oak hill hospital

Every morning Mickey Smith makes the 40-minute commute from his home in Crystal River to Oak Hill Hospital in Hernando County.

But the CEO of Oak Hill Hospital is not alone. About 4,500 Citrus County residents last year chose the facility for their medical care. More than 100 people from Citrus County also work at the accredited hospital.

In a business where most hospital heads stay only a few years before moving on Smith is an anomaly. He has been the hospital head for 18 years, overseeing the hospital’s expansion from 180 beds in 2006 into a medical campus with 350 beds on its 140 acres. The hospital opened in 1984 with 96 beds.

He wants the hospital to be south Citrus County’s medical destination when people need health care or have an emergency.

The hospital, owned by Hospital Corporation of America, is a teaching hospital and enjoys several accreditations, including from The Joint Commission, Commission on Cancer, American College of Radiology, and College of American Pathologists.

It’s Hernando County’s only open-heart surgery hospital, offers orthopedic and spine surgery, pediatric emergency care, labor, delivery, NICU care, and women’s imagining.

What else does Oak Hill Hospital have going for it, according to Smith?

“It’s the same as real estate: location, location, location,” Smith said. “People are fleeing New York. People are fleeing Tampa to come here. With the Suncoast it’s easy.”

Oak Hill Hospital is also close enough to larger hospitals that can provide more specialized care if it’s needed, he said.

“The other thing that’s happened is that technology has leveled the playing field,” he said, allowing small and medium sized hospitals to offer services once only performed at larger, metropolitan facilities.

“And what’s really been transformative for us is the teaching (and residency) program,” Smith said, offering graduating medical students eight accredited programs.

The plan is to try and persuade young doctors to stay in Hernando after they finish their residency programs, helping to shore up a doctor shortage that’s also being seen across Florida and the nation.

To accomplish that the hospital’s training program is putting an emphasis on Florida medical students, said Dr. Jason Grabert, the program’s assistant director.

But to pay the bills, Smith said it all comes down to dollars and cents and Smith admits he is a numbers guy.

Outside the door of his office and in the administrative lobby, Smith has three monitors that track patients in the ER, admissions, and operating rooms.

In 2019, the hospital had more than 19,300 admissions and 65,000 ER visits. The hospital and affiliated buildings on campus has 1,900 employees.

Many of the hospital’s Citrus County patients come to the Oak Hill because of location, Smith said, citing Oak Hill as the closest hospital from Homosassa south.

But it’s also the quality of care, he said.

The hospital has about one half the turnover of its nurses than the national average, Smith said. It was the first in the United States to require all of its eligible emergency room nurses to be board certified.

Setting the ER standard higher costs the hospital more in salaries, but the ER can guarantee its patients a higher level of care, Smith said.

In a health care field where most CEOs stay a few years before moving on, Smith has headed Oak Hill Hospital 18 years. He said he wants to stay on and oversee the many improvements the hospital has undertaken.

The hospital last week had about 93% occupancy. Last year it added about 70 beds to keep up with demand.

The hospital also has its own in-house pharmacy for patients who are leaving the hospital with employees who will bring them their medications to their room. The pharmacy will also fill their prescriptions after they leave and will make free home deliveries.

Smith said that because Oak Hill is a teaching hospital he has to be committed to buying state-of-the-art equipment. He said he also wants to keep the hospital a place where young doctors want to work.

One of those doctors is Dr. Tiffany Simon who graduated from Oak Hill’s residency program.

“I always wanted to be a rural, small town doctor,” she told the Chronicle. “The hospital takes care of us and there’s no place I’d rather be.”

The hospital has the latest technology and matched the services in Atlanta where she trained, “so why not stay,” she said while working in the hospital’s ER.

Dr. Bradley Stellflug said the hospital’s reputation is drawing patients, especially from outside the county.

“Ask anybody. Patients are asking to come here,” he said.

Dr. Hamoui Nabeel is an interventionist in radiology and urology.

“There have been continuous upgrades here,” he said of Oak Hill. “The nursing care is unbelievable. … The ER rivals much larger (hospitals).”

“It’s a privilege to come here and actually practice here,” he said.

