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Bridewell Heads Efforts to Increase Viability, continued from page 1 being one of the largest, best-paying employers in the area and one of the largest purchasers of supplies. An organization that is working hard to keep rural hospitals in the Delta healthy is the Arkansas Rural Health Partnership (ARHP) headed by CEO Mellie Bridewell. ARHP is pulling together rural hospitals throughout South Arkansas (mainly the Delta region of the state) to share services and provide better care for the areas served. ARHP is a non-profit partnership of fourteen individually owned rural hospitals that provides support services and programs, cost-saving resources and negotiation, provider training and education, and access to patient education opportunities to enable its partners to provide the best care locally. Rural hospital closures across the U.S. have become a growing public concern. According to the National Rural Health Association, 107 rural hospitals have closed since 2010, with more than 120 and counting closed since 2005. “People need to understand, if we don’t start doing something to help rural hospitals, they are going to start closing faster than we have seen,” Bridewell said. “My job is to fight for survival of these small hospitals. I want to help hospitals in rural Arkansas stay afloat with good-bottom line economics allowed by things like collaborative purchasing, negotiation of contracts, access to healthcare services through telehealth, and quality healthcare services that keep the rural patient at home. Healthcare is rapidly evolving and many rural hospitals, especially those with limited resources, are becoming overburdened as challenges grow. A huge concern is that more changes ahead will create an even more dismal future for these small hospitals.” Bridewell said an important issue to address is the high costs of outsourcing. This outsourcing is necessary for rural hospitals to provide health services in rural communities. The challenges of lack of resources locally causes hospitals to contract out services and staff to support their business office, emergency department, hospital, nursing staff, and in some cases their administrative staff. They become dependent on contractual services that cost more money to the hospital, and the hospital ends up financially worse off. An example would be a nurse employed by the hospital making $40 per hour who quits, but continues working at the hospital under a staffing agency might increase costs to $100 per hour. Currently, there is focus on healthcare transformation and how to move hospitals toward care coordination. ARHP has been actively supporting quality improvement, care coordination, and healthcare provider training along with education initiatives to better prepare member hospitals and clinics for the upcoming changes. “With healthcare evolving, small rural hospitals are being forced to look at transitioning to include offering a wider variety of healthcare services and many have gotten into the primary care business. Helping these hospitals with the necessary changes is something we really need 6

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JANUARY/FEBRUARY 2020

to prioritize if we are to continue to keep local healthcare. We must also recognize that quality healthcare services mean making sure every employee in every hospital, clinic and community health center has access to education and compliance training. That has been a focus for the ARHP in 19 Delta counties during the past nine years.” Since 2016, the hospitals have gotten involved in mental and behavioral health. Bridewell said they now have three opioid grants and are working with drug courts and task forces building relationships and helping people addicted to opiates. ARHP would not be what it is today without its committed board of directors and partners, according to Bridewell. ARHP has five staff members including Bridewell who are employees of the University of Arkansas for Medical Sciences through the UAMS Office of Strategy Management where Bridewell serves as the director. “UAMS’ investment and support in ARHP has provided a valuable connection between a large academic health partner and rural that makes sense,” Bridewell said. “This alignment enables our organization to be able to connect seamlessly to quality services and support provided through various departments across the UAMS campus that bring resources to our hospitals and projects.” The ARHP board of directors, which meets every month, consists of the CEOs from all fourteen hospital members. “What has been most amazing to me is the commitment of my board members who are all hospital CEOs with a lot on their plate,” Bridewell said. “Every month we meet together, committed to working

together to maintain access to healthcare resources in south Arkansas. This collaboration has allowed these small rural hospitals to have a strong voice together while still maintaining independence. As we continue to move forward, I believe that we will be able to accomplish great things and create a successful model for future rural healthcare. The more I see this collaboration, the more confidence I have that this model can work.” Bridewell, originally from south Louisiana, didn’t have a healthcare background prior to moving to Lake Village in 2004. She holds a bachelor’s degree in English from Spring Hill College in Mobile, Alabama and a master’s in Management Tourism and Recreation. After a couple of years living in Lake Village, she purchased a health club. While loving her work there, she felt the need to get involved in the community around her, recognizing the need to address the health and wellness of all residents in the community. “I decided to venture out and got involved in the local Hometown Health Coalition,” Bridewell said. “I had done some successful writing in the past and felt there was a way I could help bring some funding to the area to address the health issues of the community. After working with the local hospital, I eventually took on the job as the director of the UAMS Delta AHEC in Lake Village, which began my relationship with UAMS. Through this job, I was charged with helping the hospitals in Chicot and Desha counties. It was through this job that I was able to convince five local hospital administrators to help me start up the Greater Delta Alliance for Health (now the ARHP). These original

