Lyndon Baines is blunt when it comes to health care.
“This should be a bipartisan issue,” he declared. “No matter what party you're in, you should care about the health of human beings.”
Small-town politicians don't often take on hot-button issues that send state and national politicos scampering along party lines. But as the first-term mayor of Jamestown, Baines is not in a typical situation.
The city is reeling from the closure of Jamestown Regional Medical Center, an 85-bed hospital and emergency room that served the town and Fentress County, a neighboring Upper Cumberland community.
Baines' counterpart, Fentress County Executive Jimmy Johnson, is equally candid.
“I don't put it above education,” he said, “but I put it pretty close to there.”
The pair have sought intervention all summer ― from Rennova, the Florida-based medical laboratory company that owns the hospital; from their representatives in the Tennessee General Assembly; and from Gov. Bill Lee during a meeting in his Nashville office.
“It feels like the owner of this hospital is holding us hostage,” Baines said during an Aug. 6 Stand for Rural Healthcare rally organized by the Tennessee Democratic Party outside the closed facility on Hwy. 52 West.
The group later moved to the Fentress County Courthouse for a roundtable discussion. There, Johnson weighed in with opening remarks.
“It's a very sore issue with a lot of people, myself included,” he said.
It's the dog days of summer, and Johnson's worries echo those of the people he leads: the expediency of treatment that leave rural residents prone to injury from farm accidents, vehicle crashes and snakebites, not to mention an aging population and those on disability who depend on hospital care for what can be complex medical issues.
Signature HealthCare of Fentress County sits directly behind the hospital. The county's sole nursing home houses some of its more frail residents who have relied on the close proximity to the hospital to attend to their needs. For some, the hospital environs are as familiar as those of their rooms across the parking lot.
Johnson and Baines are perplexed why officials with Rennova, which also owns hospitals in Oneida and Jellico, are reluctant to let go of the Jamestown facility. The two officials said they continue to talk with Rennova CEO Seamus Lagan at least once a week.
“There has been an offer to him ― two offers” to buy the hospital, Johnson said.
But no offers have been accepted. Ambulances heading for the nearest hospital often turn south on Hwy. 127 for the almost-80-mile round trip to Crossville's Cumberland Medical Center.
And Jamestown Regional's doors remain locked, a cache of wheelchairs sitting pell-mell behind the glass door closest to the entrance. “Emergency/Admissions” read lighted lettering aglow over the main entrance.
The automatic doors don't open, despite the welcoming yellow fluorescent lighting spilling from them and posted visiting hours. Lest one forgets, signs from a color printer are taped to the door to remind them.
“Jamestown Regional Medical Center is temporarily closed,” the bold letters read, with “temporarily closed” in red and all caps.
Affixed next to them is a handwritten statement. Signed by Jamestown primary care physician Dr. Mark Clapp, it seemingly speaks for the entire county.
“With God's help, we will be back!!”
'It's almost a perfect storm'
Cumberland County's neighbors to the north aren't alone.
Jamestown Regional Medical Center is one of 14 hospitals that have closed in Tennessee in recent years, said Bill Jolley of the Tennessee Hospital Association.
Eleven of those have been rural hospitals, like Jamestown Regional and Celina's Cumberland River Medical Center, another Upper Cumberland facility that shuttered its doors earlier this year.
“It’s almost a perfect storm,” Jolley said during a Cookeville roundtable hosted by Republican U.S. Rep. John Rose. “Without intervention, I think we’ll see more hospitals close.”
Rural Tennesseans bemoan the closings, but hospital officials believe some of their medical care choices could be part of the problem. Opting to see doctors in the more urban environs of Nashville and Knoxville supplements those facilities.
“We’re a more mobile society, and people are not staying in these small communities for care,” said Paul Korth, CEO of Cookeville Regional Medical Center. “But we’re going to have to figure out something because, in all these small communities, these services are needed. Emergencies happen.”
It’s hard for rural hospitals and communities to attract new doctors as established physicians retire. Cumberland County, for example, lost 13 primary care physicians since 2011.
“We have the same issue with nursing and even lab techs,” noted David Bunch, Cumberland Medical Center's chief administrative officer. “It’s across the board.”
