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In last ditch effort to stay open, Holly Springs hospital ends inpatient care

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In last ditch effort to stay open, Holly Springs hospital ends inpatient care

Alliance Healthcare System in Holly Springs is Mississippi’s first rural emergency hospital – the first in a trend some say indicates the further decline of health care access in the one of the country’s poorest and sickest states.

Hospitals were able to apply for the new federal designation mere weeks ago, when the Mississippi Department of Health rolled out its rules for “rural emergency hospitals.” The federal government finalized the program in November.

Rural emergency hospitals are a step below critical access hospitals, which must have 25 or fewer inpatient beds, provide emergency services, keep its patients for less than 96 hours and be located at least 35 miles from another hospital.

The resources at rural emergency hospitals are even fewer — they must end all inpatient care and transfer patients to larger hospitals within 24 hours of the patient coming to the emergency room.

The hospital has already begun getting rid of all its inpatient beds and discharging current patients, as reported by the South Reporter, Marshall County’s community newspaper, on Wednesday. The acute care center is currently licensed for 40 beds, though its daily census doesn’t go much higher than four or five patients a day, according to hospital CEO Dr. Kenneth Williams.

The hospital has partnered with North Mississippi Medical Center and will transfer its patients there if necessary, he said.

He also said Alliance is one of just a handful of hospitals across the country approved for the designation so far.

As of Thursday, spokespeople from the state Department of Health said Alliance’s new hospital designation hadn’t been approved by the Centers for Medicare and Medicaid Services. But according to Williams, it had been approved by both required parties, CMS and the state Health Department, on Wednesday. 

“I haven’t even had a chance to share this with my staff,” he said Thursday. “Yesterday was an exciting day for me to have that designation. I’m looking forward to the future to see how it works out.”

Rural emergency hospitals also can’t provide swing bed services, which means if a hospital operates a nursing home, that has to close. Alliance does not operate a nursing home.

Both rural emergency and critical access hospital designations are meant to ease financial stress — if a hospital qualifies as either, in exchange, they get paid more for their services. Rural emergency hospitals also get monthly payments from the federal government.

The program is aimed at preventing the closure of rural hospitals and creating a way they can increase financial viability and maintain operations. The idea is that rural hospitals at risk of closure already struggle with low patient counts and low payments for inpatient care.

But it’s meant as a last resort for hospitals that are barely surviving because of the limited amount of services a rural emergency hospital can offer.

State Health Officer Dr. Dan Edney considers it a closure when a hospital converts to an REH because of the loss of services. He tweeted in early February about the state’s first “loss” of a hospital, which is around the time Alliance applied for the designation with the Centers for Medicare and Medicaid Services and the Mississippi Department of Health. He compared rural emergency hospitals to triage units.

Williams, on the other hand, sees them as “expanded outpatient hospital systems.”

Rep. John Faulkner, a Democrat who represents Holly Springs, was not immediately available for comment Friday morning.

Williams bought the hospital two decades ago when he heard it was struggling. During its first years under Williams, he said the hospital was making money. Then in 2006, it lost almost $2 million with the arrival of Medicare Advantage plans, which are privatized versions of Medicare that often deny needed care and underpay hospitals.

Holly Springs is a certified retirement community, which means most of the hospital’s patients are on Medicare.

They’ve had good years and bad years since, but it’s been mostly downhill, especially since the pandemic began.

“I knew that our hospital couldn’t exist under the payment system it is under right now,” Williams said.

A little more than a decade ago, Alliance tried applying to become a critical access hospital. They were rejected because of the hospital’s proximity to Memphis.

Now, Williams says the federal rules are a little more relaxed, and he decided to apply at the recommendation of his partner, Quentin Whitwell, who operates hospitals in north Mississippi and serves as legal counsel for Alliance Healthcare, and the hospital’s financial team.

“With REH, the robust outpatient services the clinic brings to the community will be enhanced, along with continued 24/7 coverage, and the costly services will be reduced while receiving an annual subsidy,” Whitwell said when reached by text Thursday. “We are glad it worked out.”

Few Mississippi hospitals are making money, especially in the state’s more rural regions. The problem is multifaceted, but experts say the crisis has resulted from a combination of state leaders’ refusal to expand Medicaid, insurance companies’ low reimbursement rates and the pandemic forcing costs up in all areas, including staffing.

“The funding of health care in rural America is going down,” Edney previously told Mississippi Today in an interview. “There is no one coming to the rescue.”

Williams said many of the challenges hospitals are facing lead back to insurance payments and managed care plans, like Medicare Advantage.

He could’ve closed the hospital back in 2012, Williams said, when it first applied for critical access status, but he’s done everything he can to keep it open, including some layoffs and reorganizing their staff.

