 26

21

...-~- ---,..-- 25

n

18
-F- --

F - - -

41
34''

.. 40 36

... . ... . ..

37
'i6

..

-

<._, Draffin Tucker

Days cash on hand from short-t erm sources show declines over the time period w ith 35 in 2014 t o 26 in 2018, a 26% decrease in liquidity. All individual phases showed de.clin es in this ratio w ith decreases of 10%, 12%, and 33% in Phase One, Phase Tw o, and Phase Three respectively.

43
0 ,Q!!It. ADivision oftilt GeorgiaDepartmanl ofCommunity Heollh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Long-Term Debt to Capitalization
Ratio Type -Capital Structure Desired Trend - Decreasing Definition - M easu res the relat ive importance of long-term debt in the hospita l's
permanent capital structure. Net assets and long-t erm liabilities are often referred to as permanent capital since they will not be repaid within one year. Hospitals with high va lues have relied extensively on debt as opposed to eq uity to fin ance their assets and are said to be leveraged. Meaning risk may be viewed unfavorably by many cred itors. Formula - Long-Term Debt/ (Long-Term Debt+ Net Assets)

Georj)ia - 34%
Long-Term Debt to Capitalization Nat'I Rural- 6% Other Nat'I Rural- 36%

70.0%

60.00/o

50.0%

40.0%

30.0%

20.0%

10.0%

0.0%
2014

An Pii-ases

32%

Phase Phase

21-_

_

_

_2_~0~
59%

i:i Phase 3

24%

-- - ___ 2915.

2016

2917

2.0. 18

-- - ____

-3-3-%-
28%._ 57%

-_---+-------?3.~8'.%'!,~.-
53%

-

-

-----

-~e7'.Io:'/~o----~
47%

, -

-

-

35%
-4276.%.%

-

-

-

-

27%

37%

38%

35%

')Draffin Tucker
Long-term debt to capitalization reflects if the hospital is using debt to f inance its operations. The expected trend for this ratio is decrea sing; however, for all phases, the ratio went from 32% in 2014 to 35% in 2018. Both Phase One and Two showed declines from 2014 to 2018, but Phase Three went from 24% in 2014 to 35% in 2018 resulting in the overall summary increase for all phases.

44
0 .Q!!J;!,,, ADivision oflho G,orglo 01p1rtme,I ofCommunity H11llh

0
Net Position
Net Position
$250,000 $200,000
l $150,000
s $100,000 $S0,000

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

<"5 Draffin Tucker
Net position is comparative to stockholders' equity and reflects how the hospital's overa ll net assets are performing. Both Phase One and Phase Two have increased over the time period with 26% and 18% increases, respectively. Phase Three declined 17% over the same t ime period.

45
0 ~.Q!!,.!!"" ADivision ol lhe Georgia 01putment ol Community Ht11th

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Findings: Other
Through additional commentary collect ed within the qu estionnaire, as well as meetings and discussions with Grantees during t he fun ding period, it was recogni zed th at th e RHS Grant Program reinforced th e need to focus on som e basic business practices and principals.
Som e of t he ge neralized recomm endations offered as a result of the " lessons learned" fro m this program are:
Every hospital should build and/or improve existing relat ionships with the community; don' t ta ke the community for granted.
Recognize t he importance of engaging (and st aying engaged w it h) st akeholders, providers, and community partners.
Re-evalu at e services offered by your hospit al; eliminate or add services based on need, utilization, cost, and ability to generat e revenue. Don't continue "doing w hat has always been done" simply due t o 'tradition' or out of 'f ear of change'.
Marketing is extremely important; don't assume your community is aware of t he servi ces you offer or the qu ality of your care. M arketin g, promoting your services, and educating your co mmunity on w hat you have to offer is th e first st ep in reducing outm i grat i on .
Invest in your employees. Improve employee morale and workplace satisfa ct ion. Solicit input from st aff and implement reasonable suggestions. M aintain high expectations for professionalism, productivity, compet ency, and quality of work. Above all, lea d by exa m p l e.
Show pride in th e facility. Improve the appea rance of the hospital, parkin g lot, and surrounding areas. Sometimes huge improvements can be made by simply cutting the grass, trimming t he bushes, perking up the flower beds and picking up trash in the parkin g lot. First_impressions are lasting.
And last, ensure all st aff underst and the importance of creatin g a fri endly and w elcoming environment for vi sitors and co-workers alike. Offering a smile, being kind and polite, professional and respectful, and "going the extra mile" ca n improve the reputation of a hospital w ithout the need for a budget increase.
The St at e Office of Rural Healt h asked t he Chief Execut ive Offi cers of Grantee Hospitals to provid e a st at em ent regardin g their experi ence w ith th e grant program . A full listing of responses can be locat ed in Appendix F of this document.

