By Rose Hoban
In the 30 years Mike Stevenson has been leading Murphy Medical Center, he’s seen it happen too often: People wait to get the treatment they need.
“They’re too proud to get care they cannot pay for, and therefore don’t get it until too late in their disease,” he said.
Stevenson calls these folks the “proud poor.”
“I …have just too many examples in this rural area,” he said, referring to the Smoky Mountains that surround Murphy and that allow folks to live isolated from the rest of the world in the westernmost tip of North Carolina. “They die because of it.”
Stevenson has had many patients show up at the door of MMC unable to pay. But, that door has always been open, in no small part because Stevenson kept the hospital running through turbulent times.
“You talk to people in Murphy, a lot of people will say ‘We wouldn’t have a hospital in this town if it weren’t for Mike,’” said Julie Henry from the North Carolina Healthcare Association. “It takes ingenuity and perseverance and a lot of sweat.”
The population of far-western Cherokee County has changed over Stevenson’s three decades in town. Factories and manufacturing plants have closed taking jobs with them. Now the economy has rebounded with an influx of retirees.
This story here because of pumpkins.
My engineer husband’s co-worker participates in Pumpkin Chunkin’ competitions, where he uses a big concrete, steel and wooden machine constructed in his driveway to hurl 10 pound pumpkins across an open field. (If you’re a Science/ Discovery Channel viewer, you’ll understand. For the rest of you, trust me, it’s the most fun geeks can have.)
We were invited to go along to the Clay County Pumpkin Chunkin’ in October, just outside of far-western Murphy. Well, if we were going to drive five hours west, I was going to do a story out there. The obvious choice, for me, was to do a profile of Murphy Medical Center, which has managed to stay afloat and provide good care even as other rural hospitals in the state have struggled.
In the past I’d been pointed to Mike Stevenson, the hospital CEO, as an example of visionary and creative leadership on a number of occasions. So, when I called, Stevenson was open and invited me to follow him around for a morning at his facility.
It was a fascinating glimpse into what it takes for a small hospital to survive and continue to provide quality care. At the same time, I walked into a time when Stevenson is getting ready to merge his facility with a larger health care system, so the story became about something a little bit bigger.
“My commitment has been to work and support the board through our merger,” which he hopes to be complete by early 2018.
When Stevenson arrived at Murphy Medical Center in 1988, the place was on life support. In the eight years it had been open, the hospital had three management companies and was $2 million in the red.
A year later, the hospital was paying bills on time.
Stevenson deflects the credit for reviving the hospital, saying that it was the “teamwork of dedicated people who were committed,” he said. “The job I did was to become the number one cheerleader.”
In the 1990s, he took MMC from being a county supported not-for-profit facility to being a private not-for-profit. Becoming a private entity allowed the hospital to do some fundraising, which helped to secure financing.
“The financials were the pits, but we were able to work with the local bank, which loaned us capital to start some needed projects,” he said. “The place had gone for 10 years without any improvements.”[sponsor]
Over the past few years, there’s been the sharp uptick in people arriving with mental health and substance abuse problems. Those patients were clogging up the emergency department, tying up beds that could serve those with medical problems, who also are more likely to be able to pay. Stevenson said there were often four or five patients in the 12-bed unit waiting for commitment.
“We had to spend our precious resources,” Stevenson said. “We had deputies out there, the other clientele felt… uncomfortable.”
Stevenson found the money to build a separate locked holding area for patients facing involuntary psychiatric commitment. Often those patients can wait days for a bed (North Carolina’s average wait time for a bed in a psychiatric hospital was 120 hours as of the end of June). On the Monday morning that he walked this reporter through the locked door into the psychiatric holding area, there were a handful of people waiting.
“We once had a patient here for more than 100 days,” he said. Eventually, that patient was transferred to a psychiatric facility in Greenville, almost eight hours away.
Telepsychiatry has helped some.
“There’s hardly any psychiatrists out here and none to take care of inpatients,” he said.
Across town from the main hospital facility, Stevenson’s pride and joy was once the model house for a luxury log cabin builder. The living room turned waiting room of the primary care/urgent care clinic sports a trophy deer head over a fireplace.
Walking through the clinic, Stevenson greets most workers by name, he asks about children and spouses.
Stevenson and his board had considered building their own facility to house their primary care clinic, but when this place went up for sale, they jumped. Adding to the two-story structure was cheaper than building new, and the place has a warm and homey feel, with exposed wood and warm colors throughout.
“The architect did a really nice job with… the renovation,” he said.
“It’s easy to tell people where we are, we say we’re in the cabin,” said Fay Palmer, who is doing paperwork at a computer station in the hallway. “Everybody knows.”
The clinic has 12 rooms, for family practice, urgent care, wound care and a room kitted out for doing minor surgery, such as stitches or setting a broken wrist. There’s also an x-ray suite.
Clinic manager Rick Starry said the daily volume runs anywhere between 60 to 100 patients, ramping up during the winter cold and flu season. Having the urgent care clinic has taken some of the pressure off of the ER across town.
“Sometimes where we’ve had to close for staffing problems or something like that, the ED is out there shrieking, “Oh no” because it’s a lot,” Starry said. “It’s like I 26 in the afternoon over there, 3:00 is rush hour in the ED and it just stacks up like crazy.”
The hospital has also benefitted from the clinic’s primary care practice that has allowed it to become federally qualified as a rural health center. That designation brings annual federal grant funding with it.
The primary care practice also allows for better care coordination for patients with complex chronic conditions, “instead of having all of these specialists, who are out there doing things that family medicine providers are unaware of,” Starry said.
Stevenson has not been shy about saying that Medicaid expansion would have been helpful for MMC, which had an operating margin of less than one percent in 2016.
The past few years have been rocky, the 57-bed facility has about two-and-a-half months of cash on hand, something Stevenson calls “not that good.” The hospital has just broken even for the year, leaving little revenue for updates such as new radiology machines, which could keep the hospital competitive.
The area sees a lot of back and forth with people from Georgia and Tennessee, and there are other hospitals within an hour’s drive: Angel Medical Center in Franklin and Tennova across the border in Tennessee. Last year, North Georgia Medical Center in Ellijay, an hour south, closed.
It’s been important to have a local hospital in town, with a local administrator, said Meridith Jorgensen, who heads up the county Chamber of Commerce.
“[Stevenson] has done well at acknowledging and responding to our unique community health care assets as well as challenges,” she wrote in an email to NC Health News.
Just this week, Stevenson announced Murphy Medical Center would be merging with Chattanooga-based Erlanger Health Care. The deal, which will be finalized in April, represents Stevenson’s determination that the town get a good deal.
That’s something Jorgensen expressed as well, in particular, to maintain Murphy’s appeal for retirees.
“In terms of Cherokee County relocation inquiries, healthcare is always in the top 3 points of consideration for potential new residents,” Jorgensen wrote. “Although the healthcare world may view our hospital as small, the impact has been large.”