The Wayne County Commission met in special session on Thursday, February 3, 2023 at 6:00 p.m. County Executive Jim Mangubat called the meeting to order, and County Clerk Stan Horton called the roll. Commissioners present included Herbert Brewer, Logan Shull, Tom Mathis, Stephen Pevahouse, Colby McDonald, Tyler McDonald, Jeremy Heard, Stan Hanback, Sherrie Powers, Kathryn Staggs, David Martin, Alvin Creecy, and Rickey Kelley. Also in attendance were County Clerk Stan Horton and County Attorney Andy Yarbrough. Commissioner Vickie Petty was absent.
Only two items were on the agenda for this special meeting. The first was the Clifton water line proposal. Clifton City Manager Doug Kibbey addressed the commission and presented what he said was his final proposal for the City of Clifton to take over the county water lines in their area. Kibbey said that this issue had been dragged out for way too long, and a few commissioners verbally agreed. Following some discussion, the commission agreed that the proposal needed to be looked over by the Water Committee before being approved by the commission. A special Water Committee meeting was scheduled for Thursday, February 9 at 5:30 p.m., and another meeting on Monday, February 13 at 7:00 p.m.
The only other item of new business on the agenda was a discussion regarding Wayne Medical Center. The room was filled with staff members of the hospital, along with other concerned citizens. Maury Regional Health representatives who were there to address the commission and answer questions were Dr. Martin Cheney, Chief Executive Officer, and Mr. Charlie Brinkley, Chief Administrative Officer. The two were introduced by outgoing Wayne Medical Center CEO Tyler Taylor.
It is with no doubt that a bombshell was dropped on the commissioners, medical professionals, and others present at the meeting. Most all came to the meeting to hear the latest plans on whether to renovate the current hospital or to construct a new one.
A recap of what the commission has been discussing in recent months is as follows (per the minutes of County Commission meetings):
Wayne County owns the building that houses Wayne Medical Center, and Maury Regional Healthcare leases the operations of the facility. Maury Regional is the employer of the 181 employees of Wayne Medical Center and the Maury Regional Health doctor’s offices in Waynesboro and Collinwood. Maury Regional also owns all the equipment and furniture inside the hospital. Maury Regional’s lease with the county ends in June 2024.
A major component of the money lost at Wayne Medical Center at Maury Regional’s expense is the reimbursement from Medicare and Medicaid. Maury Regional officials say that the operating expenses of the hospital far exceed the amount they are reimbursed from insurance.
Two options were presented to the commission by former Wayne Medical CEO Tyler Taylor that would help Maury Regional make the decision to stay: 1.) completely renovate the existing Wayne Medical Center facility, including the addition of several thousand square feet to accommodate all the needs of the hospital, or 2.) construct a new facility, possibly at the county-owned land in the Industrial Park on Highway 13 South. Mr. Taylor explained the two different classifications that would determine the hospital’s capabilities and insurance reimbursement in both facilities.
If the existing facility were to be completely renovated, it would be changed from what is called a Pay per Service classification (PPS) to a Rural Emergency Health (REH) classification. In this scenario, the hospital would essentially just be an emergency room with no inpatient beds. All patients would be limited to a 24-hour stay in an observation bed.
The other option would be to build a new facility that would be at least 35 miles away from the nearest hospital, which the existing facility is not. If the facility meets the distance criteria, it could be classified as a Critical Access Hospital (CAH). If Wayne Medical Center were to become a CAH, they could not only continue the services they currently offer but add more services as well. A new CAH facility would have between 16 and 25 inpatient beds, and the Medicare/Medicaid reimbursement rate would be 101% – a big improvement over the current 65%-70% reimbursement rate.
As stated before, the commission came into last Thursday’s special meeting with the impression that Maury Regional would extend their contract (which expires in June 2024) and continue to manage the facility if certain needs were addressed. When Dr. Cheney and Mr. Brinkley began to address the commission, it soon became apparent that Maury is pulling out of managing the hospital, and will not renew their contract once it expires.
Dr. Cheney began by explaining how rural healthcare is rapidly changing, and how hospital procedures are progressing so quickly due to technology. He said that all hospitals are experiencing a decrease in patient volume. This is due in part to surgeries that used to require the patient to stay in the hospital for several days, and now these surgeries are performed by laser or robot and are basically outpatient procedures. He said that rural hospitals are suffering a loss in patient volume as well, partly due to the fact that insurance, mostly Medicare and TennCare, either refuse to pay for inpatient hospital stays or pay a flat rate for an inpatient stay, no matter how long it may be.
Dr. Cheney went on to explain that Maury Regional Health continues to lose money every year at Wayne Medical Center, including the ambulance service (EMS). His final assessment, which he said was based on recent financial analysis by an independent firm, was that Maury is no longer willing to partner with the county to manage the hospital. The only way Maury would consider staying in the picture is if the county is willing to pay them a management fee of several thousand dollars every month. This is a complete turnaround of the current situation, which is that Maury pays the county a fee every month to lease the facility and equipment.
He presented a few options for the county to consider, including closing the hospital altogether, or finding another company willing to work with the county and manage the facility. The option that Cheney actually recommended to the commission was to turn the hospital into an urgent care facility.
The stunned commissioners began to ask Dr. Cheney and Mr. Brinkley some questions, including questions about the ambulance service (EMS). County Executive Mangubat confirmed that he recently received a letter from Maury stating that the EMS contract with Maury would expire in April of this year. Some of the commissioners expressed their concern that they had not been made aware of this. Dr. Cheney stated again that EMS loses money not just in Wayne County, but in multiple other counties. He said that payments for services rendered are not nearly enough to cover the expenses of maintaining the ambulances and keeping up with new technology.
Dr. Cheney went on to say that Maury Regional would consider continuing their management of our ambulance service only if the county would pay them a management fee of several thousand dollars per month, just like the management of the hospital. He pointed out that the county is required by law to provide ambulance services to their residents, and that even if the county chose not to renew the EMS contract with Maury, they would have to find another company to partner with that would most likely require a management fee as well.
Dr. Cheney did say that Maury would be willing to extend the current EMS contract until December 2023 so that the county has time to plan what they are going to do.
According to Dr. Cheney and Mr. Brinkley, Maury Regional is losing well over $1 million dollars every year at Wayne Medical Center and the ambulance service. Although commissioners were led to believe by outgoing CEO Tyler Taylor that building a new hospital and making it a critical access facility would cut those losses and keep Maury interested in renewing their contract, it became very apparent on Thursday that Maury Regional Health is not on the same page.
County Executive Mangubat stated that he had recently spoken with two companies who might be interested in managing the hospital. The first is North Alabama Medical Center, the company that owns the new hospital in Florence, Alabama. The other is Braden Health, a company that has recently acquired healthcare facilities mostly in West Tennessee, including Decatur county. Commissioner Sherrie Powers reiterated the fact that this whole situation is critically urgent and must be acted upon as soon as possible. The other commissioners agreed.
The next scheduled regular commission meeting is on Tuesday, February 21 at 7:00 p.m. The Budget Committee will be held at 6:00, prior to the regular meeting. The hospital situation will undoubtedly be the hot topic on the agenda for both.