46
0 .Q!!IL. AOMslon ollht Gt orgla Oopt rtmontolCommunity Hfllil>

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Summary
The spot light on the rural hospital closure crisis across the country and t he conversations th at began because of th e closures brought t his situat ion t o the Nation's attention. Georgia is fortun at e that Governor Deal chose t o add ress t his cri sis in an aggressive m ann er.
Continuing into Govern or Kemp's Administration, Georgia is providing on-going support for rural hospita ls t hrough the Rural Hospital Sta bilization Grant Program and other rural-focused initiatives. The RHS Grant Program has al lowed an opportunity to det ermin e which grant fund ed project s have or have n't w orked, and all hospitals, even those that have not been part of the Stabilization program, can and wil l continue to benefit from the results of this funding.
Grantees acknowledged th at due to the requirements of the grant, th ey bega n evaluating their day-t o-day pr act ices and reviewing hospital dat a from a different perspective . M any rural hospitals had been fun ctioning in a "survival" mode for so many yea rs that selecting proj ect s and making decisions about effective ways to spend grant fund s was surpri singly ch allenging to some. The va lue of an up-t o-dat e Strategic Plan was recognized by Hospital Grantees through this program.
The St ate Office of Rural Hea lth reports frequently on the RHS Progra m in loca l, region al, and state level m eetings. As th e goals of th e program and the results of proj ect s select ed by grantees is spot lighted in these public forum s, all hospitals are encouraged t o place a higher emphasis on intern al assessments and st rat egic planning.
Oth er st at es have now taken the lead in hospita l closures, but t he visibilit y and success of the
Rural Hospital Sta bilization Grant Program has allow ed ot her stat es to bring this program into their conversat ions as they begin to address these problems in t heir own st at es.
The Stat e Office of Rura l Hea lth is fortunate t o have the responsibility of adm inist erin g this gra nt and w ill provid e follow up information on Phase Four and Phase Five outcom es as an add endum to this report in December 2021.

47
0 ,Q!!Jil/, A OMtloo of lht Oto,gl1 01p1r1m1nt of Community H111lh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Sources
2019 American Hospital Association Rural Report, www.aha.org.

Georgia: 2010 Population and Housing Unit Counts 2010 Census of Population and Housing. U.S. Department of Commerce, www2 .census.gov/library/publications/decennial/2010/cph-2/cph-212.pdf.

"About Appling HealthCare." Appling Healthcare, www.ahcs.org/.

"About Crisp Regional Health Services." Crisp Regional Hospital, www.crispregional.org/about/ .

"Welcome to Emanuel Medical Center." Emanuel Medical Center: About, www.emanuelmedica l.o r g / a b o u t /.

"Union General Hospital, Inc." Hospital in Blairsville, GA / Union General Hospital,

www.uniongenera lhealthsystem.com/ugh .



"Get To !<now Your Habersham Medical Center." About Habersham Medical Center/ Habersham County Medical Center in Demorest GA, www.habershammedical.com/about/.

"About Miller." Hospital Authority of Miller County, www.millercountyhospital.com/about-us/.

"Upson Regional Medica l Center." URMC, urmc.org/.

" Hospital History." Bacon County Hospital, www.baconcountyhospital.com/getpage.php7name=history&sub=BCH%2BHistory.

"Chatuge Regional Hospital." About Us / Union General Hospital, www.uniongeneralhealthsystem.com/crh

"TRHS News." New name and location for Cook Medical Center, h t t p : / / w w w . tiftregiona I.c o m / b o d y .cfm ?id =38S&action =deta i l & r e f= 1606

"Inpatient and Outpatient Care." Effingham Health System. www.effinghamhea lth .org/ourservices/inpatient/.

"About Us." About Us - Irwin County Hospital, irwincntyhospital.com/about-us/.

"About Us." Welcome To Jasper Memorial Hospital, www.jaspermemoria lhospital.org/about-us/.

"Our History." Liberty Regional Medical Center, www.libertyregional.org/getpage.php?name=history.
48
0 ,Q!!J:!w, A Diviolon oJ th, Gtorgi Oopart,,,,nt ot Community Hu1t11

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

" History." Memorial Hospital & Manor, 31 Aug. 2017, www.mh-m.org/about-us/history/.
"Mitchell Co unty Hospital." Archbold M edical Center, archbold.org/mitchell.
"About Us." Archbold Medical Center, archbold .org/about.
"SGMC Lanier Campus." South Georgia Medical Center, www.sgmc.org/our-locations/sgmc-laniercampus/.
"Welcome to Washington County Regional Medical Center." Washington County Regional Medical Center: About, www.wcrmc.com/index.php?id=235.

