Maintaining Rural Health Access in the Face of Competition with Cathy Pimple

JH: Right. Today we’re talking about maintaining access to healthcare in rural communities. Kathy’s here to share her journey of sustaining rural healthcare in the face of significant competition and challenges. We’ll talk about growth strategies, big health competition, of course, what all this has to do with rural health. So, Kathy, let’s jump into it. Tell us a little bit about Newman. What type of hospital are you? What services are you delivering? What are the care models that you’ve deployed recently? What is your patient population? Give us a give us an image of Newman.

CP: Something I get really excited about talking about for sure. So, Newman Regional Health has been a community hospital, governmental hospital, county owned and supported for over 100 years. So there was a gentleman with the name of George Newman who over 100 years ago donated $50,000, and the hospital was built. The first CEO and superintendent of the hospital was Core Miller Hall. Again, just a resounding, lady that also started the hospital and within six months started a school of nursing. So clearly, again, myself and others stand on her shoulders today. We also, as a hospital system about 20 years ago, started with clinics too. So, we have a multi-specialty rural health clinic. Just to ensure ongoing access for the community. All one campus. And right literally in the heart, in the very center of Emporia is where our hospital is located, in the very center of Emporia.

JH: And remind our listeners, Emporia is about 23,000—24,000.

CP: Yep, 23,000—24,000 in Emporia, the county is about 32,000.

JH: Oh, wow. So, Emporia is where it’s happening.

CP: It is. So definitely we support about the kind of the seven-county area. But there are other small hospitals in three of those counties that we again partner and just again work to support their hospitals as well.

JH: Are you the largest?

CP: We are the largest employer. Well actually, there’s the university there. So, we are one. Yeah, we are one of the top employers there in the community. Definitely community hospital. So actually, there’s the university there.

JH: So, you have the university. You’re one of the top employers. Economic engine for your community. Devastating for a community hospital of your size to stop operations. The impact would be hundreds and hundreds of jobs. So, describe your hospital model. How many inpatient beds? Do you do Everything from OB. Give us some insight into that.

CP: So, we are. So, we are. We’re a critical access hospital, probably one of the largest critical access hospitals in the nation. We have a beautiful newly built emergency room. It has 18 beds in it. We serve about 14,000, that come through the ED on an annual basis. We do have again, our obstetrical unit. We have two OB-GYNs—

JH: Which is rare for critical access to have an equal unit. It’s usually you don’t see that. So, you’re serving how many deliveries do you serve?

CP: About 350 new, new babies. New lives into the world every year.

JH: Never gets old, right? Every time I go to the hospital and they changed the bell because we have a little bell that we chime in, it’s just, it’s like, all right, this is why we’re here.

CP: The little miracle. A little miracle almost every day. We do also have again, we’ve seen a lot of growth in just our surgical services. So, we have stepped into the robotic world. With, with again, about three years ago, we added DaVinci. And then for our orthopedics the robot we use again Maiko. So that is exciting.

JH: So, when you look at your surgical procedures in your OR, you’re addressing ortho? Can you explain the specialties.

CP: So, we have general surgery and orthopedics and urology and then ENT as well and then just the gynecological procedures.

JH: All employed or is it a mixed model?

CP: Mostly all employed. Yeah, mostly all employed. We also, uniquely as a critical access hospital, have an interventional Cath lab. So, we have two interventional cardiologists. Well so we looked at just again our east central Kansas. And we could just see the mortality rate. So, by adding interventional cardiology we’ve again improved outcomes. People are living longer in our county. So, we yeah, we’re ACC accredited as a Cath lab.

