Something has got to change about the way health care is delivered in the Delta.
The hospitals that serve the region are struggling to keep their doors open. They can’t afford to provide many of the specialties they previously offered. They have a hard time attracting physicians, and the nationwide shortage of nurses is particularly acute in rural areas like this.
Hospitals have been hit with a double-whammy. The population losses plus the major shift in health care to outpatient treatment have severely reduced the number of people who require inpatient care, leaving hospitals with much more space than they can fill. And because of the poverty in the region, not only do these hospitals have a heavy load of treating patients without insurance, but those that are insured are predominantly covered by either Medicare or Medicaid, whose reimbursement rates generally don’t cover what it costs to provide the care.
That leaves only a few options.
You can let some hospitals close or scale them down to little more than an emergency room. Or you can figure out a way for the hospitals to collaborate by sharing patients and coordinating medical services so as to maximize efficiency and provide as much care within a reasonable distance from home as possible.
But if you are aiming for greater collaboration between hospitals with different owners, you have to figure out an organizational way to make that work. Someone has to decide what services are so essential that every community must have them locally, what services are specialized enough that they should be reserved for maybe just one hospital in the network, and what services are so specialized or expensive that they are left to the major medical centers, such as those in Jackson or Memphis, that have the volume to support them.
The Delta Council has an idea how this might work. It has been working on the blueprint for a regionalized approach for more than a year, getting input from Dick Cowart, a Mississippi native and Nashville attorney who is considered a leading authority on health-care law and systems. This past week, it presented a general outline of the idea to the Mississippi Legislature — but it was met with a lot of suspicion and distrust from a group of Delta area lawmakers, with race being, as it often is, at the root of the distrust. Those lawmakers, mostly Black, said they were not consulted about the plan as it was being formulated by a group that is largely white.
According to reporting by Mississippi Today, the Delta Council plan centers on creating a Delta Rural Health Authority, which would manage not just a group of hospitals but also health-care facilities in the region, such as medical clinics and federal qualified health centers.
Communities would not be forced to participate. They could opt in or out, but presumably if they opt in, they do so with the understanding that they are willing to relinquish some local control.
That’s obviously going to be one of the major sticking points. Hospital administrators may see the value of avoiding expensive duplication of services, but politicians tend to worry only about what’s in their backyard. They see hospitals not just as places for providing medical care but also places where they can find or create jobs for their friends and supporters. They don’t want to lose that avenue of patronage.
There was also pushback over who would appoint the nine to 12 people who would sit on the authority’s board. Cowart told lawmakers that the governor would have three appointments, but a draft of the Senate bill, according to Mississippi Today, would give him the say over five appointments, including at least a couple who could be from anywhere in Mississippi.
Gov. Tate Reeves is not the most popular person in the Delta, a heavily Democratic region that went for his opponent, Brandon Presley, in the November general election. Democratic leaders accuse Reeves of neglecting the Delta on economic development projects while contributing to the hospitals’ financial struggles by stubbornly refusing to expanding Medicaid.
Some even claim that if Mississippi had accepted the federal government’s sweet deal of expansion when it was first offered a decade ago, the hospitals in the Delta would not be in a crisis.
That is an exaggeration. Medicaid expansion would be helpful, just as Reeves’ recent successful effort to enhance Medicaid supplement payments has been helpful. It’s ridiculous that Reeves has thumbed his nose at expansion.
But it is not a panacea for what ails the Delta’s hospitals. The uninsured are only one part of their dilemma. They are being squeezed by insurance reimbursements that are not keeping up with rising costs, with more infrastructure than patients, with an aging and shrinking supply of physicians and other skilled medical personnel.
That’s why a new, comprehensive approach is needed. If someone has a better idea than regionalization, let’s hear it.
- Contact Tim Kalich at 662-581-7243 or tkalich@gwcommonwealth.com.