Richard Tumlin, chief administrator at St. Thomas Highlands Hospital in Sparta, said a study of the surrounding communities found a 29-physician shortage.
Korth said the difficulty recruiting physicians had contributed to CRMC’s decision to close the Celina hospital. It was recently purchased by Rural Hospital and Clinics of America LLC, led by Johnny Presley of Crossville.
The CRMC administrator said the federal government may want to consider expanding programs to offer student loan forgiveness to medical providers choosing to work in underserved communities.
“Providers coming out of school today are heavily in debt,” Korth said. “A lot of our young and bright kids don’t want to go into medicine.”
Other options pitched by hospital leaders include loan forgiveness and Medicare-funded residency programs in rural communities.
'Is health care a commodity
… or is it a right?'
Tennessee Democrats believe the state's hospital closures are directly affected by the Republican-led General Assembly's refusal to expand Medicaid with federal dollars available through health-care reform enacted by former President Barack Obama.
“Research shows that expanding Medicaid makes a hospital six times less likely to close,” Mary Mancini, Tennessee Democratic Party chairwoman, told the audience during her party's roundtable in Jamestown.
Alternatives offered by Republican governors Lee and his predecessor, Bill Haslam, have also fallen stagnant.
“It simply makes good economic sense,” added Randall Rice of the Tennessee Health Care Campaign, an advocacy group rallying for Medicaid expansion, told those assembled at the Fentress County roundtable. “It's criminal what they're doing to this state. It's something like $7 billion that this state is giving to California and Arkansas.”
The federal program covers 90% of expansion costs. Rice and Mancini said Republicans balked at paying the remaining 10%, even when the Tennessee Hospital Association volunteered to foot the bill.
That sentiment is echoed by Republicans in Washington, many of whom view expanded access as a “right” to health care.
Michael Alexander, an experienced hospital administrator and Upper Cumberland newcomer tapped by Rennova to lead Jamestown Regional, broached that subject during Rose's roundtable.
Alexander's tenure thus far has been rocky. His hiring was announced by Lagan via a June 10 press release. The Centers for Medicare and Medicaid Services terminated the hospital's Medicare payments June 12, and the hospital closed the next day.
“It comes down to one question. Is health care a commodity that you buy as much as you can afford, or is it a right that everybody ought to get?” he asked. “We’re trying to sit on the fence and get a little in both sides and put that question in the future.”
“That’s not the answer,” replied Rose. “It cannot be; it is not a right. We can’t go down that path.”
Rose, who represents both Cumberland and Fentress counties as part of the 6th Congressional District, said making health care a right restricts freedom and leads to problems like those seen in Venezuela, Cuba or the former Soviet Union.
“We’ve got to have an incentive for people to struggle, to support themselves,” Rose said.
Fentress County is one of 15 Tennessee counties the federal government labels as “distressed,” meaning it's among the 10% most economically troubled counties in the nation.
The Appalachian Regional Commission, which ranks the economic status of all 3,113 counties in the nation, places Fentress County at 2,808th, with a per-capita income of $18,817 and a poverty rate of 23%.
“The hospitals closing ― the bulk of them are happening in counties that are not huge,” Rice said. “They're sicker, they're poorer, and they're uninsured.”
And, he and others at the Democrat roundtable in Fentress County noted, those people are often intimidated by the process of signing up through the Health Care Marketplace or for TennCare ― if they know how to find the information at all.
“One of the things people really need to know is what sources are available,” said John Robbins. He's the field representative for state Rep. John Mark Windle, whose District 41 includes portions of Fentress County.
“They don't know where to go,” he said. “They don't know what to do.”
Rice's group works through those intricacies. One of the people he's helped, a woman forced to leave her job due to the severity of her multiple sclerosis, was facing $1,200-a-month premiums under the COBRA health insurance law.
“Now, she's getting good, quality insurance for $16 a month,” he said.
'People have accidents, and
people need medical help'
“If you get hit by a car, you're liable to die from lack of medical intervention,” said Caren Wheeley, a Fentress County resident who worked at the hospital from 1990-'93 and serves as the county's Democratic Party chairwoman.
Standing in a blazing August afternoon sun outside Jamestown Regional's main entrance, she waited for her party's rally to start.