Dr. Xavier Jenkins has performed more than 1,000 robotic assisted surgeries. In the 2000s he practiced in Minnesota and Missouri but visited friends and family in Hernando County.

Asked why he chose Oak Hill, he said he wanted to work in a hospital that offered his specialties, but most important his values.

As for Smith, the CEO said his own job won’t be done until Oak Hill becomes “the place to work, bring families, and bring doctors.”

Meanwhile, he expects the number of patients, and employees, from Citrus County to keep growing.


Source:  Citrus County Chronicle

Nicklaus Children’s Hospital, the only pediatric trauma center in Miami-Dade County, is suing the state to challenge a law that would permanently allow another hospital to operate a competing trauma center without having to undergo the same kind of scrutiny, saying that the competition could functionally put Nicklaus’ facility out of business.
Nicklaus filed a lawsuit late last week against the state Department of Health to stop Kendall Regional Medical Center, which is owned by the Hospital Corporation of America, from operating as a Level I trauma center in the region. The department regulates which facilities have approval to operate as trauma centers, which treat the most serious injuries like gunshot wounds and severe burns.
The lawsuit, filed in Leon County circuit court, contends that part of the law — which was passed in March — violates the state Constitution by being written so narrowly that it amounts to a “special law” for Kendall alone. State statute requires that lawmakers notify the public in advance or hold a referendum for voters in the area before pushing through a law that grants a benefit to a private corporation.
A provision in the law requires the state to grant Level I trauma status to any center that had provisional approval for that tier before January 2017 but still did not have final verification by December. Kendall was granted provisional authority as a Level I trauma center in May 2016, though Nicklaus Children’s Hospital — which is part of the Miami Children’s Health System — had challenged the initial approval.
The new law would make Kendall’s trauma status permanent without the facility being required to go through a review or an on-site verification survey, attorneys said.

The lawsuit claims the law allows the Kendall trauma center “to automatically bypass in-depth review, including a determination of need, and to receive the department’s final approval as a Level I trauma center without meeting the same requirements and standards, and undergoing the same approval process, as other hospitals.”

Lawyers for Nicklaus also claimed that allowing Kendall to permanently operate as a Level I center would so limit Nicklaus’ coverage area and revenue that “the predicted volume reduction would amount to a constructive closure of [Nicklaus’] pediatric trauma program.”
Competition from Kendall, attorneys wrote, would drive up demand for a limited number of trauma personnel. Some pediatric patients have already been diverted to Kendall, which is a few miles away, the lawsuit added — the volume of Nicklaus’ trauma alerts during 2016-2017 decreased by 30 percent, according to hospital director of governmental relations Lani Ferro. Nicklaus “is likely to suffer irreparable harm because any final approval of Kendall’s Level I status, and the significant damage flowing therefrom, cannot be undone,” the suit alleged.

“This special law is devastating to the standard of care for the region’s children,” Narendra Kini, CEO of Nicklaus Children’s Health System, said in a statement. “Furthermore, this law will only fragment trauma care and decrease pediatric subspecialty expertise, as pediatric trauma centers afford children a better chance at survival.”

Kendall Regional Medical Center and Hospital Corporation of America — better known as HCA — did not respond to requests for comment.
The legislation including the clause for Kendall was a broad-reaching bill that sought to overhaul the state’s trauma system after years of lawsuits over various facilities in the state — in part as HCA has opened trauma centers at its own hospitals.
Hospitals with more established trauma centers have long fought approvals for new centers, arguing that too many facilities would cut into a limited number of cases and lessen the amount of practice their providers get treating complicated injuries. HCA has argued in the past that adding more facilities expands access to care for seriously injured patients.
State Sen. Dana Young, R-Tampa, who shepherded through the compromise legislation, said the trauma bill was a “nice balance of all competing interests” that had sought to resolve several disputes by grandfathering in facilities that had already received provisional approval from the state or those that had received verification and had their status challenged.

“It wasn’t like picking one or two or leaving others out. We tried to be very consistent,” she said. “The bill took a broad brush in order to get our trauma center statute back on track.”