JH: That is incredible. So, you’re well beyond what a normal critical access hospital would look like and serving a community. Take us through a little bit of the journey because, you know, you’ve had some challenges and you and I have talked about those challenges. They presented some opportunities. You know, when you’re faced with challenges, you either come up with a very quick plan or at the end of the day, you know, you run and hide, but you did not run and hide. You came up with a very aggressive plan to have growth and have a strategy of fighting. And your story was highlighted once before on my podcast that I talked about. And I guess, you know, as you look at your CEO role in the last three years, you came in with some unprecedented times post pandemic issues that we’re dealing with. I’m assuming that that staffing is a challenge for you as it is across the country for rural recruitment, retention, those type of things. But talk to us about some of the challenges and opportunities that you have faced in your role. And then we’ll dive a little bit deeper into some of those. I think we’re into some of those.

CP: I think you mentioned a couple of them JJ so from, from a staffing perspective, coming out of Covid, like many, many other hospitals, we relied a lot on agency staff. So, we’ve been able to pull out of that completely.

JH: Phenomenal. It’s all done. You’re fortunate.

CP: Yeah, it’s all done it. You know, I think in one of the reasons that we are fortunate though, is we have, again, Emporia State University that has a tremendous nursing program and also a technical college, Flint Hills Technical College. So, they again produce, several LPN’s every year.

JH: So, do they do like a surg techs and MA’s?

CP: We’re talking about search text. But yes, it is a need.

JH: Good. Yeah, because that’s a need right now for us.

CP: I’ll pass that along to Doctor Dougherty.

JH: Yeah. Pass that along a side note, you had indicated that when the hospital opened a hundred years ago, that you that they started a nursing school. Did that dissolve that?

CP: So, it transitioned it. So, I’ll have to, you know, we’re going to think back from a history perspective. So, it was 100 years ago. It was a diploma program for decades and decades. And then in 1995—96, it transitioned and had it become a partner with Emporia State University and transitioned to a baccalaureate program.

JH: Very good. So, it incorporated into it. Very good. I just wanted that for a reference point because, you know, that was, we had talent pipelines back then when we ran nursing schools and then hospitals decided to turn those over to our universities. And then we watched something very bad happen, you know, which was the door was wide, but unfortunately, the exit door was very small. We weren’t graduating a lot of nurses. And we are faced with that problem today of some shortages. So, I just curious about that. And I didn’t mean to interrupt your, your challenges, but you know, staffing is a challenge. You got rid of your travelers, which not all hospitals have. We’re almost there. I mean, we’re at 95% reduction, but it’s still very difficult. Beyond the staffing, then what are the other challenges that you faced?

CP: Yeah, you know, one of the things that we uniquely, well, not uniquely, I think, again, it happens throughout the United States is just outmigration of services. So, when you look at a rural health literature, and one of the aspects that is very challenging is when there’s revenue extraction out of the market. Because, JJ, one of the things that I hear on your podcast, because you know it and you’ve had others over and over share the same message. In rural we have fixed cost. So, we have to be able to find a way to have and capture and keep revenue in our community hospitals, because we’ve got to have access for obstetrical care and emergency care. So those revenue generating lines are incredibly important to rural community hospitals.

JH: You know, this hospital, Hillsdale, 110 years old now, was once there’s a very brief period of our history where we were hospital was owned by the city of Hillsdale and governed by a board of city trustees. I would assume that as county government. You’re part of that picture. Has it been a challenge to deal with some of the political forces in that realm? And I’m not looking to identify anything specific, but obviously, you’ve got commissioners, I would assume, right? Is that comprising your board or how does that function? I guess because that will lead into our next question about how do you navigate some tough discussions in growth and service in a political world, because we’re usually political neutral in our boards, but with your county on board? I don’t know. I want your perspective on that because how does that work?

CP: JJ so you probably named one of one of my personal greatest challenges. The last three years is, you know, I know people, but politics, again, was not really something that I had developed a skill set into. So, Newman Regional Health is again county owned governmental hospital. The county commission appoints the hospital board.

