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Story of a Christmas Hospital Re-opening — Issue #8

Core COO Jessica Long Became CEO of a Bankrupt Hospital at Age 30. Here’s Her Story.

In May 2016, the Chattanooga Times published a multi-chaptered, nearly book-length investigative report on the saga of Hutcheson Medical Center, a county-owned, highly troubled community hospital located in the North Georgia community of Fort Oglethorpe.

The newspaper wrote about the years-long downward spiral, the “unstable environment,” having rotated through three CEOs in four years, and about how the hospital failed to pay claims for the self-funded health insurance of its employees. The story chronicled the bad decisions of previous leaders, the market forces that put Hutcheson “in a hospital bed,” and the “pride from the men at the top” that forced the enterprise into bankruptcy.

Finally, the newspaper chronicled the “revival,” in which the holdings company that owns ApolloMD, where I was working at the time, decided to purchase the hospital for $4.2 million. I joined the board, while Core COO Jessica Long, who had been working with me at the time, became the hospital’s CEO. Just three days before Christmas in 2015, we re-opened a bare-bones operation inside the Emergency Department.

It was an exhilarating experience and one that I believe is instructive for anyone working in healthcare.

So, as Christmas approaches, I invited Jessica to tell the story of the Christmas hospital re-opening from her perspective. I hope you enjoy and we at Core wish everyone a safe and happy holiday season.

– Dr. Boykin Robinson, CEO

Story of a Christmas Hospital Re-Opening

By Jessica Long, COO

I will never forget the night before we re-opened the hospital. I was in my car in the parking lot leaving at around 11 pm. As I was pulling out, a woman in a Volvo station wagon pulled in front of me and parked her car perpendicular to mine so I couldn’t leave. This was before we got better lighting in the parking lot, so it was dark.

She got out of her car and walked over to mine and motioned for me to roll my window down. She proceeded to tell me how important the hospital was to the community and how meaningful it was that we were making an effort to keep it open. “You don’t understand,” she told me. “This community needs this hospital.”

Hutcheson’s Troubled Past

How decisions were made 40 years ago, in any industry, is fundamentally different from how they need to be made today. We no longer live in a world where handshakes, taking care of your buddy, and personal interests can successfully co-exist with best business practices and patient care.

Hospitals today are held accountable for providing quality care through several different regulatory bodies. And they are held financially accountable through various incentive programs and contracts with insurance carriers. We are no longer incentivized to keep a patient in the hospital with per diem reimbursement. Instead, we are incentivized to care for patients and discharge home appropriately and expediently. We all know that keeping someone in the hospital for an extended period is not in anyone’s best interest.

Hutcheson Medical Center had a medical staff that was used to practicing according to how they saw fit and frankly were never held accountable. This was coupled with leadership that at best had good intentions but did not execute and at worst was self-serving and corrupt.

An example of good, but misguided intentions would be the beautiful hospital lobby. The hospital hadn’t appropriately increased employees pay in years, nor had it invested in updating equipment to improve patient care, yet they invested millions for this beautiful new lobby. In a lot of employees’ eyes, that lobby epitomized the problem.

Financially and operationally speaking, there was no clear strategy. They were operating pretty much the same as they had 15 years ago. There was no payor strategy or critical evaluation and negotiation with contracts. From an operational perspective, there weren’t processes in place to ensure collections or accountability.

Figuring out how to change quickly when you are owned by three different counties, all of which have competing priorities, is challenging enough, but when the hospital started to lose market share to other more sophisticated hospital systems across the border in Tennessee, it made it near impossible to come back.

Hutcheson had the upper hand and all the market for many years, but when it couldn’t adapt to the key changes in our industry, it spiraled and within a matter of years lost a significant portion of its market share. The hospital had ended up with a black eye in the eyes of the community because of poor decision-making.