But at some point, “you cut muscle instead of fat,” Williams said.

One report from the Center for Healthcare Quality and Payment Reform puts a third of rural Mississippi hospitals at risk of closure, and half of those within a few years.

“Too many small rural hospitals are closing,” Williams said. “Big hospitals are struggling, whether or not they admit it, but you can get by if you’re doing high-end procedures.

“But just to take care of a regular patient who has congestive heart failure, with diabetic ketoacidosis, who is sick, they (insurance companies) don’t want to pay you for it.”

According to data from the CHQPR, Alliance Health has been losing money for the past few years, both overall and specifically taking care of patients.

And just in case the rural emergency hospital structure doesn’t work, Alliance is still applying for the critical access designation, too. If the new designation doesn’t stabilize the hospital, it can revert to its original status as an acute care facility or, if it is approved for the critical access hospital designation, it can convert to that, instead.

“Would I prefer to have us continue to operate the way that we were, having patients be admitted? Absolutely,” Williams said. “It is unfortunate that we had to make this move, but it is the right move based on the reality of health care and this payment system.”

According to Edney, Mississippi can likely expect more conversions to rural emergency hospitals – or, as he refers to them, “closures” – in the coming months.

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

Mississippi Today

On this day in 1944

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mississippitoday.org – Jerry Mitchell – 2025-02-09 07:00:00

Feb. 9, 1944

Credit: Courtesy of Warner Brothers

Alice Walker, novelist and poet, was born the eighth child born to sharecroppers in Eatonton, Georgia. 

During her youth, she was accidentally blinded in one eye, and her mother gave her a typewriter, which enabled her to write. She studied at Spelman College and Sarah Lawrence College, receiving a scholarship to study in Paris. She turned it down to go instead in 1965 to Mississippi, where she joined the civil rights movement. 

Part of her work involved taking depositions of sharecroppers, who like her parents had been thrown off the land. She and her husband, civil rights attorney Mel Leventhal, married in New York in March 1967, and when they returned to Mississippi four months later, they became the first legally married interracial couple in the state, where interracial marriage was still illegal. 

They persevered through death threats, working together on the movement. Leventhal served as lead counsel for the NAACP Legal Defense Fund, and Walker taught history to Head Start students and became pregnant. 

Grief overcame her after Martin Luther King’s assassination, and she lost her unborn child. She continued to teach, showing students at Tougaloo College and Jackson State University how poetry could be used in activism. 

After moving to New York, she finished her novel, “Meridian,” which describes the coming of age of civil rights workers during the movement. In 1983, she won the Pulitzer Prize for Fiction for her novel “The Color Purple,” which has since been adapted in both a movie and a Broadway and movie musical. She has continued to champion racial and gender equality in her writing and her life. 

“Activism,” she explained, “is the rent I pay for living on the planet.”

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

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Mississippi Today

On this day in 1968

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mississippitoday.org – Jerry Mitchell – 2025-02-08 07:00:00

Feb. 8, 1968

The Orangeburg Massacre resulted in the killings of three South Carolina State College students, Henry Smith, Samuel Hammong and Delano Middleton Credit: Courtesy of South Carolina State University

Students Samuel Ephesians Hammond Jr., Henry Ezekial Smith and Delano Herman Middleton were shot and killed by state troopers who fired on demonstrators at the South Carolina State College campus in Orangeburg, South Carolina. 

Fifty were also wounded in the confrontation with highway patrolmen at the rally supporting civil rights protesters. 

The students had been protesting at the All-Star Bowling Lane, which refused to serve the Black students. When police arrested protesters, chaos ensued, and police began beating protesters with billy clubs, sending eight students to the hospital. Angry at what had taken place, students set a bonfire in front of the campus. When authorities showed up to put out the fire, one officer was injured by an object thrown from the crowd. 

State troopers began firing their guns at the unarmed protesters, killing two students, Hammond and Smith, as well as Middleton, a high school student who was simply sitting on the steps of the freshman dormitory, waiting for his mother. 

The governor tried to blame “outside agitators” for what happened, but the federal government brought excessive force charges against the nine troopers. The jury acquitted the troopers, who claimed they acted in self-defense. 

In contrast, a jury did convict activist Cleveland Sellers of a riot charge in connection with the bowling alley protests, and he was forced to serve seven months in prison. 

The violence became known as the Orangeburg Massacre, foreshadowing the shootings that followed at Kent State University and Jackson State University. 

