The dilemma for rural healthcare

Janie Sinacore-Jaberg takes the helm at MedWest-Haywood
By Vicki Hyatt | Jan 09, 2013
Photo by: Vicki Hyatt Newly named MedWest-Haywood CEO Janie Sinacore-Jaberg addresses the Haywood County Board of Commissioners.

In his last action as the interim-CEO of MedWest Haywood, John Young, western division vice president for Carolinas Healthcare System, introduced Janie Sinacore-Jaberg, who took the reins at the local hospital in mid-December.

Young called the time a “bittersweet moment” for him, saying he became very engaged in the community since taking over the interim job and has learned “how much this community cares about its hospital.” He said Sinacore-Jaberg is very enthusiastic about the opportunity and will be able to spend all her energy on making MedWest-Haywood successful.

“I’ve never seen anyone as excited as Janie about coming to this community,” he added.

In her brief remarks to the board, Sinacore-Jaberg said she looks forward to working closely with the commissioners and others in the community in the future.

In his departing remarks, Young also offered a few insights on the challenges ahead as MedWest works through the changing healthcare environment.

That includes the new reality where lowered physician payments have led to hospital-owned physician practices, and a diminishing Medicare and Medicaid payment model as the federal government reins in costs for programs that help the elderly and the impoverished. Lower federal reimbursements present a dilemma for rural hospitals where there is a larger Medicare and Medicaid population, as well as a higher percentage of bad debt and charity care, Young said.

“Many hospitals find it impossible to make a profit in a rural community,” Young said, noting the physician expense has upped the stakes. While the physician network cost was $700,000 at MedWest-Haywood when Carolinas Healthcare first took over, the cost now is close to $5 million annually.

“That’s an extra expense that Haywood never had to carry,” he said.

Nationwide, there used to be 10,000 hospitals. That number has dwindled to 4,400, Young pointed out.

Cost-cutting measures have put in place throughout the MedWest system over the last two years, including a recent round of employee layoffs that will add $3.8 million to the bottom line in Haywood alone.

“They were tough decisions,” he said, and what's needed now is to grow market share for the medical care that can and should be provided locally.

Strong partnerships are needed so patients can be referred elsewhere for procedures or care not offered locally, but “for things we can do, we do it as well as anywhere in the world,” he stressed.

He acknowledged it is “hard to be a prophet in your old land,” in conveying that message.

“Sometimes bigger is better, but often it is not,” he said.

The hospital’s market share took a nosedive after Haywood Regional Medical Center was decertified as a qualified provider by the Center for Medicare and Medicaid in 2008. Since that time, the market share for MedWest-Haywood has reached its pre-2008 levels, but with reduced government reimbursements, an even higher share is needed to make ends meet.

“We will continue to work on expenses and continue to grow market share,” Young said. “Now with Janie, there will be a full-time presence working every day to make that happen.”

Young had high words of praise for the medical staff and said MedWest-Haywood does have a future, “but it is not going to be easy.”

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