Hutcheson’s Best Resource

There was a lot of focus on the negatives at Hutcheson, which were no doubt sensational, but I could write a novel about the one thing this hospital had going for it: its people. I have never encountered a group of more dedicated employees. Unfortunately, none of these people had been given a voice or the chance to grow as leaders and professionals, but boy were they willing to work and evolve themselves when given the chance.

You know who knows more about ins and outs of equipment needs than the CEO? The Lab Manager, Pharmacist, and Facilities folks…anyone that is using the equipment daily. You know who has ideas about how to turn rooms faster and coincidentally runs a service that can heavily impact patient satisfaction? The head of Environmental Services. If you give people a voice and let them get creative, they are going to come up with way better ideas than you could have imagined on your own.

I remember walking to our leadership meeting with all the service line leads, a meeting which I scheduled in the board room. As folks came in, they either sat against the wall or stood. I asked them to move to the table and we carried on, but after the meeting I had multiple people come up to me and tell me that they had never been allowed in the board room before, let alone to have a seat at the table. Most of our leadership team was comprised of people who had been at the hospital for years and it still blows my mind to think that there was this underutilized depth of knowledge just standing in the back for so many years.

The people that worked at that hospital put it before themselves and their families. They forwent paychecks when the CEO was taking that money home for himself. The Department of Labor began an investigation into the CEO that preceded me and into other Hutcheson colleagues for fraud related to the failure to pay the healthcare claims for the Hutcheson employees. Some of the people who were still working there were filing for bankruptcy because their employer wasn’t paying their claims. It was horrifying.

A Non-Traditional Opportunity

In the first week of December 2015, the hospital officially closed its doors. Windows were boarded up. Hundreds of employees were laid off. The hospital had stood as a cornerstone of the community since its construction in 1953. Back then, residents who referred to themselves as part of a “cornerstone club” had donated parts of their paychecks to help pay for the hospital’s founding. Now, just a few weeks before Christmas, it was closing.

At the point we stepped in with Hutcheson, the operation and facility weren’t viewed as a worthwhile investment to anyone else. There was too much debt, too much liability. The allegations of fraud meant there was also a lot of risk: what problems would new owners unearth once in there running the hospital?

Yet the hospital undoubtedly had potential. It had a Certificate of Need to provide some key services to north Georgia. It was located just south of Chattanooga which is a very cool little city. It had an incredibly supportive community and served three counties that were making significant investments in infrastructure to support population growth.

It was non-traditional and it would take some outside-the-box thinking, but it was a worthwhile opportunity and an exciting one to me.

Zero-Based Everything

We had to re-open the hospital within 14 days or we would lose the Certificate of Need. Meanwhile, there were about a hundred employees who had recently been laid off, several of whom we would need back to reopen. The longer we waited the more likely it was they would find jobs somewhere else.

The hospital campus we had inherited was in severe disrepair. We had broken elevators, leaky roofs, and the equipment was beyond its lifespan by years. Fortunately, the facilities team had worked at the hospital for over 30 years and as a result of not having the money necessary to update equipment the way it should be, they were incredibly creative and industrious with band-aiding and knew the ins and outs of every square inch of that hospital.

From a list of former employees handed to us by the bankruptcy court, we started interviewing for our staff. We just had to do our best to sort through and identify who was committed to improving the care and the service to the community. When we found them, we offered them jobs on the spot to come back.

From a staffing standpoint, it was an opportunity to hire and build infrastructure with only truly necessary positions. Everything was zero-based, from the budget to the team. We started with nothing and created and built out only what was necessary to meet our end goal of serving the needs of the community and slowly building back a successful hospital operation.

Every single process, policy, person we hired, I asked “why”. I know I drove people crazy, but in an otherwise established operation, it’s too easy to fall back on what is comfortable and what we’ve always had access to. We had to ask ourselves if what we were wanting to invest in or build out was serving a purpose and if it wasn’t, we didn’t do it. We didn’t have the bandwidth as a team or the financial backing for anything superfluous.