Kendall was among about half a dozen facilities that were subject to similar grandfathering clauses to resolve their trauma status, according to a final bill analysis. Included was Aventura Hospital and Medical Center, another HCA facility, which had received final approval as a Level II trauma center but had its status disputed by Jackson Memorial Hospital.
Ferro said Nicklaus was not included in the crafting of the bill and began meeting with lawmakers in February to object to the grandfathering provision that was eventually adopted. The law was passed unanimously by both chambers and signed into law by Gov. Rick Scott, a former HCA executive.

Representatives for Nicklaus at the time “didn’t want Kendall approved under any circumstances,” Young added. “I didn’t think that was an appropriate resolution.”

The law also added a strict need formula that would make adding any additional new trauma centers beyond those grandfathered in more difficult. It also reduced the number of “trauma service areas” to 18 regions and created an advisory council to propose criteria for future approvals.
Source: Miami Herald

As state lawmakers prepare to determine the specifics of an $87 billion budget, hospitals are ready for the annual fight over state funds.
But this year’s negotiations, already off to a slower start, are likely to also be tangled by lower revenue, higher Medicaid costs and the political fallout from the state’s worst school shooting, which continues to rattle the Florida Legislature.
A top Senate leader said Tuesday both chambers had agreed on allocation numbers for the overall components of the state’s budget, including $543.6 million more in health and human services, which includes five state agencies. But the big-picture numbers only start the messy process of negotiating how those dollars are spent.
Both the House and Senate had rolled out plans earlier this month that diverged on healthcare spending, primarily how to compensate hospitals for Medicaid care. The House plan would preserve additional Medicaid payments, known as automatic rate enhancements, to 28 hospitals that currently serve a larger percentage of Medicaid patients. But the Senate plan would redistribute the $265 million in additional inpatient funds to all of the state’s hospitals instead, decreasing the amount of money those 28 hospitals receive.
The Senate’s proposed shift would disproportionately affect some of South Florida’s largest institutions — including Miami’s Jackson Memorial and Broward Health, which would lose $59 million and $17 million, respectively, according to an analysis by the Safety Net Hospital Alliance of Florida. Tampa General would lose $14 million, and Nicklaus Children’s Hospital in Miami and Johns Hopkins All Children’s in St. Petersburg, which each see about 70 percent of patients covered by Medicaid, would lose $10.5 million and $5 million, respectively.
But major for-profit hospital chains would see their reimbursements rise under the redistributions: the Hospital Corporation of America, which operates nearly 50 hospitals in the state, could see its reimbursements rise more than $40 million. Baptist Health South Florida, a nonprofit group of hospitals, would also come out ahead, according to the Safety Net Hospital Alliance.
The budget proposals have remained stalled since they were both passed Feb. 8, waiting for legislators to name budget conferences to begin the negotiating process between both chambers. But the process of agreeing on the funds could prove to be messier this year than most.
The Legislature has committed to hundreds of millions in additional expenses to address the shooting at Marjory Stoneman Douglas High School in Parkland, where 17 people were gunned down two weeks ago. Legislators are still trying to determine how to balance spending in the overall budget with the Parkland package, which will funnel at least $400 million in initiatives for gun control, school safety and mental health. The state is also expecting about $167 million less in corporate taxes than previously estimated after revenue estimates were revised, and in health care, legislators have to also tangle with about $100 million more than expected in Medicaid costs from the previous year.
Those numbers could affect overall budget discussions and the pace at which legislators come to an agreement on spending as a whole.

“When you take $400 million and put it towards necessary efforts, that creates challenges in other areas of the budget,” said budget chair Sen. Rob Bradley, R-Fleming Island, when he announced the allocations agreement Tuesday. “We’re up to that challenge.”

But those discussions are unlikely to directly influence discussions about hospital funding, which largely deals with redistributing the same amount of money in one pool, said Lindy Kennedy, vice president of the Safety Net Alliance. “I don’t see it impacting it directly, as the two chambers line up their priorities.”
For the session to end on time, lawmakers must come to an agreement on the budget by March 6, providing for a three-day waiting period before it can officially be passed. The session is scheduled to end March 9.
Source: Tampa Bay Times