Muskogee Regional Medical Center has passed the one-year marker as a for-profit facility in the hands of its new management, Capella Healthcare.

The Tennessee company began leasing the hospital from the city in April 2007.

There are obstacles that exist that the hospital is determined to overcome — obstacles that other hospitals around the country also are facing. But a number of improvements already have been made, new doctors hired, and plans are in the works for additional improvements, according to Chief Executive Officer Steve Mahan.

Jamie Ragan, 27, said he has only had to go to the hospital a few times, but service there has been consistent.

“I went in early last year with strep throat,” he said. “And I was there a couple of times this year. I went in when my blood sugar was high. I’ve been diagnosed with diabetes, then I had a bad reaction to some medication. They treated me pretty good. I haven’t noticed anything different.”

Former mayor Wren Stratton said she would give the new management a B minus; above average with room for improvement.

“It has been a year of adjustment; us to them and them to us,” she said. “They have brought some really cool people to the table.”

Although Capella has added nine more hospitals to its oversight, MRMC is the largest. It generates a “significant amount” of corporate revenue, Mahan said.

As soon as Capella took over management in 2007, it became a for-profit entity, and accountants were tracking every penny. According to administrative reports, it began to operate in the black during the fifth month of Capella’s management.

Mahan said recently that most indicators are positive.

The $29 million improvement to the hospital, begun before Capella took over, has increased the hospital’s chances for growing its physician community, he said.

“The Westside Expansion has helped us sell our story,” he said. “I’m very grateful to the authority board that they had the foresight to bring that on board.”

As for reports that doctors practicing at the hospital have been at odds with administrators, Mahan said that is an ongoing fact.

“A friend of mine who lives in Muskogee and is on the board at St. John Medical Center told me the medical community at MRMC has always been a little tumultuous,” he said. “I’ve been CEO at six hospitals, and there is always some friction. I’ve tried to make the right decisions and be consistent.”



Other hospitals face similar issues

Mahan said much of the challenges the hospital is facing are national in scope. That’s a major reason MRMC’s physicians are often frustrated.

“What the (federal) government has done is use hospitals to implement changes they want made,” he said. “We’re the people on the ground. Doctors can’t call the president of the United States or the CMS (Centers for Medicare and Medicaid Services), but they can express their concerns through their lobbying efforts and by talking to us.”

MRMC is the second largest employer in Muskogee, according to the Muskogee Development Corp. The hospital has 975 employees. An estimated 800 of those jobs are full-time equivalents.

One of the most stubborn problems the hospital faces is physician recruitment. Capella researchers estimate this geographic area needs approximately 50 new doctors. Mahan has set a goal of achieving that number during a four-year period. He’s also trying to counterbalance the loss of a few physicians.

“We have lost some; two in the radiology group found other opportunities,” he said. “But we’re fully covered by excellent locum tenens (interim) physicians.”

Kathy McGee of Checotah wrote to the Phoenix about taking her grandson to the MRMC emergency room. She was shocked that no surgeon was available.

“The ER staff was great,” she wrote. “When advised that he needed an appendectomy, the family was asked which hospital they wanted him transported to because there were no surgeons on call on the weekends. It doesn’t take a genius to figure out that the hospital could hire at least one other surgeon.”

McGee described the situation as a “degradation of the level of surgical availability” and added that it was “inexcusable and insulting to area residents.”

Mahan said the three general surgeons in town — Jerry Bouman, Richard Reutlinger and Timothy Robison — are currently declining to be on call for the emergency room.

“While every specialty on our staff is taking call, our general surgeons are not,” he said. “What we are trying to accomplish has to be done in concert with our physician community. So, some of the things working against us are self inflicted.”



Efforts under way to recruit physicians

In response, Mahan has begun the process of bringing interim surgeons on board for emergency situations such as the one McGee encountered.

He also described several features of their recruitment effort:

• Created new full-time physician relations position in July 2007.

• To date, invested more than $1.5 million in recruitment expense and plan to spend millions more to continue this effort.

• Retained three national recruiting firms and have 16 more on a contingency basis.

• Recruited 10 new physicians including: four hospitalists, two OB-GYNs, a physiatrist (physical medicine and rehabilitation), an interventional cardiologist, an internist and a pediatrician.

Mahan said there was a long-standing physician shortage before Capella took over MRMC. What’s different now is that Capella has sizable corporate resources to devote to recruitment which the previous administration did not.

Mahan said the hospital is reaching out to medical students.

“One-third have been residents in training,” he said. “We’ve been catching them (medical students) in their third year. We’ve told them that if they will commit to coming to this community, we will pay them a stipend during their last year of residency.”

Adding to the challenge is MRMC’s rural location. Mahan said he has read one survey of medical residents where 85 percent said they preferred the idea of going to work in an urban environment.

Mahan said he is making sure physician candidates know about Muskogee’s proximity to Tulsa and its attractions.