JH: So, but again, that relationship between our county commissioners and our board is critical. And that’s one thing over the last three years that I’ve recognized that we haven’t always done a great job is, again, ensuring that you really are governmental entities, whether that’s the county commission or the city commission, that we have time with them and we can share with them what our needs are, what our opportunities, and that we partner and just caring for the community. So just really opening up the avenues of communication so we can again learn how to support the residents of Emporia and Lyon County together. What I want to focus on something that you talked about earlier, and you know, you’re building this infrastructure of healthcare. You’re creating new pathways, and you don’t find that with, you know, in a lot of our critical access hospitals because they’re just challenged with the day to day, and they’re certainly not adding OB-GYN. Many hospitals beyond any type of critical access or eliminating OB-GYN and other services, (like) behavioral health. It looks like you’re going in the opposite direction of that. And I want to talk about that. I want to talk about your growth strategy. Can you share with our listeners, you know, when you woke up three years ago as a CEO and said, all right, I’m in charge of this. I mean, surround yourself with the great people that you have. I’ve met some of them wonderful people, but at the end of the day, you know, heavy is the head that wears the crown. And so, you’re responsible for every aspect of that operation. And one of the things that I think that you’ve done remarkably well as I followed your journey is reviewing your growth strategy. So, talk to us about what is your growth strategy. Talk to us about what is important about the growth strategy and how is it impacted you.

CP: Yeah. So, JJ one of the things three years ago, and I have it in my purse, I’ll show it to you there. I wrote down on a little card and it’s again pretty ratted and tattered because, actually it’s in my toothbrush drawer, I might be too late, but it really, it’s a quote about that just again, everything rises and falls with leadership. And so just again stepping into that and just accepting that responsibility and accountability for the community was, was important to me and continues to be today. Growth strategy. Over the last three years, our net patient service revenue has increased by 15 million, or 18% in the last three years. So, how did we do that? And it’s just, again, allowing our community hospital and the clinical teams to shine. So much of it was about provider physician and advanced practice provider recruitment. So, in 2024, we again recruited four. And then last year we recruited five were on track to recruit eight providers this year.

JH: Are you doing that out of medical school or are you doing this in nontraditional manners?

CP: Some of it, some of its medical school. And, you know, when we think about access, there are challenges with it. You know, one thing and JJ, you probably see this, too, in your community, if we can get a provider into our hospital and they can see our people and fill our culture, it’s easy.

JH: Absolutely. Absolutely. Just got to get them in.

CP: We just have to get them in and again it really again that credit goes to our existing medical staff because they are just again, they are experts and what they do. And they’re just really great people. They’re great colleagues. They’re mentors. They care about the community. And it just it feels different. And we hear that.

JH: So, tell me about as we look at growth strategy, name some of the things that you’re proud of that you’ve been able to with your team bring that’s new, exciting, generating revenue. If you had revenue growth of 18%. That’s phenomenal. How’d you get there?

CP: So, I think, a lot of it is, around surgical services. And we were watching our cardiology program grow. Orthopedics. And it was actually pre-pandemic. We did a partnership around orthopedics. So, we actually, again, went into really a collaborative relationship with a hospital about 80 miles from us, Lawrence Memorial, health, LMH Health. And they, independent hospital.

JH: Okay. Very good. So similar to yours?

CP: Yeah. Independent community hospital? Similar to ours. And, we created a shared vision, and they have just an incredible orthopedic group. And that they helped us build that program. And right now, again, Doctor Willis is our full-time living local orthopedic surgeon. And he’s fantastic.

JH: So, a lot of growth in surgical, as you look at beyond surgery, right then you have social determinants of health issues. Are you addressing any of those right now at your hospital? And I would assume some of the clinic growth you’ve had, right. As you bring new providers on, talk to us about what that looks like in your community, in communities.

