- Associated Press - Sunday, March 15, 2015

LINTON, Ind. (AP) - Small-town Greene County General is one of just 29 county-owned and independent hospitals left in Indiana, where money woes and trouble recruiting doctors have resulted in mergers and takeovers by bigger and more financially stable medical networks.

“We’re completely independent,” Chief Executive Officer Brenda Reetz told The Herald-Times (https://bit.ly/1Bti1wf ), pride in her voice.

The 25-bed critical care hospital and its staff are rooted in the rural community. Reetz returned to Greene County in 2012 as the hospital’s operations officer, then got promoted to the top job after longtime hospital administrator Jonas Uland retired.

Two decades ago, Reetz was a White River Valley High School student mowing lawns in Linton and working as a volunteer, then as a paid nursing assistant, at the convalescent center in Lyons. The now-hospital CEO is Greene County born and bred.

Reetz loved nursing, got a degree and worked at hospitals in Vincennes and Bloomington before going on the road as a traveling nurse, landing jobs in North Carolina, Texas, California and finally Oregon, where she settled. Reetz got a bachelor’s degree there from Chamberlain School of Nursing and worked in Oregon as an emergency room nurse supervisor and also as an ER administrator for Providence Medical Group.



Then she returned home to Indiana. “I had wanted to come back, and it all fell into place.” She and her husband moved from the West Coast to the Midwest, their toddler son in tow. “We live right across the road from the farm where I grew up.”

Beneath that hospital CEO business suit lurks a nurse who knows patients are the priority. “When I hear ‘code blue in the ER,’ I’m there, just in case they need help. I can still clean a hospital bed, and I do. The nurse never goes away.”

And this nurse is focused on the future of Greene County General Hospital. “If you get sick, if you have a heart attack, if you are ready to deliver a baby, we are here, offering primary care and also specialty care,” Reetz said. “It’s hard to put a value on that. Sometimes, it’s a person’s life.

“In a rural area, we are a medical necessity. And cost effective. If you take a Greene County General Hospital patient and send them to an urban center, the cost there would be 2.5 percent higher.”

The hospital newsletter tells the stories of two Greene County families grateful their local hospital was there when medical emergencies arose. Jeff and Jennifer Wilson’s daughter Livie developed a high fever, then lost consciousness after her family rushed her to the emergency room, where her fever spiked to 107 degrees. Staff there administered fever-reducing drugs and packed ice bags around her, then loaded the girl onto a helicopter to Riley Hospital for Children. She spent a week there recovering.

Kelly Reel’s pregnant daughter suffered a blood clot and had to undergo an emergency C-section in August 2012 upon arrival at Greene County General before both mother and baby were rushed to Indianapolis for specialized treatment. “We are so fortunate to have the hospital nearby,” Reel said. “I believe getting her to a facility close by was instrumental in saving her life. It was such a scary day, and for a while we thought we would lose her and possibly the baby.”

Harry Huber, president of the hospital’s board of trustees, also knows firsthand the value of having a hospital a mile down the road from his home. When the retired elementary school principal’s health took a downturn last year, he found himself in Greene County General Hospital’s emergency room. He ended up having surgery, and was a patient on the third floor for 10 days.

“I was ill enough that I could have been transferred to a bigger hospital, but I trusted the doctors we have here on our staff,” Huber said. “The way I see it, it’s quite an honor, to have local people - friends and neighbors - take care of you. When I opened my eyes and someone came to take my vitals or do a test, most of the time I knew them or their family. They cared for me. It’s community and family. I understood then the value of the hometown mission we have always emphasized.”

Huber said keeping the hospital independent and local has always been a priority but has become more of a challenge in an era in which mergers and takeovers of small rural hospitals are the trend.

Indiana once had 51 independent county-run hospitals, but in recent years, the number has dwindled to 29 as some have fallen into debt and others have outlived aging facilities. Both situations require infusions of cash that can be difficult to come by in rural counties, which often opt to rid themselves of the burden of maintaining a hospital.

Larger hospitals and networks step in, absorbing debt and sometimes building new facilities to replace the old ones. Most recently, in November, Wabash County Hospital relinquished its independent status when the board of trustees voted to affiliate with Fort Wayne-based Parkview Health and Community Health Systems. It’s now Parkview Wabash Hospital.