49
0 ,Q!!I!", ADivisiooorthe Goorglo Dtp1~m,n1or Communily Hu ith

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Appendix
The following documents can be located in this sectio n of the report:

Appendix A Press Release - "Deal Releases Rural Hospital Stabilization Committee Report"

Appendix B Rural Hospital Stabilization Committee Final Report to the Governor

Appendix C Map of Funded Sites

Appendix D "Where Are They Now?" Project Questionnaire Template

Appendix E Responses to Questionnaire

Appendix F Quotes from Chief Executive Officers

so
0 .Q!!l!", ADivision of the Gtorgla Oop1rlmtnt ol Community Hoa1U1

n~ Y J GEORGIA DEPARTMENT OF COMMUNITY HEALTH
Appendix A
Press Release
"Deal Releases Rural Hospital Stabilization Committee Report"
0 ~-2~I!,,. AOivi,lon ol 0,e o,orgl Oop1nmen1olCommunity H11llh

For immediate release Feb. 23,2015

Office of Communications (404) 651-7774

Deal releases Rural Hospital Stabilization
Committee report
Immediate action to be taken in order to meet the needs of rural hospitals across state, governor says
Gov. Nathan Deal today released t he final report of recommendations from his Rural Hospital Stabilization Committee, which was created last April to identify and provide solutions for the needs of Georgia's rura l hospital community.
"When a rura l hospital struggles, a community struggles," said Deal. "Back In April we stood at a critical juncture fo r some of our state's rural health care systems, and this comm ittee was just one of the paths taken to ensure that Georgians, no matter where they live, have the ability to receive adequate care. These recommendations, a result of countless hours of dedicated analysis and review of a system that affects not only our citizens' well being, but also our local economies, w ill serve as a strong starting point toward providing high-quality health care t hroughout rural Georgia."
Included in the recommendations is the establishment of a four-site pilot program, based upon an integrated "h ub and spoke" model, to relieve cost pressures on emergency departments and ensure that the best, most efficient treatment is received by patients. The program aims to increase the utilization of new and existing technology and infrastructure in smaller critical access hospitals, W i-Fi and telemedicine equipped ambulances, telemedicine equipped school clinics, federa lly qualified health centers, public health departments and loca l physicia ns. The four proposed hubs of initial implementation are Union General, Appling Health System, Crisp Regional and Emanuel Regional Medical Center.
"Just as a medical emergency can't wait, neither can we wa it to act upon these recommendations," said Deal. "An additiona l $3 million w ill be allocated in this year's budget to the State Office of Rural Health within the Georgia Department of Community Health to fund the necessary too ls the four hubs need to effectively im plement th is pilot program. It is my hope that these efforts are not a temporary fix, but rather the begin ning of a long-lasting road to recovery for our rural health systems."
The committee, which included health care professionals, legislators, loca l officials and business owners, also recommended the maintenance of existing Certificate of Need laws to protect existing rural hospital infrastructure. Other legislative f ixes include the expansion of t he scope of practice for midlevel providers, such as nurse practitioners and physician assistants, who could help bolster health care resources in rura l communities.

"First of all, I want to t hank t he governor for listening to my concerns about the plight of rural hospitals and health ca re in rural Georgia and for creating th is comm ittee," said Committee Co-Chair and state Sen. David Lucas. "Since April, we have worked to put together meaningful solutions to address these needs. On behalf of the entire Rural Hospital Stabilization Committee, I th ank the Governor Deal and his staff for instituting programs to st art the process of trying to address hea lth care in rural Georgia."
"The Rural Hospital Stabilization Committee tasked by Governor Deal has worked hard to achieve our goal of identifying and providing solutio ns for our state's most chall enging rural health care needs," said Comm ittee Co-Chair and state Rep. Terry England. "Together, w it h the support of the General Assembly, the Governor's Office and state agencies, we are committed through these recommendations to improve our rural hospita ls, and by ext ensio n, the quality of life of all Georgia citizens."
Brian Robinson brobinson@georgia.gov
Merry Hunter Hipp m hhi pp@geor gia.gov