The on-campus arena has since been renamed in honor of the slain students. Jack Bass, the co-author of the “Orangeburg Massacre,” which details the slayings, has called for South Carolina to do something similar to what Florida did with regard to the Rosewood Massacre — award money to surviving children and college scholarships to grandchildren. 

“Perhaps,” he wrote, “it is time now for South Carolina to clear its conscience.”

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

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House unanimously passes bill to make kratom 21+

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mississippitoday.org – Gwen Dilworth – 2025-02-07 12:58:00

The Mississippi House of Representatives passed a bill Thursday to limit kratom purchases to people 21 and older and to ban synthetic kratom products, also known as kratom extracts.

It’s one of four pending bills addressing kratom in the Legislature. Two bills impose an age limit on purchasing the substance, while the other two make kratom or kratom extracts a controlled substance. 

Critics of the herbal substance, which is commonly found in gas stations and tobacco or vape shops, say it is a highly addictive and dangerous drug that produces stimulant- and opioid-like effects. But advocates argue it is an effective tool for treating opioid use disorder, chronic pain and depression. 

Rep. Lee Yancey

“It’s one of those things that needs to have a fence around it in order to protect not only those that take it but also those who are affected by those that take it,” said Business and Commerce Chair Rep. Lee Yancey, R-Brandon. “And currently there is no fence.” 

HB1077, authored by Yancey, will require people to show proof of age when purchasing kratom and require retailers to keep the product behind the counter. It institutes fines for people under 21 who buy kratom and retailers that sell the product to them. 

It also outlaws synthetic kratom extracts, or products that contain high concentrations of 7-hydroxymitragynine, one of the chemical components in kratom that binds to the same receptors in the brain as opioids, like codeine.

The bill passed in the house unanimously with a vote of 115-0. It now advances to the Senate. 

A similar bill in the House authored by Judiciary B Chair Rep. Kevin Horan, R-Grenada, would impose the same regulations and levy a 5% tax on kratom products. Rep. Yancey said he plans to bring this legislation to the floor for consideration. 

More than thirty counties and cities in Mississippi restrict or ban kratom products at the local level. 

Two other bills in the Legislature this year seek to make forms of kratom a Schedule III controlled substance, which would institute criminal penalties for possession and make it available only with a prescription from a licensed health care provider.

Penalties for small amounts of Schedule III drugs in Mississippi include a maximum of one year in jail or a $1,000 maximum fine. Other Schedule III drugs include benzodiazepines, ketamine and steroids.

A bill in the Senate authored by Drug Policy Chair Sen. Angela Turner-Ford, D-West Point, would schedule only synthetic kratom products, while a bill in the House by Drug Policy Chair Rep. Stacey Hobgood-Wilkes, R-Picayune, would schedule all forms of the drug, including pure leaf forms. 

Turner-Ford said she does not support banning all forms of kratom, given that it is a naturally occurring plant. Hobgood-Wilkes said there are many natural substances that are dangerous.

Hobgood-Wilkes said she believes bills solely to restrict kratom to consumers 21 and older don’t go far enough. 

Yancey said he supports scheduling the substance, but has grown frustrated by unsuccessful attempts to ban the drug in years past. 

“This year I’ve decided that getting 50% of what I want is better than getting 0% of what I want,” he said. 

Dr. Jennifer Bryan, the president of the Mississippi Medical Association, urged lawmakers to schedule kratom as a controlled substance at a House Drug Policy hearing Jan. 28, given its highly addictive qualities. 

“This is what the next phase of the opioid crisis looks like,” she said. 

State Health Officer Dr. Dan Edney said he supports making the drug a Schedule III drug because it would remove kratom from stores but impose relatively small penalties on people who possess the drug. 

He pointed to the success of lawmakers designating tianeptine, another substance sold in gas stations and used to treat depression, a Schedule III drug in 2023. 

“I personally have not seen a case of tianeptine since the ban last year, except one case that got it from Louisiana,” he told lawmakers Jan. 28.

Christina Dent, an advocate who opposes a criminal justice approach to drugs and addiction, said banning kratom entirely would harm people who are using kratom as a tool to stop using opioids or for other health conditions, and create a dangerous underground market for the substance. 

“Banning kratom and putting people in jail who use it will lead to more crime, more health problems, and more families destabilized by incarceration,” she said.

She said she supports bills that restrict the sale of kratom to young people and ban the sale of synthetic kratom products. 

This is not the first time the Legislature has sought to regulate or ban kratom. The House passed a bill in 2022 to make kratom a Schedule I drug and a bill in 2023 to ban kratom extracts. Both died in the Senate. 

Yancey said passage of a bill to regulate kratom this year will depend on the Senate’s appetite for such legislation. 

“The Senate needs to step up and do their part,” he said. 

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

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