There have been reports that patients with emergency orthopedic needs have been unable to get help at MRMC and have been taken to Tulsa. Mahan said that’s also becoming more common in other facilities.

“Pay for call has been an issue at this hospital, and it is an issue that is flaring up in a lot of areas of the United States,” he said. “In the Tulsa market, every hospital is paying for call; that means you’re paying them (physicians) a stipend for unassigned ER call. The vast majority of our medical staff does take call without compensation.”

Mahan said doctors face a “burden of unassigned call” because of the rising number of uninsured in this country and emergency rooms being on the front line.

“When these doctors are young and starting out it’s a great way to build practice, but in a community like ours where we know we have a physician shortage, and we have a lot of very mature physicians with mature practices, it places a real burden on them,” he said. “For the younger physicians coming out it’s changing value systems and more of an increased emphasis on quality of life than physicians of earlier eras.”

Mahan said that, despite his sympathy for the predicament doctors face, MRMC itself cannot afford to absorb the consequences.

“The thing that hospitals cannot be is the deep pocket for every time the physicians take an income hit, due to a change in reimbursement by the government or a commercial insurer, because we’re taking those hits too,” he said.



Competition stiff to recruit physicians

David Edwards at Office Medic, which does medical office management and recruitment, said most of MRMC’s problems are typical of area hospitals.

“It appears that MRMC has struggled some,” he said. “If you look in the classified ads, you’ll see hospitals from McAlester and Durant that are advertising. There is a crunch in health care in physicians and clinical staff. In Muskogee at the Children’s Clinic, we were short a pediatrician for a year and a half. There is a lot of competition. Hospitals from Okmulgee and Henryetta are drawing from the same pool of people.”

Edwards said the competition means a lot more advance planning for recruiters.

“In recruitment of physicians, you’ve got to start way ahead of time; a year before they actually get out of school,” he said. “With established physicians, you have to find the right match, and it can easily take six to nine months. That’s not just locally; you’ll hear the same thing if you call a hospital administrator in Texas, Missouri, Kansas or Arkansas. I know that the hospital (MRMC) is working diligently.”

Adding to the difficulty is the fact rural hospitals are usually not as lucrative as urban locations. Edwards said that shrinks the number of physician candidates.

“Rural hospitals are drawing from a smaller pool,” he said. “That’s true of any business, whether it’s physicians or plant managers. That person or their spouse may be accustomed to living in a metropolitan area.”

The construction of a new hospital in Muskogee might put a strain on the availability of doctors.

Mahan was diplomatic about what will happen when Muskogee Community Hospital opens.

“Most physicians will work at both hospitals, and the only significant effect will be that it puts more pressure on precious resources,” he said.

Mahan said he and his staff are working with Oklahoma State University to arrange for MRMC to become a teaching facility. The hospital is also close to funding a faculty chair at Bacone College.

“We provide scholarships to other schools as well, but Bacone put forth a proposal,” he said. “We’ve been looking quite some time for a director of the medical technician school (which operates in house). That is one of only three such training centers in Oklahoma.”



Plans in the works for improvements

Although there are persistent rumors of massive layoffs, Mahan said the only big staff change they have made was in transcription.

“It was going to cost us $150,000 to upgrade medical records transcription,” he said. “We have decided to outsource those services.”

MRMC spokeswoman Laurie Hoog pointed out the hospital’s increasing community involvement, new women’s center and wound management center, and a revitalized speakers bureau.

Mahan said two major improvements are in the planning stages:

• A new intensive care unit, emergency room and maternal/child tower — “That is within our facility plan. We would be looking at doing something like that on the five-year time horizon. On a much shorter term we want to be breaking ground on our new ER/ICU complex. Demand is growing; we had 37,000 visits last year to our ER. We want to build the ICU right over that. There are good reasons for that when you have trauma cases or post surgery; it puts them in proximity to each other. That will be our first major expansion.”

• An on-site helicopter as part of an interventional cardiology program — “That’s very real, and right now we are talking to various providers and deciding which one we want to have on site. We have to have that when we do interventional cardiology. When that procedure is going on in the hospital, in case one accidentally perforates a vessel, you have to be able as quickly as possible to get them to Tulsa.”

Dr. Timothy Holder, with Maternal and Family Practice Associates, said there has been more attrition than he initially hoped.

“There have been a few bumps in the road, such as loss of staff,” he said. “The current administration has hired physician recruiters, which was one of the reasons why we wanted to make the changeover in the first place. They also have a nursing recruiter, and that’s a nationwide problem.”

Holder said at least one major problem has been addressed under Capella’s management.

“The other big change is in the way the emergency room is managed; we have rarely had to go on divert,” he said. “And, they’ve re-opened ER south, which has helped with overcrowding in the emergency room. The current administrative team is very good. Of course they have a lot of challenges ahead, but I feel confident in them.”