HJAR Mar/Apr 2024

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2024 15 a patient, genuinely wants to help the community, wants to live in a rural area, and wants to try to find the best way to support their patients and understand their current situations and how they can help make those improvements as they go forward. Editor You had a recent visit from the governor. Did you have a chance to talk to her about the Medicaid challenges that you face? Peterson We had a really good visit with the governor. We got to tour her around the hospital a little bit. Then, we got to sit down and talk to her about some of our struggles and challenges. She probably knew some of this, but we pointed out to her that Arkansas is one of the lowest paid hospitals onMedicare. We know she doesn't have any input on Medicare, but all commercial rates and everything seemed to be based off of Medicare. Then, we talked about when the last increases were for Medicaid, which was in 2007. Our last outpatient increase was like 1992. Editor Your last increase was 1992? Peterson Yes, it was 1992, and it was actually a decrease in outpatient payments. Editor So, you haven't had a pay increase since? Peterson Not on Medicaid pricing, no. Editor What percentage of your hospital is Medicaid? Peterson About 15%. Well, no. I take that back. When I say 15%, that includes the expansion, and that's about 8%. So, about 7% is Medicaid. Editor Wow. Does that affect the infant mortality rates? Peterson How should I say this? I don't think payment directly affects a rate. I do believe it affects the challenges and why you see fewer labor and delivery units across the state and across the nation. For us, we have about 62% Medicaid deliveries, if I remember correctly. The delivery world has changed so much in that, when I first moved here, we had about six family practice physicians delivering babies. Then, we had two or three OB-GYN doctors, so we probably had eight or nine physicians delivering. All the family practice doctors have gotten out of delivery. They just haven't found that that fits in their practice anymore. At one time, we were down to two OB- GYN doctors, but we do have three now. It's just very difficult to recruit OB-GYN doc- tors. They're in high demand. They like to be in places where their call is 1 in 8 instead of 1 in 3. They like to be in larger facilities, non- rural areas. Then, you start paying more for physicians, more for anesthesia. It is a very expensive area, and yet, the majority of your babies are Medicaid, so your reimbursement is not very good. Some hospitals choose to get out of that business because they can't find the people, or they can't afford it. We've been fortunate enough to be able to con- tinue providing the service. We plan to con- tinue to provide that service, but it is very challenging to keep it going. Editor Do you think that's part of the reason that Arkansas has such high maternal and infant mortality rates — because there have been closures? Peterson Again, I don't put the two together. I see it as a challenge to reimbursements. I think we have to work as providers, and we have to work as a state on, "How can we reach these people earlier? How can we make sure they get into their prenatal care? How do we make sure that they get the right care?" I think there are other reasons versus just strictly the cost. I do see an indirect, but I don't see a direct. Editor We understand you were asked by the governor to take a look at managing Fulton County Hospital. Peterson Yes, the governor did an audit and asked us this summer if we would take a look and see if we could manage Fulton County Hospital. We've been able to work closely with Fulton County Hospital. We're really glad to be able to expand our services over there and to be able to keep Fulton County Hospital open and able to serve those patients in those communities. It goes hand-in-hand with our philosophy of trying to get that service as close to home as possible. That's how you really affect that day in and day out of building those relationships with your primary care. I know that people are going to go to telemedicine and apps and all kinds of things like that. I get that. We're moving in that direction, too. But I also know it's that relationship that makes you really consider and makes you decide to make those personal changes that are required in your health — to be involved and to be able to get involved in your own healthcare and in the improvement of your health. That's really important. Editor Part of your job is to plan for emergency preparedness. What's on your radar for that? What's your plan? Peterson What's happened in recent years is so amazing. The one thing you're not planning for is really there, you know?Who would've thought of COVID? When we look right now at emergency preparedness, we think about safety first in the hospital. Maybe it's a bad analogy, but I'm old enough to at least remember the VietnamWar on the news. The analogy I make is healthcare workers and soldiers in the Vietnam War are kind of the same in that when the VietnamWar started, sol- diers were heroes. But by the time the war ended, soldiers were zeros — not inmy mind, but that was the American mindset. I think healthcare workers, when COVID started, we were all looked at as heroes, whether we're administrators or providers. By the time COVID got done, it's amazing how people do not respect healthcare work- ers. So, safety for our workers is a key issue