n

GEORGIA DEPARTMENT

~ J ) I OF COMMUNITY HEALT H

Appendix B
Rural Hospital Stabilization Committee Final Report to the
Governor

0 ,Q!!l!L. AOivilion of \he Goorgla Oop1rtm1nl of Community H11lth

~~~~rt 0...
It
~- " ,.,

Rural Hospital Stabilization Committee Final Report to the Governor

February 23, 2015

Rep. Terry England Sen. David Lucas
Co-Chairs

Rural Hospital Stabilization Committee

Table of Contents

.

Report

Background

3

Findings

4

Final Committee Recommendations

5-6

. . Final Report

Rural Hospital Stabilization Committee
Background
In April 2014, Gov. Nathan Deal announced his appointments to the Rural Hospital Stabilization Committee, which was created to identify needs of the rural hospital community and provide potential solutions.
"In March of this year, I proposed three revisions to the way we approach rural health care, with one being the Rural Hospital Stabilization Committee," Deal said. "I recognize the critical need for hospital infrastructure in rural Georgia and remain committed to ensuring citizens throughout the state have the ability to receive the care that they need. This committee will work to increase the flow of communication between hospitals and the state and improve our citizens' access to health care. I am proud to welcome this team and look forward to what we stand to accomplish."

Members of the Rural Hospital Stabilization Committee

Rep. Terry England, Committee co-chair Sen. David Lucas Committee co-chair Jimmy Lewis Temple Sellers, Esq. Greg Hearn Scott Kroell Maggie Gill Wade Johnson Dr. Angela Highbaugh-Battle Charles Owens
Molly Howard Jimmy Allen Dr. Thomas Fitzgerald Ronnie Rollins David Sanders Dr. Jeffrey Harris

Georgia House of Representatives
Georgia Senate
HomeTown Health Georgia Hospital Association Ty Cobb Regional Medical Center Liberty Regional Medical Center Memorial Health Lincoln County Commission Chairman Pediatrician Georgia Department of Community Health, State Office of Rural Health Jefferson County Superintendent Business Owner and Tift Regional Hospital Board Member Tanner Medical Center, Emergency Medicine Community Health Systems Fannin Regional Hospital OB-GYN

The Committee members represent a variety of constituencies in and perspectives on the healthcare system, from legislators, CEOs, and healthcare professionals to business owners and local officials. All brought their unique perspective to help shape the recommendations contained in this report.

The Committee respectfully submits this final report to Governor Deal for his consideration. This report contains Committee approved recommendations, and represents the culmination of over six months of dedicated review and analysis by the Committee.

I . I I Final Report

Rural Hospital Stabilization Committee
Committee Findings
The Committee heard testimony that four rural hospitals have closed in recent months with total of eight having closed or attempted to reconfigure in last two to three years. Additionally, fifteen rural hospitals are considered financially fragile , with six operating on a day-to-day basis.
One of the main areas of focus for the Rural Hospital Stabilization Committee was to address Emergency Department (ED) stressors in rural hospitals that can contribute and lead to their closure. In an effort to address this issue, a process to scale down hospital operations and create a stand-alone ED was proposed. After testimony and research it was determined that stand-alone EDs are not financially viable, due to several reasons. There are issues with the reimbursement mechanisms and there are extremely high labor costs and capital investments. National trend data also shows most of these being developed in wealthier, suburban areas as opposed to rural areas. It was determined that it takes approximately15,000 ED visits to breakeven which equates to a needed population of approximately 35,000. However, Georgia has virtually no rural hospitals in counties capable of supporting an ED without outside subsidies
The committee also agreed that rural healthcare is facing many transformations due to the Affordable Care Act, changes in the State Health Benefit Plan (SHBP), and the continued reduction of reimbursements. ,
Research by the committee highlights the many resources we have throughout Georgia that can assist in maintaining our rural healthcare infrastructure. Federally Qualified Health Centers (FQHC) report 156 access points in Georgia. There are 55 school systems that have already adopted telemedicine through their school nurse program and there are in excess of 20 nursing homes that are telemedicine equipped. Georgia is also fortunate enough to have 1,000 ambulances already equipped with locator systems and WIFI capabilities. Many of these also have telemedicine capabilities. Georgia has skilled physicians, both independent and hospital owned, that are serving our rural patients. The committee is supportive of Governor Deal's initiative to grow residency slots in Georgia to address physician shortages, especially in primary care. It is the hope of the Committee that these young doctors will establish their careers in Georgia, especially in our underserved and rural communities.
These findings helped guide the Committee to the recommendations included in the remainder of this report.
. . Final Report

Rural Hospital Stabilization Committee
Final Committee Recommendations
Below are the Rural Hospital Stabilization Committee's final recommendations to Governor Deal.
Four Site "Hub & Spoke" Pilot Program Legislative Budgetary

Four Site "Hub & Spoke" Pilot Program