CP: Primary care is again, it’s so critical. It is the driver. I think again, I had again and just a healthcare colleague that says primary care is king. And it’s true. That’s true. So, we over the last three years have also begun to add internal medicine. So now we have within our primary care family practice, pediatricians and internal medicine, supporting and the social determinants. We have a community health worker program. So, we have two individuals that work and are really extensions of our primary care. And we are working through food insecurities, transportation. They actually, you know, when you give individuals the opportunity to again see the need and develop solution, it’s amazing what they can do. One of the things, one of the more recent things that they’ve done is, created a laundry love program. So once a month they, we help individuals that don’t have the means to have clean clothes, come into again a local. Once a month. And it is growing. And we celebrate the loads of laundry that we do, you know.

JH: It’s really amazing, isn’t it, to see how the social determinants of health play a role. I remember attending a Becker’s conference with Scott Becker, and the first introduction to that was about 15 years ago for me. And I thought, what is that? And understanding now the value of social determinants. If you have food, you know, obviously it has a part of healing. If you have your medication access to medication, those are all very, very important. So, it sounds like some of that work that you’re doing is focused on, you know, the social determinant of the patient.

CP: And, you know, it goes back to, you know, when I started, you know, I had some time in home care nursing. And when I talked about just the system of care. I mean, that’s part of it was just, again, working with patients and families that 30 years ago, again faced similarly, what we face today and just not having some of those basic, health needs.

JH: So, we’re going to transition into really the heavy part of our topic today. But before we do that, you know, my wife always tells me I cannot have favorite grandchildren. I’m like, too bad, I can I can have favorite grandchildren. And so, what’s your favorite growth strategy that you’ve deployed? And I know we love them all. And there’s all so special. But what makes you like really proud that you’re able to achieve in the last several years? As you look at growth and you know it’s hard because then whoever you don’t name. So, this is a disclaimer. She loves you all equally. But at the end of the day, what have you just kind of like; You know what? We did it. We achieved that.

CP: Yeah. I you know boy I’m going to discard around that JJ.

JH: Okay. All right, all right. That’s all right. You’re a politician.

CP: Yeah, I’m learning right. I’m learning. It’s just it’s just too hard to state one because, you know, every person, every service has such a unique gift to give.

JH: Right. But is there one recent one that you’ve implemented where you see, you know, the community impact or the opportunity? Where you there when you put your Cath lab in?

CP: Yes. When we started the Cath lab, you know, that is that is huge. You know, we did just go through last year and re-accreditation and there’s tears around the room just because we see the impact. We see the impact of again save lives and improved quality of life and in the team. The team that delivers that cardiology care, they’re just special. But every team is special JJ.

JH: So, if you’re listening today as one of Kathy’s leaders, you’ll know that she loves you all equally. So, it’s all good. So, remind our listeners before we jump into this next section, which is really going to close this out today, which is we’re going to talk about some of the challenges of competition and the market and that. But let’s go through some quick tips here. So, the hospital what percentage is Medicaid and Medicare commercial. Do you have that roughly to paint the picture of what your community looks like. So, Medicaid government payers, would that be 50%, 60% 70%?

CP: 50%

JH: 50%. All right. So decent commercial insurance that you have in your community, right. Total number of employees?

CP: 650

JH: 650. One of the largest employers in your community, 100-year-old institution or greater, established by someone who had vision for community. You have a mission, vision and value statement. I’ve seen those, you have strategic direction and plans. All of that is wonderful. I mean, you have a long history and what’s at risk of a hospital closure or all of those things, 650 jobs, you know, the impact of care, access to care, social determinants of health, all the things that you’re doing.

So, I want to transition into today’s topic and talk a little bit about some of the challenges and struggles that you faced around, market expansion and what we face to be a rural hospital in an environment where it seems to be the reward comes to the big hospitals. And what I mean by that is their ability to negotiate with payers typically is better because they have more incident rates. They have obviously higher catchment of patients. So, they’re able to negotiate higher rates. Sometimes their insurance companies that are owned by big system hospitals that we are subjected to, in rural communities, we find a higher rate of government payers. In an aging population, we find Medicare as a payer. And so, all these challenges are coming in. But the disadvantage for rural is that we are rural, and we have not been able to lobby Congress to pass any meaningful legislation that would provide any type of special reimbursement for rural. And in fact, H.R.1. has ultimately sealed the fate of a lot of hospitals.