“The hospital needed to get access to money to replace the building and were not getting favorable responses regarding loans and federal financing,” Indiana Hospital Association Vice President Spencer Grover explained. “Without access to capital, they had to look beyond remaining independent.”

Grover said two independent southern Indiana hospitals - Clark Memorial in Jeffersonville and Scott Memorial in Scottsburg - currently are negotiating with larger nearby hospitals and a Tennessee-based medical management firm in hopes of finding a way to stay viable while no longer being on their own.

The most recent numbers from the American Hospital Association, from 2011, show that just 39 percent of community hospitals across the nation were independent that year, down from 49 percent in 1999. The decline has continued the past three years as more hospitals fall victim to age and financial troubles.

A study from the health care finance firm Irving Levin Associates showed that hospital mergers and acquisitions increased from 51 in 2009 to 94 in 2012. Indiana’s two biggest hospital networks - IU Health and St. Vincent - are part of the trend and have been taking over hospitals around the state during the past decade. Bedford’s two once-independent hospitals now have new owners and names: IU Heath Bedford Hospital and St. Vincent Dunn Hospital. IU Health also owns Bloomington Hospital.

But it is possible, and beneficial, for places like Greene County to maintain their local hospitals for an aging population in a place where population growth stopped with the end of surface coal mining 20 years ago.

Hospitals can limit what they do and seek designation as a critical access hospital, a federal certification that allows hospitals to be reimbursed for the actual costs of services instead of fixed rates that pay less. Greene County General became a critical access hospital in 2003.

Hospitals have to meet certain standards for critical access status: They can’t have more than 25 inpatient beds, must maintain an average length stay of no more than 96 hours for acute inpatient care, must offer around-the-clock emergency services and also be located in a rural area at least 35 miles away from another hospital.

Critical access hospitals stay small and focus on more common and less-serious ailments that require shorter hospital stays, and refer more serious conditions to bigger hospitals, often located less than an hour away, after stabilizing patients. Reetz said a local person suffering a heart attack would receive initial care - crucial within an hour - then be sent to a bigger hospital for more advanced procedures. “We can break up a clot, prevent loss of heart muscle, right when they come in our door. We get them into an ambulance and send them to Bloomington for a heart cath, or whatever they need.”

In order to best serve patients, Greene County General Hospital’s board members a few years back decided that in order to stay in the game, they needed to invest in the future. In 2012, the hospital embarked on a $7.5 million expansion that added 8,500 square feet.

They refurbished the emergency department, expanding from three private rooms to eight. There is a new main entrance, and the laboratory, radiology department, pharmacy and physical therapy area have been renovated.

The hospital has expanded its staff, partnering with specialists who have offices and outpatient clinics located on the second floor for cardiology, surgery, oncology, hematology, pulmonary and orthopedic services. And they recently added a gastroenterology specialist.

CEO Reetz is excited about the hospital’s success recruiting new doctors to the Greene County Health system. Dr. Chris Holmes, a pediatrician from Bloomington - “She’s our first pediatrician,” Reetz said - opened her Linton office last year.

The hospital head said the recent arrival of Dr. Thomas Martin, a geriatrics specialist focused on treating patients in the final years of their lives, and Dr. Kelly Ramsay, a family practice physician trained in obstetrics who will be delivering babies, rounds out the cast of doctors.

“I had all four of my kids here, including twins,” said Halea Franklin, the hospital’s marketing director. “It was important, the personal care and knowing people.” The hospital chief of staff, Dr. Frederick Ridge, delivered her at the hospital where they both now work.

Reetz is not the only member of the leadership team who hails from the local community. Chief Financial Officer April Settles, a certified public accountant, is a 2001 graduate of White River Valley High School. Director of Nursing Lea Ann Camp began her career at the hospital 10 years ago as a registered nurse in the intensive care unit and emergency room. Kyle Cross, who oversees the hospital foundation, is a lifelong Greene County resident who graduated from White River Valley High School in 2007. …

The hospital hosts a breakfast for military veterans on Thursdays, and the cafeteria food is tasty enough to attract lunch customers from town who have no other business at the hospital. The Rotary Club meets there, and the hospital hosts civic events and supports local causes.

But keeping people healthy is in the forefront of everything the hospital does.

“We’ve had to make changes to remain viable, always remembering that the people we are taking care of are the people next door, the people we go to church with, the parents of the kids our children go to school with,” Reetz said.

___

Information from: The Herald Times, https://www.heraldtimesonline.com

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