five members have turned to fourteen members and the ‘community’ I served eventually grew to the south Arkansas region and here I am.” A hospital in Lake Village or Dumas has one voice. However, together the hospitals in ARHP have become one of the largest healthcare entities in the state. Bridewell said this means they have enough patient volume to speak to not only legislators and grant funding agencies, but also with payers. “We can now negotiate and converse with payers and contractors and we are heard,” she said. “That wouldn’t happen with one or two hospitals, but it works with 14.” Bridewell and her husband together have two daughters, three sons, three daughters-in-law, and three granddaughters. She credits a lot of her success to her husband, Robert, an attorney in Lake Village, who continues to support her hectic life and is her biggest supporter. “We are all about family and enjoying our life on the lake and spending time cheering the Hogs on in Fayetteville,” Bridewell said. Her greatest accomplishment, she says, has been raising her two daughters, Lillie and Camille. “One is beginning her career in healthcare next month and the other is pursuing a degree in law and policy (hopefully healthcare policy); imagine that!” she said jokingly. For more information, go online to: Arkansas Rural Health Organization, https://www. arruralhealth.org/

Finalized Healthcare Price Transparency, continued from page 5 an a la carte list of prices, the rule also requires each hospital to include a list of 300 “shoppable” services, described in plain language, with all the ancillary costs included. So, in effect, a patient could look up the total cost of a knee replacement, hernia repair or other treatment. Insurers, under the proposed rule, would have to disclose the rates they negotiate with providers like hospitals. They would also be required to create online tools to calculate for individual consumers the amount of their estimated out-ofpocket costs for all services, including any deductible they may owe, and make that information available before the consumer heads to the hospital or doctor. It would go into effect one year after it is finalized, although it is not known when that will occur. Although consumer advocates say price information can help patients shop for lower-cost services, they also note that few consumers do, even when provided such information. Earlier this year, the administration ordered drugmakers to include their prices in advertisements, but the industry sued and won a court ruling blocking

the measure. The administration has appealed that ruling. Nonetheless, Health and Human Services Secretary Alex Azar said the administration is confident. “We may face litigation, but we feel we are on sound legal footing for what we are asking,” Azar said. “We hope hospitals respect patients’ right to know the prices of services and we’d hate to see them take a page out of Big Pharma’s playbook and oppose transparency.” He and other officials on a call with reporters admitted they don’t have any estimates on how much the proposal would save in lowered costs because such a broad effort has never been tried in the U.S. before. Still, “point me to one sector of the American economy where having pricing information actually leads to higher prices,” said Azar. Azar cited some studies that show that when prices are disclosed, overall spending can go down because patients choose cheaper services. However, such efforts also generally require financial incentives for the patient, such as sharing in the cost savings.

The proposed rule for insurers urges them to create such incentives, said Seema Verma, who oversees the federal government’s Center for Medicare & Medicaid Services. George Nation, a business professor at Lehigh University in Pennsylvania who studies hospital pricing, called the final rule and the insurer proposal “exactly a move in the right direction.” Among other things, he said, the price information may prove useful to employers comparing whether their insurer or administrator is doing a good job in bargaining with local providers. Today, “they just see a bill and a discount. But is it a good discount? This will now all be transparent,” said Nation. Kaiser Health News  is a nonprofit news service committed to in-depth coverage of health care policy and politics. And it reports on how the healthcare system — hospitals, doctors, nurses, insurers, governments, consumers — works. In addition to its website, its stories are published by news organizations throughout the country. Its website also features daily summaries of major healthcare news.

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January-February 2020 Arkansas Medical News  

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January-February 2020 Arkansas Medical News  

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