The Georgia Department of Community Health, State Office of Rural Health will be designated as the oversight entity for the proposed pilot program implementation and monitoring. This pilot seeks to build out an integrated "Hub and Spoke" model to prevent the over-utilization of the ED as a primary care access point. Rural hospitals often see over-utilization in patients with congestive heart failure, chronic illnesses (diabetes), and social disease states. The "Hub" systems have, in addition to the hospital, nursing home, home health, and rural health clinic components. The four proposed hubs are Union General, Appling Health System, Crisp Regional, and Emanuel Reg ional Medical Center. The "spokes" would include the following:



Smaller Critical Access Hospitals



Ambulances- W IFI and Telemedicine equipped



School Clinics- Telemediclne Equipped



Federally Qualified Health Centers



Public Health Departments



Local Physicians

The goal of the "Hub and Spoke" model is to best use existing and new technology to ensure that patients are being treated in the most appropriate setting thus relieving some of the cost pressures on the smallest rural hospitals' emergency departments. Using many of the resources outline above, healthcare professionals can ensure that each patient is being transported to the appropriate setting, monitor chronically ill patients to help them avoid repeat trips to the hospital and address frequent fliers that clog our small emergency rooms. Using methods such as health apps with medical reminders, social and community services like Meals on Wheels and mobile monitoring will relieve some of the most costly pressures on small hospitals.

It should be noted that these methods and technologies will need to be accepted and

recognized by both the CMOs and the State Health Benefit Plan in order to ensure that services

provided receive the appropriate reimbursement. Additionally, it is the desire of this committee

to see this pilot operate as a public-private partnership. Thus, it is important that the state's

CMOs, SHBP administrators, private insurers and local governments are willing to work

collaboratively with the Department of Community Health, State Office of Rural Health on this

pilot program.

Final Report

-

Rural Hospital Stabilization Committee

These four pilot sites and the various spokes will need to address software systems and process improvements to ensure this model can work. These include:



Fully installed Electronic Health Records (EHR)



Fully developed ICD-10 software and processes



Advanced case management processes



Physician Office process improvements (Amerigroup pilot)

Additionally, the Committee encourages the four pilot sites to continue to work with the Department of Community Health, to seek improvements in the regulatory system . It was discovered that there are regulations and rules in place that might hamper the implementation of some of the above ideas. Any changes to regulations should be considered with compliance with federal statutes like EMTALA in mind.

The Committee fully agrees that this model is not the complete or the only solution to the many problems facing rural hospitals. It is, however, a method of testing best practices and determining what works best in our communities so that they can be replicated across the state.

Legislative

The Committee determined that in order to maintain and protect the fragile rural hospital infrastructure existing Certificate of Need (CON) laws need to be maintained. Further, the Committee recommends the expansion of the scope of practice for mid-level providers, such as nurse practitioners and physician assistants. With a growing physician shortage, it was determined that these expansions could help bolster healthcare resources in rural communities.

Budgetary

T he Committee is requesting $3,000,000 to be appropriated to the Georgia Department of Community Health, State Office of Rural Health (SORH). The Department's SORH would then grant this money to the four sites for hardware, software , program development, process improvements and training needs as well as the implementation, monitoring, and evaluation costs.

I.Ill Final Report

n

GEORGIA DEPARTMENT

~)JI OF COMMUNITY HEALTH

Appendix C
Ru ra I Hospita I Sta bi Iization
Grant Program Map of Funded Sites

0 ,Q!!It. ADivi,ion of th, G,orgia OapartmonlofCommunily Hulth

RURAL HOSPITAL STABILIZATION GRANT PROGRAM FUNDED SITES
RHSGP Yea r 1 - RHSGP Year 2 - RHSGP Year 3 - RHSGPYear4 - RHSGP Year 5

~ GEORGIA DEPARTMENT
~ ' OF COMMUNITY HEALTH
Appendix D
Ru ra I Hospita I Sta biIization
Grant Program ''Where Are They Now?'' Project
Questionnaire Template
O ~.Q!!J:t . ADivisionof lhoGeorgin Dopiu1mont otCommunity Health

State Office of Rural Health Rural Hospital Stabilization Grant Program
"Where Are They Now?n Project
Introduction, Project Purpose and Goal:
The Rural Hospital Stabilization Committee (the Committee) provides oversight of th e Rura l Hospital Stabilization Grant Program (RHSGP) administered by the State Office of Rural Health (SORH). Each November, SORH orga nizes a meeting to provide the Committee w ith an update on t he RHSGP, the project s selected by each grant recipient, and a status update of t hose grant funded projects.
SORH will be presenting a comprehensive written report to t he Committee at the annua l meeting on November 71", 2019. To assist in preparing this report, each recipient of a Rural Hospita l Stabilization (RHS) Grant is requested to complet e a questionnaire detailing projects funded through the RHS Grant, t he impact of those individual projects, and the sustained benefit of the program to both t he recip ient hospital and the surrounding comm unity.