Scott Becker was just on my podcast from Becker’s Healthcare, talking about the research him and his team did in 734 hospitals are at risk of closing in this country. Half of them are at immediate risk of closure in this country, immediate like very soon. A lot of those hospitals that are on that list are hospitals that are trying to make it in their community and provide as the economic engine, social determinants of health, the list goes on. So, all of that preamble to say you’ve had some challenges and you have gone public with statements of keeping care local, and we don’t need to get into all of the specifics of it. But I want you to paint the journey for our listener, because you are the story of David and Goliath. And, the battle is certainly not over for any of us in rural health as we try to navigate what is our position in healthcare today as the government seems to want to scrap us, how do we survive? How do you not only survive, but how do you sustain? We understand other concepts. While primary is care is king to the operations, cash is king to the financial operations. Without cash, she can’t reinvest in the organization, the people and the list goes on and market competition all around us, while it’s healthy and good, sometimes isn’t scaled properly. And so, with that, can you give us a little background on some of the challenges that you faced recently?

CP: Yeah, I do, and I before I step into that, I do want to just comment and just reinforce the statement around, really having the opportunity to negotiate for improved commercial payer reimbursement. And that’s a significant challenge. There’s definitely not an even an even playing field for that. We you know, we’ve talked about. We don’t we don’t even have the opportunity we’re given. I you know, and it’s interesting we talk about that and with again, legislators and again community stakeholders. And it’s not until like we put, you know, an explicit example, that I think they start to really understand. And with just the price transparency, we can see the difference, you know, so for example, let’s just say a CT of the abdomen. So, when we can see this through price transparency. You know, there’s again a larger health system that for that CT of the abdomen is going to be reimbursed 1300? And you know what Neumann Regional Health gets reimbursed?

JH: Let me guess 612.

CP: How about 480.  two and a half times more. We can look at some of the larger commercial payers and in, in granite, you know, we have again a better reimbursement rates than others, but it’s, it’s millions of dollars of difference for us. So, we’ve got to across the nation.

JH: Yeah, I agree it has to be fixed. It has to be some scaling going on. In, in you know, I hate to use this because not everybody should get a trophy, but there should be some fairness. You know, when you look at the algorithm.

CP: Right. It does have to be equal, but it can’t be so inequitable, right? We’re absolutely right where it creates a disadvantage now for us.

JH: Yeah. It’s a great, great perspective. And great point. I think unfortunately for you and I we know that that’s a payer issue. And on the same token, we have the government doing the same with we’re 70% Medicaid Medicare here. And so that is a significant impact whenever the government moves the needle a little bit for us and takes away, let’s just say, 1 or 2 or 3%, that’s sometimes our margin in rural hospitals like Hillsdale. So, very good perspective. Let’s talk a little bit then more about some of the dynamics right in your town that you’re dealing with.

CP: So, we, you know, we do have again, a larger health system that again, provides care. And our community has for again, the last three decades, a wonderful relationship with the providers that live in, in the community. And have again, over time tried to work and really press upon the importance of collaboration and coordination, because we know competition, although it’s sometimes hard for people to understand because you and I, we value competition. We’re competitors ourselves.

JH: We do. Yeah. But in healthcare, it’s different than the car dealer and the grocery stores.

CP: It is. And competition in Metropolitan, that looks different. Metro competition in a rural market.

JH: It’s all about access to care. It’s very easy for versus urban. Absolutely far different. It is. It is because it’s all about access to care. And it’s very easy for an urban center to move into a rural community. And the first thing that they get rid of is OB-GYN, and they get rid of site services. And those patients are traveling 45 or 50 miles away. So, we know that receiving care at all because they can’t get there. So those are the challenges, you know, or just not receiving care at all.

