Ozarks Community Hospital, in Springfield, which serves primarily those on Medicaid and the uninsured, will close its inpatient and emergency units soon after the Centers for Medicaid and Medicare Services (CMS) decided it didn’t meet the definition of a hospital.
And its CEO, Paul Taylor, couldn’t be more frustrated with how they ended up at this point.
OCH opened in January 2000 in a former hospital that had been closed for more than two years. It had 45 beds, according to Taylor, but they weren’t being filled, so they looked for specific needs in the area. That led to the opening of a 10-bed geriatric behavioral (gero psych) unit for patients from area nursing homes who were being forced out because of dangerous behavior. They came to OCH for evaluation, therapy and in some cases—medication. Besides the geriatric psych unit, they had five to ten medical inpatients.
According to Taylor, the hospital was forced to close its gero psych unit in 2013 after the Recovery Audit Contractor Program took back payments made to OCH for patients admitted to the unit saying they weren’t medically necessary. He said legislators and the Missouri Hospital Association stepped up on their behalf saying the inpatient program was needed.
"What are you going to do--put them in the Tiger Hotel or something? You know, an elderly patient that's demented and has other psychosis. No. They have to be in a hospital. They have to be in an inpatient bed," Taylor said.
He says OCH appealed to get back the money and won, but the damage was done. They went from a small hospital with around a dozen patients in the hospital to “a pretty large clinic organization taking care of a lot of Medicaid patients.” OCH’s patient payer mix, he said, is 90% governmental and uninsured.
The Healthcare Facilities Accreditation Program, who were contracted by CMS, visited OCH in 2015. Taylor believes CMS told them to be on the lookout for small volume inpatient hospitals that “cherry pick” the services they offer in order to make more money. He feels they got caught up in what he calls a “dragnet.” After HFAP’s visit, CMS sent state surveyors to OCH.
He told a room of employees last week he was willing to do what it took to meet the definition of a hospital, but he couldn’t get CMS to tell him what that means.
"Maybe I can do it. Tell me--what's the standard? Is it 20 percent inpatient to 80? Is it 30 percent to 70? is it 10 to 90? Tell me," he said.
He said they filed plans of correction and were told in January of this year they were in compliance. But on July 13, he got an email from CMS telling him they were terminating the hospitals’ Medicare provider agreement, which he said is a death sentence for a hospital.
"If you lose your Medicare provider agreement it automatically terminates your Medicare provider agreement and every other payer contract you've got. No one will pay you," he said.
He pushed for CMS to send him a notice of deficiencies, so they could file a plan of corrections. They sent it but not until after a public notice of the hospital’s closure on August 1 was published in the News-Leader.
A law in Missouri, he said, allows hospitals to suspend their licenses for up to 180 days for “good cause,” but he’s not optimistic.
"Knowing the CMS appeal process, there's very little chance I'm going get a decision in 180 days. I believe we're going to win on appeal, and I'm going to win on appeal even if there's no way I can reopen the hospital, because I have proof that we were doing nothing wrong," he said.
Seventh District Congressman Billy Long and U.S. Senators Roy Blunt and Claire McCaskill have written to CMS requesting that the agency delay the termination of their Medicare provider agreement with OCH until the final result of the hospital’s appeal. But Taylor said, since they’re barely operating in the black, he’s not sure they’d have the resources to reopen if they were given the chance.
Rather than shut down entirely, though, the hospital will become an outpatient clinic of the Gravette Hospital, a critical access hospital in northwest Arkansas that’s part of the OCH system.
They will no longer offer inpatient care, and they’ll shut down OCH’s emergency department and operating room. But Taylor said they’ll still offer other services, including radiology, cardio-pulmonary, physical therapy and their physician clinics.
"But we're going to stay open, and we're going to keep providing good care. We're going to stay in the Medicaid Medical Home program. My goal is--we've got 2,000 patients in that program, and we're the biggest in the state, they haven't seen anything yet. We're going to have 5 or 6,000 people in that program in a few years," he said.
They’ll keep growing the clinics, he said, but that will become more difficult because the hospital won’t be there to supply the overhead support for those clinics.
"Medicare revenue declines by 40 percent for my clinics and my other departments. We were losing money before that happened," said Taylor.
But he said, “I have incredible people, and they’re mission-driven. We will stay open.”
Meanwhile, human resources is working individually with the approximately 200 people who are being laid off due to the hospital’s closure. And OCH recently held a job fair with around 20 companies in attendance.
The closure, he said, will likely have a big impact on Springfield’s other hospitals. “They payer mix for the ED (at OCH) by hospital standards is horrific—80 percent Medicaid and uninsured,” Taylor said. “Now they’ll have to go somewhere else for emergency services.”
According to OCH, the following facilities will remain open and can accept new patients while continuing to welcome Medicaid, Medicare and Tricare and other insurances.
OCH Primary Care Clinic (2828 N. National), OCH Medical Offices Clinic (2828 N. National), OCH Northside Behavioral Medicine Clinic (2828 N. National), OCH Evergreen Clinic (1540 E. Evergreen); as well as OCH Christian County Clinic (Nixa), OCH Sparta Clinic (Sparta), OCH Webster County County Clinic (Rogersville), OCH Wellpointe Family Medical Clinic (Marshfield), OCH Lawrence County Clinic (Mt. Vernon), OCH Polk County Clinic (Bolivar), OCH Jasper County Clinic – Carthage Campus (Carthage), OCH Noel Clinic (Noel), OCH Gravette Clinic (Gravette, Ark.). Our health system also includes a hospital in Gravette, Arkansas.