Through the fi nancia l support provided by the RHSGP, the State of Georgia has demonstrated a genuine interest and investment in our rural hospitals. Our goal for t he Rural Hospital Stabilization Grant Program: Where Are They Now? report is to provide t he Committee with factua l, meaningful information specific to the investment of these grant fund s.
Instru ctions:
We are asking t hat you carefully review t his questionnaire, review any necessary records or data required for this report, and respond to these questions w it h as much detail as possible.
This questionnaire is divided into four sections: 1) General Grantee Information, 2) Project Specific Details, 3) Overa ll Impression and Benefit of RHSGP, and, 4) Financia l Data Collection.
Sections 1 and 3 are self-explanatory.
Section 2 will require you to complete Attachment "A", Narrative fo r each individual proj ect funded through the RHSGP. Attachment "A" is included with t his document.
Section 4 acknowledges the inte nt for SORH to partner with Draffin Tucker to utilize and summarize your hospital's financial data from your audited financial stat ements and other provided grant-specific financial information. Draffin Tucker will provide SORH with a multi-year trend analysis and
summarized results of th e RHS Grant recipi ents.
Section 4 does not require a signature . SORH staff will follow up with the CEO (or designee) t o confirm
approval prior to compiling this component of the report .
We respect your time and rea lize this report will req uire a significant effort on your part. To ensure you have adequate t ime to prepa re your response, we are requesting this report be returned to the State Office of Rural Health on or before the close of business on Tuesday, April 30, 2019.
Please e-mail your completed report to Nita Ham at nham@dch.ga.gov.
If you have any questions or need any additional information, please feel free to reach out to Nita at t he above e-mail address, or by telephone at 229-401-3086.
Page 1 of4

State Office of Rural Health Rural Hospital Stabilization Grant Program
" Where Are They Now?" Project

Section 1 : General Grantee Information

The information below was collected from your RHS Grant documents. If any errors are identified, please make your corrections on t his document.
Name of Grantee
I. {Hospital)

The f unding period for your RHS Gra nt is listed below:

I Date Funding Began:

I Date Funding Ended:

The total award amount to your facility is listed below:
I Total Award Amount I

The projects selected by your facil ity and funded with Rura l Hospital Stabilization Grant Program monies

are listed below:

Projects Selected by

1.

Your Facility

2.

3.

4.

Please provide Information in all areas shaded in green.

In t he space below, please provide information about t he designated RHSGP Project Ma nager (PM).

Name of PM:

Was the PM selected from staff already employed with yourfacility, or

hiredfrom outside your organization?

Is the PM still an employee ofthe organization? If so, In what capacity?

Section 2: Project Specific Details
For each ind ividual project you have identified above, please complete the Attachment "A" Narrative. Attachment "A" Narrative is a separate form t hat has been included in your e-mail along with this document.
Submit all Attachment A documents with this completed questionnaire on or before the Identified deadline.
Page 2 of 4

State Office of Rural Health
Rural Hospital Stabilization Grant Program
"Where Are They Now?" Project
Section 3: Overall Impression and Benefit of RHSGP Please review t he question in the column on t he left and provide your response in t he green box.
Based on your expe ri ence w ith the RHSGP, do you fee l this program met its intended objective to ensure patients rece ive t he "right ca re in t he right set t ing, at t he right t ime and fo r t he right cost"? Please explain how your projects supported this objective. Did your facility seek other grants/funding sources to expand or
sustain any wo rk begun
t hro ugh t he RHSGP? Overall, w hat do you
feel was t he most
beneficia l or impactful component of you r projects? Please ex plai n . Overall, what do you
feel was t he least
beneficial or impactful compo nent of your projects? Please explain. Based on your experience w ith t he RHSGP, if given the opportunity to st art your project over, would you have made the same decisions, choices, done anything different ly, etc.? Exp lai n .
Page 3 of 4

State Office of Rural Health Rural Hospital Stabilization Grant Program
"Where Are They Now?" Project

Based on your experience with the RHSGP, what suggestions or advice would you offer to a new RHS Grant r ec ipi en t?
Section 4: Financial Data Collection
The State Office of Rural Health will partner with Draffin Tucker to review pre and post grant financial data, which will be included in the report to the Committee. Reporting of this information will be
blinded; hospital-specific information will not be provided or identified in either the written or verbal
report to the Committee.

Hospital financial data Audited financial statements from fisca l year 2014 through your most

t o be utilized:

current fi sca l year.

SORH st aff will contact the CEO (or desired designee) to obtain permission for Draffin Tucker to access hospital specific information for this report. Below, please provide the name and cont act information of your CEO or his/her designee.

Individual to be Contacted:

Current e-mail address and phone number:

While compiling this report, additional information may be requested by SORH staff.
Please submit the completed questionnaire and all Attachment "A" documents to the State Office of Rural Health on or before the close ofbusiness on Tuesday, April 30, 2019. Please e-mail your report to
Nita Ham at nham@dch.ga.gov.
Thank you!!

Page 4 of 4