CP: Because they can’t get there. You know, with having again, a larger healthcare system in your community, you know, what we’ve experienced is about $12 million of extraction of care that we could provide. You know, of that we because we have interventional cardiologist, we could again provide that care. But we have again, an outside system that does send the cardiologist and the orthopedics. So, it’s just great providers. But what we’d love is for them to do care in our hospital. But again, unfortunately, they go again about 60 miles away to, to provide that care that generates that revenue. You know, one of the things that we’ve been challenged with and you mentioned that, you know, three years ago was really, a strategy from this health system to build, really a campus that includes surgical services and advanced imaging.  So, there’s already duplication, but to add advanced imaging and surgical services, that’s going to hit us at about another $7 million JJ.

JH: Well, you’re already serving the community and the needs of the community, right. And that’s 100-year history of that and doing it with high quality and low cost, because rural can provide it at a lower cost. We know that there’s proof of that.

CP: We do that, you know, in Kansas it’s not you know, it’s not a certificate of need state Michigan is. You know, I’ve looked at Michigan, just again, a lot of the guiding principles for the CON, you know, around advanced imaging. I mean, if Kansas had the same again, certificate of need guidance, it would look different in those things. That type of, duplication would not exist.

JH: It wouldn’t exist. It wouldn’t exist. And it’s and it’s not necessary. That’s why I was not a supporter of CON early on in my career. I am an absolute avid supporter and continue to lobby our Michigan legislature to continue to allow the CON for the right reasons. You know, Tennessee based hospital for profit system would park, do all of their PET scans in my community, and they would outsource those revenues right back to their mothership in Tennessee, Texas, where they’re from. And so, this does allow us to be able to address and sustain local healthcare with those baseline services. But you’ve been at this for a while now, three years that you’ve battled it and you’ve had a lot of good successes. You’re still vibrant, you’re strong, you’re profitable, things are moving along in the right direction for you. You feel good about that I’m assuming.

CP: One of the things that when we talk about, larger health systems, they can leverage a lot of different things. But one of the things that they can’t is community trust. cannot buy that.

JH: Right. Can’t buy that. You can’t go in and have a politician, you know, garner it. It’s going to be deep within the veins of that community. And that’s and that’s what you’ve really hung your hat on. And I and I commend you for that, because you had a very good campaign encouraging your community to support you. And they have and they continue to do that. It’s far from over, obviously, as all of the hospitals in every region are finding new ways to try to secure additional catchment of patients, the challenges are going to be even more real for us into the future.

CP: You have to put the work in and you have to have good strategy and you have to have an excellent team and a committed medical staff and an informed and well cared for community. You know, the other thing, though, JJ, that I have discovered over the last three years is that there are, a lot of great leaders of other big systems too, and that that collaboration across the state has been incredible. Some of our strategy has been just that, though, partnerships with like-minded, culturally compatible philosophy.

JH: Tertiary center that knows the understanding the value of keeping certain services local for access, not to divide the market, not to violate any anti-competition, but it’s strictly for access. Better access. Patients who lack transportation cannot drive 55 minutes away to get their routine blood work and/or to meet with their primary care physician. They can go there for their tertiary care.

CP: And there’s so much goodness in that opportunity.

JH: There is. But it’s got to be the right partner. They have to understand the value of all of those things. And that’s probably been a little bit of a challenge in your community. It’s been a challenge in our community, but it can be done. There’s certainly, you know, proof of that. You’ve established some relationships. I think you even have a relationship with some physicians that come in right?

CP: Yeah, we do. Also, a couple different things that have happened over the last three years is one, our relationship with Lawrence Memorial. The again, independent community Hospital has continued to grow. But we have we have also joined a strategic affiliation that’s really three-way with Lawrence Memorial and the University of Kansas healthcare system. And they threw really again, KCIC which is a broad clinically integrated network for rural hospitals across Kansas. And the University of Kansas Health System has supported that entity to ensure access. And through that is where many rural hospitals are standing up. Telehealth for those subspecialties that you and I were not ever going to know.

