Last summer, Greenwood Leflore Hospital was on the brink of closure and up for lease.

Now, despite applying for grants from the Legislature, closing several service lines and requesting a more lucrative hospital designation, the hospital is back to square one: it's going up for lease again.

Greenwood's hospital is co-owned by the city and county and has long been plagued with financial struggles, like many of Mississippi's rural hospitals. During the pandemic, the hospital's finances went from bad to worse, as costs went up and payments did not.

In an effort to stay open, Greenwood Leflore has closed several departments and services, including neurosurgery, urology and inpatient dialysis. Most recently, it shuttered its labor and delivery department and intensive care unit.

Interim CEO Gary Marchand told Mississippi Today in February that the hospital was running out of money and months away from closure.

However, thanks to a credit line increase from its owners and the passage of a statewide hospital grant program, Marchand said in April that the hospital would stay open until at least 2024.

In the meantime, in order to make the hospital more financially viable, leaders applied for Greenwood Leflore Hospital, which is currently classified as an acute care facility, to be converted to a critical access hospital. Critical access hospitals are reimbursed by Medicare at a higher rate.

But the hospital's application has not yet been approved, and approval isn't guaranteed — critical access hospitals must be located 35 miles from the nearest hospital, and South Sunflower County Hospital in Indianola is 28 miles away.

Marchand is hoping for a waiver because of transportation challenges in the Delta, but it could be months before he gets an answer from the federal government.

Until final approval, Marchand said the hospital needs a “plan B” to stay open.

“From Greenwood Hospital's perspective, plan A is to get critical access hospital status and obtain long-term viability,” he said. “I think the owners … just wanted a backup plan.”

Hospital leaders are publishing an RFP, or request for proposal, on Aug. 29 in the local paper, the Greenwood Commonwealth, to solicit bidders to take over the hospital. This time around, the RFP includes an option to buy the hospital outright, not just lease it. 

Greenwood Mayor Carolyn McAdams said she's already heard from several “entities as far as California” about their interest in the hospital.

The space went up for lease last year, and the hospital was in discussions with the University of Mississippi Medical Center to lease the facility. But mere days before the deal was expected to be finalized, UMMC pulled out. A UMMC leader only cited “health care economics” as a reason.

At the time, Greenwood Leflore Hospital reportedly owed Medicaid millions in advance payments it got when the pandemic began, and UMMC did not want to take on those debts.

According to Marchand, an RFP for a lease with an option to purchase has a relatively short time frame for completion, which is why leaders went with that option last year — the hospital's situation was dire.

Now, Greenwood Leflore Hospital can afford a little more time — though not much more. Marchand declined to get into specifics about the hospital's finances.

“The hospital is still struggling,” McAdams said. “The city and county had to go in and do the $10 million line of credit so we could get through this process of applying for critical access without them having to worry every month if they were going to be able to meet payroll or not.”

According to a Greenwood Commonwealth article from Aug. 16, a consultant hired to advise community leaders about the hospital suggested that Greenwood Leflore Hospital cut administrative pay and base its physician pay on productivity.

Marchand said he was not considering making those changes.

Greenwood hasn't gotten the money it was promised from the Legislature yet — because the grant money is coming from pandemic relief funds and not the state general fund, many hospitals have reported difficulties getting their hands on their allotted money and will only be able to claim part of it.

Greenwood was granted a little under a million. As of this week, they've received $0, according to Marchand.

“To my knowledge, they haven't paid a single hospital,” he said.

No hospital has gotten that money yet, confirmed Kris Adcock, senior deputy at the Mississippi State Health Department. It's not clear when it'll be disbursed.

McAdams said hospital leaders are pursuing both an RFP and critical access designation, not one over the other, exhausting all options to ensure the facility's survival.

“Every community needs a hospital,” she said. “We serve not only Greenwood but all the communities around us … There are a lot of people here who can't go to Jackson. They can't even get to Grenada. They need access to this hospital.

“Truly, it's terrible, but we are not the only hospital struggling here. All of our community hospitals, especially in the Delta, are struggling with the same problem.”

One report puts nearly half of the state's rural hospitals at risk of closure. In rural Mississippi, these closures could be especially devastating, both for these communities' economic livelihood and Mississippians' wellbeing.

McAdams said that without Medicaid expansion, the situation is only getting worse. Republican state leaders have steadfastly opposed expanding Medicaid to the working poor, despite support from the majority of Mississippians.

It's essential that its hospital status is either changed or the facility is bought, Marchand said, and the window in which Greenwood Leflore Hospital can figure out a solution is quickly closing.

“I don't think that we can cut any more service lines and be of service to this community,” he said.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.