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| Palo Pinto General Hospital: Challenging Times |
| Hospitals | |
| Written by G. Jeffrey MacDonald | |
| Monday, 01 October 2007 | |
 Despite the area’s nursing shortage, this rural hospital is staying out of the red and enjoying an expanded facility.  Harris Brooks, CEO “There aren’t many general, orthopedic, or thoracic surgeons in this rural area,” said PPGH CEO Harris Brooks. “In our surrounding counties, people have a choice: do they want to drive to Mineral Wells for that service, or would they rather go to Wichita Falls, Abilene, or Fort Worth?” Hospitals aren’t the only game in town, either. Patients can also choose among a growing number of boutique operations, such as stand alone MRI centers, where Brooks said patients tend to get faster service than they would from PPGH, a county-owned hospital. Nurses, too, have multiple options for employment. Because hospitals just 40 miles away in the Fort Worth/Dallas area pay higher salaries, factors such as lifestyle and pleasant working conditions have become important factors at PPGH. What’s more, PPGH isn’t big enough (it counts only about 35 inpatients on an average day) to keep the full attention of specialists like neurosurgeons or oncologists. Hence, the hospital has to share one of each with other area facilities. None of these competitive factors lend themselves to a quick fix. But PPGH has nevertheless reversed the cash hemorrhage that plagued the operation in the late 1990s, breaking even or achieving surpluses in each of the past seven years. The approach employed to erase red ink at PPGH wouldn’t work for every healthcare organization, but it showcases what can be accomplished by leveraging key tools at a hospital’s disposal. Retaining nurses can be difficult, Brooks said, especially during summer months when the hospital is only half as busy as in winter, known at PPGH as pneumonia season. But competitor hospitals, by signing PPGH nurses for a couple of extra shifts, make it possible for nurses to stay onboard at PPGH even during periods when their hours take a dip. Even so, PPGH has recognized that today’s nursing shortage will only get worse. In the coming decades, Brooks said, aging baby boomers are sure to put further strain on an already stressed system. But rather than planning to recruit nurses from afar, PPGH focuses on finding the future workforce in its own backyard. The hospital makes a point to host high school students, for instance, through an outreach program intended to help students see themselves working in a health-related career. And nurses-in-training at two local colleges learn quickly that PPGH is both a good place to learn and a long-term work opportunity, especially if they want to stay in the area and raise a family in a low-crime community. “It’s much easier to grow your own nurses than to import them from the Philippines or try to recruit them from Houston or Dallas,” Brooks said. Digging deep Other challenges have required the hospital to dig deep for resources. PPGH was losing money in the 1990s, Brooks said, because of rising costs and reduced reimbursement from third-party payors. More than 10% of the hospital’s annual budget of $80 million goes to cover costs associated with treating patients who don’t pay their bills. Faced with this reality, as well as a need for upgraded facilities, PPGH set out several years ago to sell Palo Pinto County residents on the merits of raising taxes, which had been among the lowest in Texas. “We needed to educate the community to let them know, ‘Look, it’s either downsize and wither on the vine, or go for this and have a modern healthcare facility for your community,’” Brooks said. Voters approved a tax hike to bring Palo Pinto County’s tax rate into better alignment with those of other counties around the state. Even with extra tax revenue in the picture, however, PPGH would need to borrow to expand, add moneymaking services, and renovate. The hospital took advantage of low interest rates and borrowed about $8 million to execute an $11.5 million project. The results have been dramatic. Between February 2004 and August 2005, PPGH renovated 14,000 square feet and added another 24,000 square feet. Day surgery capacity is now doubled, as is the operating room area. PPGH can accommodate more urgent care patients and keep additional intensive care patients on site as well. Cutting the cost of caring for high-need patients has also played an important role. PPGH benefits from a federal grant intended to improve the lifestyle habits of some of the hospital’s neediest patients. Researchers from Texas A&M University collect patient data regularly, with support from the federal Department of Health & Human Services. Analyses of that data help PPGH practitioners to identify high-risk individuals and steer them to resources to help them live healthier lives. Government support notwithstanding, PPGH can’t do everything it would like to. For instance, the hospital hasn’t yet been able to invest in bedside medication verification systems. But on the whole, PPGH has invested strategically in its future and established a formula for staying in the black. And that’s good news for the people of Palo Pinto County, who were wondering just 10 years ago whether their community hospital would survive. G. Jeffrey MacDonald is a correspondent for the Christian Science Monitor. Based in Newburyport, Mass., he can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it |
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