JH: Yeah. We’re never going to track that here. And you don’t have the catchment for it anyway. And it’s never going to work. You know. We’re not going to do heart surgery at Hillsdale. Right. But there are other things we can do to prepare them for that. So, it’s a remarkable story. We’re going to stop it there because we could spend forever talking about it. I just want to commend you because I followed your journey. It’s why I reached out to you, you know, maybe a month ago and said, I really want an update because, you know, I follow the story. And I was so grateful not to read and Becker’s or anywhere else that, you know, Newman is, you know, no longer operating. And I knew it. I knew you were going to fight. I knew you were going to win. And, I want to talk to you about that in a in a general question, where do you see rural healthcare from your lens in the next five years? What do you think are some of our most significant challenges that we face in rural health? And it’s, you know, the conclusion of our podcast as we focus on that, but we’ll end it on a higher note, I promise. But really, where do you see that?

CP: Wow. So, you know, I think again, there are a lot of challenges. But with that as great of opportunity, JJ, I think, you know, it’s individuals like you JJ and again individuals similar that are across the United States and in every state. Just again advocating at the federal level, at the state level, I think, bringing and again, shining the light on rural health. Look at telling our stories. Look at where we’re at today, JJ, even just across the nation, you know, I think again, we have stakeholders that are leaning in and I don’t know about the state of Michigan, but I can tell you the state of Kansas, we have again, boardrooms that are now, filled with, again, our large tertiary leadership and our, again, independent community hospitals and our small critical access hospitals. So, if change is going to occur, it has to start there. And that is, that is exciting to me because when we can have Kansas healthcare leaders that value, again, the respective communities and the differences that each different type of system can bring, that’s a future of hope.

JH: It is. So, Kathy, has your CFO done any modeling of what H.R.1. is going to look like for you? The impact? Obviously, if you’re not significant into government payers, it may not have as much. For me, the impact is 6 million a year.

CP: Yeah, it will have an impact on us. You know JJ one of the things you know if you look at the state of Kansas, it’s been challenged for many years because you know we weren’t a Medicaid expansion state. Never ever did. And even like with the with the Medicaid dollar. So, like the supplemental aspects, you know, we are just now in a place that we are going to have more of our allowable cost recognized. You know, it’s going to be a pickup. So, like with the provider tax assessment. So, we’ve never as a critical access hospital. We have not been able to fully participate in that. But now we can and. It is a Kansas thing. So, before we were really held under a state methodology called the cost adjustment factor, and it really capped, again, the amount that we could be reimbursed as a critical access hospital. So that cap comes off and we’re no longer again, using that methodology as a state. And we’re now able to pay in and receive back in. The difference is about $7 million. JJ I you know we have a we have a fantastic CFO Holly French. Who again is really. She actually she’s been again doing this for again 30 years at the same hospital. And I love her to death. But again, when CMS approved the pre-print for Kansas, as soon as I seen her, she got the biggest hug ever. So, it is a game changer, but again the big beautiful bill, it will pull some of that back from it’s going to pull back. But we’ve got some relief on the way.

JH: You know it. We’ll pull back. Yeah. But at least you’ve got some relief on the way. Do you benefit from low volume adjustment. Do you know. Or disproportionate share. You don’t have any of those programs you participate in because you’re in that critical access world. Well, it’s going to be a beautiful pickup for you. You know, as we as we close out today, I want to ask you a few pointed questions. Number one, what keeps you up at night right now? So as a CEO, what is the one thing that you’re just grappling with right now? And the reason I ask this question is the story of David and Goliath came with a very good punch line and a learning lesson. That, you know, it’s not always the bigs that that win. And so, we grapple with a lot in our roles. And I want you to identify because there’s many people that listen to this, you know, who are brand new to their roles. I get emails all the time from individuals saying that particular speaker really touched me. And that particular piece of advice was beyond sage. It was what I needed to hear. And so, we like to realize that as leaders and as its most difficult times is like, what’s keeping us awake? So, for you. Well, what is it?