State Office of Rural Health Rural Hospital Stabilization Grant Program
"Where Are They Now?" Project

Attachment "A"

I Name ofGrantee
(Hospital}

Narrative

Instructions: For each individual projectfun~ed through your Rural Hospital Stabilization Grant Program (RHSGP), please complete this Narrative by responding to each item/question in column on t he left. Provide your responses in the green sections to the right ofeach item. Please be thorough and thoughtful.

Project Number l

Amount of f unding provided fo r t his project. Goal(s) of t his proj ect . Det ailed description of this project . How did t his project benefit your community? Is this project still on -go i ng? Was/is this proj ect fi nancia lly susta inable after t ermination of the grant ? Explain. Would your hospital have se le c t e d / f u n d ed t his project if the RHSGP had not been available? Explai n. Did t his proj ect lead to relat ionship development with other partne rs and subsequent addit iona l projects? Explain .

n~ Y J GEORGIA DEPARTMENT OF COMMUNITY HEALTH
Appendix E
Responses to Question:
"Based on your experience with the RHSGP, what suggestions or advice would you offer to a new RHS grant
recipient?"
0 .Q!!It. AOivi.lon of the Goorgl DepartmentofCommunityHn llh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Questionnaire Responses to the Following Question:
"Based on your experience with the RHSGP, what suggestions or advice would you offer to a new RHS Grant recipient?"
Listed below (in no particular order) are the responses received:
" Have a committee come together to discuss the most prominent needs in the community and focus on the top ones to get the most benefit from the grant."
"Defin e the measures of success, understand the frequency of reporting, fu lly access areas to see if change is possible. Appreciate how hard change is and know the change curve you are facing. Be su re there is a willingness to change but also build a case for change and innovation before begin ning."
"Take risks. Collaborate with other partners." "Based on our experience, we wou ld suggest common sense implementation project s
and choosing projects that any other parties involved are committed to the chosen proj ect and the resources needed to implement." " Learn from the experiences of others. One of the greatest benefits, besides what I learned from my own personal experience, is the knowledge that I learned from the project managers before me. Other than that, do your resea rch and find out what th e community needs. Communities are like fingerprints; they are all unique. What works for one might not work for another. One thing that I can say is invest in primary care. Access to a physician w ill help keep patients in your community more than anything else." "The best advice I can offer is the sa me I received from grant recipients that came before me: limit your project numbers and if possible choose ones that w ill complement each other so as you work on one, it will impact the other projects positively too. I feel we did this with the choices we made." "Go for it! Think outside the box some and don't be afraid to stretch your organization and yourself. Remember the interrelationships of your operation s and the need for consistent integration. Be nimble, unafraid to adapt, and ready to revise your plan if need be and it can be justified. Your hosp ital wil l be better for having made the effort to improve even if it a little short of your planned expectations. Build a t eam of three people to work on the project so that if you lose a player, the other two can continue seamlessly. Share all aspects of the venture including the presentations to SORH. Knowledge shared is knowledge gained - both for the group and the presenters. Smi le and always say "please and thank you"! Thank you!" "Align your project(s) with your organization's strategic plan. First, assess the needs from an organ izational level (ad min, BOD, etc.), then from the input of employees, then
0 .Q!!,!!1, ADivisionof tho Gtollll Oep1rtmen1 of Community He,11/1

n

GEORGIA DEPARTMENT

~)JI OF COMMUNITY HEALTH

from the community. If it's been done before, find out by whom, and ut ilize that resource." "Evaluat e t he infrastructure of any project that is undertaken, an d the ongoing fiscal needs of that project. Do not take on mu lt iple proj ect s during the year." "To make sure that you have a very detailed plan from t he start. Begin spending the grant money and invoicing the SORH as soo n as your tim elin e wi ll allow you to." "This program was such a tremendous opportunity for us to take part in. I would advise any hospita l to t ake full advant age of it and t he assista nce from the staff at the State Office of Rural Hea lt h. Patsy, Lisa and Nita are so knowledgeable and so willing to help you in any way. I truly appreciat e their guidance and help in all that they did to make our Grant successful." "We would advise a new recipient to choose one or two impactful and sustainable project s and not commit to too many projects, especially ones that cannot be sust ained." "Consid er reducing the amount of data reporting for th e grants t hat are smaller." "Select one project th at your organization ca n make t he most impact in. There is an abundance of pa perwork that is involved w ith each project so a good portion of staff time is spent co mpleting that requirement." "We r eco mmend when possible w ith such limited funds that a facility try to do as much of the construction and renovations internally. We were able t o identify intern al talent and hire a loca l tile and painter to red uce our costs of construction. The facility must have a dedicated project manager th at is experienced in construction and hospital renovations and work w ith others to get consultat ions on w hat needs to be don e to have the unit built correctly for patient care."