“This is more a concerned-citizen day than a political day,” Wheeley said. “People have accidents, and people need medical help.
“We're just hoping it can get reopened.”
Ambulance patients were diverted from the emergency room weeks before the June closing. Fentress County has five ambulances; two of which are designated for emergency calls. The other three stay busy taking people to out-of-town facilities, and Baines said county officials have found enough money to buy a fourth ambulance.
Paramedics and EMTs are taking on the roles of emergency provider that earlier this year would have been up to the community hospital. After rolling up to CMC, Cookeville Regional Medical Center, Livingston Regional Hospital or Big South Fork Medical Center in Oneida, it's back to Fentress County to start over.
With it, another problem has arisen.
“We've had people who have gone to the Crossville hospital by ambulance and have no way home,” Wheeley said.
Efforts are underway to organize volunteers to fill that need. It's only one of the ways that neighbors are helping neighbors.
“All the churches are stepping up to bat, and we're trying to take care of each other,” Wheeley said. “We're doing what we can.”
'At some point, we have
to profit to stay in business'
Hospital executives at Rose's Cookeville forum vented their frustrations over a recently approved budget deal that includes two more years of sequestration.
“That guarantees us a loss on Medicare patients,” said Thomas Kidd, CEO of Macon Community Hospital in Lafayette.
The Center for Medicare Services' wage index provides higher reimbursement to areas with higher wages. That same afternoon, CMS announced it would increase the wage index for hospitals with a wage index value below the 25th percentile, likely aiding rural hospitals.
CMC's Bunch said the change is a good start, but it's not enough. Even if the Crossville hospital is reimbursed at the same rate as nearby Cookeville, Bunch said the hospitals would still lose money treating Medicare patients.
“At some point, we have to profit to stay in business,” he said.
Because the wage index increased wage gaps between areas, hospitals often lost employees to nearby areas with a higher wage index. Replacing providers, from technicians to nursers to physicians, was more expensive than retaining those individuals, he said.
CMS rules also include a change in how a discount drug program figures costs for participating hospitals. It had been the wholesale price reduced by 22.5%. The new rule seeks to make the price the average sales price reduced by 22.5%.
“Some of these drugs will cost more than they ever have,” Bunch said.
Rose said he wanted to find a free market solution to health-care challenges. He said people with employer-sponsored plans would be the place to start.
“They’re not making decisions as a payer,” Rose said.
Hospital executives questioned if a “free market” would be a “fair market.” They must adhere to strict quality and care guidelines that other standalone facilities often do not.
Rose said he believes health care needs to have a functioning free market where patients are responsible for their health care with the ability to compare services, prices and providers and make their selections as consumers.
“Then, there needs to be a system that helps those who either through bad luck or bad planning can’t take care of themselves,” Rose said. “You want to provide compassionate care to them, but that can’t be a one-to-one comparison to the care you provide for yourself.”
He mentioned things like private patient rooms or more comfortable waiting areas and lower waiting times in provider offices.
“It’s not the quality of the care, but you might say the luxury of the care,” he said.
'We will make a move to do something'
Mayor Baines has visited the courthouse often over the past few months.
It's where he and County Executive Johnson strategized and sought answers for four hours after Baines first learned of Jamestown Regional Medical Center's impending closure from an out-of-town reporter.
He found himself back there for the Stand for Rural Health Care roundtable, answering as many questions as he could about Jamestown Regional. And he listened to the talking points for expanding Medicaid.
Leaders in Oneida and Jellico have reached out to him. Both have Rennova-owned hospitals in their communities. Jellico officials have a bargaining chip: The city owns the building and property, and any decisions made will have to include them.
As for Oneida, “they've been in this boat before,” Baines said, referring to the 2012 closure of the former Scott County Hospital. It reopened more than a year later as Pioneer Community Hospital before closing again in 2016. Rennova bought it and reopened as Big South Fork Medical Center in the summer of 2017.
Meanwhile, he and Johnson have one goal, and they aim to work together to achieve it.
“We will make a move to do something,” Johnson pledged. “It's a situation that's very needed.”
Added Baines, “Anything I can do to get this hospital open, that's what I want to do.”