JH: And keeping you and us awake at night is a real thing, right? So, at that. Yeah, at 3:00 in the morning when you’re walking through your ED because you can’t sleep like.

JH: Yeah, yeah. Or getting the email last night at 1:30 for one of my directors. “Don’t you ever sleep” because I’m emailing. Because you just. It’s what we need to do. But. But what is it? What would you say right now are as you stare down, you know, and I know people don’t like this analogy, but as we stare down the barrel of the government’s, you know, impact of H.R.1, revocation of HR and all of those things, what is it that that’s heavy on your mind right now?

CP: Again, there’s a lot of different things JJ. I think again, what I would want to share is how do you stay in the game. Right. You know, how do you keep showing up I’m caring again the responsibility. And yet the vision and also, I think again it’s about rec and how you do that as you recognize what you can control, what you can’t control. And you realize that values matter. So, you know, at our hospital at Newman Regional Health, it is empty integrity, humility, collaboration and service excellence. And that is that’s important. And in a rural community, as the CEO, your people and your community, they hold you to that. Right?

JH: They do hold you. You’ll know it’s on Facebook. It’s email. It’s text message. It’s church, it’s grocery store. There’s not a day that goes by I’m not approached. One way or the other.

CP: Yeah. It’s right. That’s approach. One way or the other. Yeah. In in and I would I guess again my recommendation around that is not to fear that but to welcome it and to celebrate it. Because we have the opportunity as rural CEOs of hospitals, of healthcare systems to be present, to truly be present, with our staff, with our physicians, with our patients, with our community, and, you know, each community hospitals again, unique. That’s why I’m looking forward to again, spending some time here at Hillsdale. Because it’s going to be unique and special in its own way. And you know that. And I know that as a community hospital leader. So, I love that. Values matter.

JH: So that is your rural health recommendation. Yeah. Stay connected. All right. In contrast, as we close out today. What are you excited about for Newman in in the year ahead. Is there a new program you’re launching? Is it a new project you’re working on? We know you’re excited about all your kids that are at the hospital, but is there is there something that you’re like, you know why I can’t wait till we get this going?

CP: I am again a mom, a boy mom and a boy grandma. So that that is an exciting part of my life. But I think, you know, just again, just to continue walking the walking the walk, service line, you know, on the way up here, I’ve had some communication with our executive director of the clinic. So, we’re really focusing on just that, that psych service line across the lifespan. So, Monday that’s going to be a focus. We’re going to again just delineate some things and get definitely. And we found two incredible providers that are going to make a difference in our community.

JH: Well congratulations. Huge success. I want to have you back on here, in let’s say 6-8 months to be able to get an update on what’s going on at Newman and share your continued story of success. You’re building a beautiful project in your community and taking it far greater than you know. When Mr. Newman gave $50,000 to growing into probably, you know, $100 million operation, expanding revenue growth, all great things, and you’re doing it for the right reason. Its patient focused. And I’ve been on your website and that’s what it all says. It’s not about revenue generation. We have to do that on the back end. But it truly is about serving the community right where you are. And you’re doing a remarkable job of it and your leadership role. I would put you the top among those I’ve interviewed and worked with in this nation. You’re doing remarkable things.

CP: Thank you. And thank you for what you do. You’ve been you’ve been, again, a mentor, a podcast mentor, and part of my every morning routine for a long time. So, thank you.

JH: Well, we’ll get you back on here okay. It’s great to have you, Kathy. And thanks to our listeners for tuning in to Real Health Today. Catch our next segment, Rural Health News to stay up to date on the current state of rural health every Monday, wherever you get your podcast. And don’t forget to check out our latest updates and resources from Rural Health Today at ruralhealthtoday.com, and make sure you subscribe so that you never miss an episode. Until next time, remember Rural Health Strong.