0 ,Q!!JI,. AD~ision or~" G1019i1 O1p11tm1n1otCommunllY H111111

n

GEORGIA DEPARTMENT

~)JI OF COMMUNITY HEALTH

Appendix F
Quotes from Chief Executive Officers of Rural Hospital Stabilization Program Grantees

0 ,2!!1!1, AO.vision of lh, G,o,gie Otptrtrrton1 of COMmuni1y Hoalv,

n

GEORGIA DEPARTMENT

~J)I OF COMMUNITY HEALTH

Quotes from Hospital Grantee Chief Executive Officers Specific to the Rural Hospital Stabilization Grant Program:
"We are extremely thankful for your time and the funds entrusted to us, with this has come opportun ities to travel down roads we would otherwise could not have done without this help and support."
" I have enjoyed the challenge of managing different projects with the ultimate goa l of contributing to stabilizing rural health care not on ly in our county, but one day perhaps to help another rural county hospita l."
"This has given us the abil ity to explore new strategies and ca re opportunities that otherwise might not have bee n an option due to lack of capitol and ri sks."
"We never anticipated the amount of physician opposition to these projects." "The project that has been the least expensive with the most results is the Commun ity
Paramedicine Program . It wou ld be wonderful if DCH cou ld explore funding options for regionalization of EMS and find ways to standardize and reimburse for CPP." "Whi le some project s focus on reducing readmissions, they also enhance the level of care we provide our patients and improve their overall qua lity of life, which is our overa ll goa l." "The project forced me as a CEO, to look at potential activities for the hosp ital that I wou ld not have considered, ones which are not eith er saving us money or generating additional revenue." "Although we discussed the need for collaboration, I believe the need is grea ter than I rea l ized." "You need a physician champion." "Change is difficult but necessary for rura l hosp ital survival." "Care coordination works especially in term s of improving individual's health; however, to rea lly have an impact on a popu lation's hea lth, you need to have enrollees from different levels of complexity. The first 7 we enrolled were 7 of the most complex in our co m m u n i t y ." 111spoke in favor of using telemedicine to bring specialty care back to our community; however, I don't think I realized how far it could go." "To really implement these projects will t ake 2 years, I wish this project had been funded for that time frame." " I hop e there continu es to be efforts to develop a payment model for community para med icine." "The Pilot Project has been more time-consuming than anticipated." "We have lea rned a great deal about our own data; th is was helpfu l in deciding on specific project s."
0 ,Q!!J;!,11, ADiYi>ion ol tht GeorgiaOeptllffltntof Communit/ Hoallh

n~YJ. GEORGIA DEPARTMENT OF COMMUNITY HEALTH "Community Param edicine - this service ca n be a benefit to the community and patients at risk. However, there is no reimbu rsement for this costly service." "Need to work closely with primary care physicians and pediatricians as they feel threatened by this project and think you are t rying to stea l their patients." "One of the most valuab le lessons has been commu nication and education regarding our local CSB. We didn't know them and t hey didn't know us before now. We are working together for the benefit of ou r mental health patients." "ED throughput, this is our most successful project to date. Simply taking the t ime to research your most problematic areas from a perception standpoi nt and t hen focusing on solutions was all we had to do." "One-year time frame was unrealistic because it takes months for so me projects, maybe a year to just get the projects off the ground and up and running. You then need time to impl ement and monitor. A 2-year time frame is probably more realistic." " I do feel that a year is not enough time to truly get an accurate picture on ROI for each project as we are nine months in and are just now overcoming some obstacles, w that said, I would like to continu e to monitor progress through our performance measures."
0 ,Q!!l!1, ADivision ofthe G,orgi Oopair1mon1 of Commvi,ity H11llh

0

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

Acknowledgements
The Georgia Departm ent of Community Health, State Office of Rura l Hea lth would like to thank the fol lowing for their dedication, commitment , and support of the Rural Hospital Stabi lization Grant Program (RHSGP):
Govern o r P. Brian Kem p, State of Georgia Nathan Dea l, Former Governor, State of Georgia Commissioner Frank W . Berry, Georgia Departm ent of Commun ity Health Clyd e L. Reese 111, Former Com missioner, Departm ent of Communit y Health Patsy Wha ley Hodge, Executive Director, State Offi ce of Rural Hea lth Charles Owens, Form er Executive Director, State Office of Rural Health Senator David Lucas, Georgia Stat e Senate Representative Terry England, Chairman, House Approp riat ions Committee Members of th e Rura l Hospital St abilization Committee RHSGP Recipients, Chief Executive Officers, Chief Financial Officers, and Project Managers Lisa Carhuff, Former RHSGP Project M anager Nita Ham, Director, SORH Progra m, RHSG P Project Manager Cole Edward s, SORH Program Operations Specia list Draffin Tucker, LLP

Authors: Nita Ham, Director, SORH Program Department of Community Health State Office of Rural Health
Sarah M. Dekutowski, CPA Partner DraffinTucker, LLP
Cole Edwards, Program Operations Specialist Department of Community Health State Office of Rural Health
51
0 .Q!!.lL. ADM,lonoflht Giorgi Oopor1/nonlolCommunily Htallh