The bankruptcy court was handling the debt payments. But there was still enormous liability risk. We didn’t have a high degree of confidence that the previous administration hadn’t been fraudulently billing Medicare and Medicaid given everything else we knew. So, we made the decision to apply for new CMS numbers and a new hospital license number. This meant delayed reimbursement and a black period during a pivotal time in the hospital’s re-birth. We wanted to re-open and give the community immediate confidence in the new ownership, but our hands were somewhat tied with zero money coming in the door, it was a tough time and not what I think any of us had envisioned, but we made it work.

The Christmas Reopening

Finally, there was the question of exactly which services and physical sections of the hospital to reopen. The Emergency Department was the front door of the hospital at that point, so we decided to go from there. We created a space for inpatient beds which was technically in the ED, but the small initial footprint allowed us to open with confidence that we could provide good patient care to a narrow range of cases and build from there.

We renamed the facility Cornerstone Medical Center, in honor of its long history and importance to the community and opened on December 22, 2015—two weeks after Hutcheson had closed its doors. The hospital had a large Christmas tree on the roof which it was used to lighting each year. Our head of Human Resources was the one that came to me stressing that these lights had to be turned on. She was right—it was a visual signal to the community that we were still there.

I had no idea how much that tree lighting meant. The second year we had a much larger celebration. When the lights and came on that year, it was a real celebration of what we had accomplished in stabilizing the hospital.

Mission, Vision, & Values

I’ve had a thing for hospitals since I was a kid. I got to experience the building and running of a hospital through my father who was a hospital CEO for many years. I watched as he brought progressive ideas to improve care and patient experience to life. I would ride my bike to his hospital when I was in elementary school just to visit. I loved it. Ever since then, I’ve had an interest in healthcare and community hospitals.

Disruption in the healthcare industry is needed, but impact to some of these smaller community hospitals is unfortunate. Cornerstone was an opportunity to thread the needle. To figure out a way to keep a hospital open in a community that needed it and to operate that hospital in a way that was intentional, financially prudent, and backed with heart.

The mission was created by employees. The values were also created by employees and were posted and used daily to hold ourselves and our teams accountable. I felt and still feel very strongly that mission, vision, and values are critically important to success and not just to put up on the wall and forget about. They are directional and foundational words that employees and managers should be able to fall back on and use as a guide when trying to prioritize work and patient care every single day.

One of the things Core pitches to our health system partners is that we really understand the hospital side of the business. We understand their pressures and goals for patient care, and we understand how physician services can support those. Many of our top leaders have experience within hospital administration, not just me. And we bring that experience to bear on behalf of our health system partners and the communities they serve.

My experience as CEO of Cornerstone Medical Center was incredibly unique and the fulfillment of a career goal at a much earlier point than I ever expected. During that time, we put the hospital on a solid financial foundation, rebuilt its relationship with the community, and set a new standard for patient care.

In December 2017, we sold Cornerstone to Catholic Health Initiatives (now CommonSpirit Health) out of Chattanooga. I can’t really put into words the amount of work it took to get that hospital to where we did in just two years. But we were financially and operationally stable and had something to offer these larger systems. I think our whole team knew from the onset that CHI would be the best partner for the hospital. The patient-first mentality, the leadership, and ties to North Georgia—it was a best-case scenario.

Healthcare has become incredibly complex. Every function and person is important. Whether you’re at the bedside caring for a patient or cleaning the floors, what you are doing is regulated in some way and as a result, it can be easy to overcomplicate execution. I was relentless in trying to keep what we could control simple and purposeful, and I was insistent that we were doing it with a team of people that were passionate about what we were doing and compassionate as individuals.

Treating every single person that you work with and care for with dignity and respect sometimes becomes secondary when you are trying to save lives and survive the rules and regs. But it’s a people business and at the end of the day. It’s impossible to be successful if you don’t extend grace and treat every person you encounter with dignity. There’s a difference between surviving and thriving, and that’s it.

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