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An upgraded condition: Jefferson Regional rebounds from financial problems under new administrator.

Like a boxer, Jefferson Regional Medical Center has been battered but not beaten, bloodied but not bowed.

Now, the Pine Bluff hospital appears ready to answer the bell in what could be a fight for its life.

Already, it's been a difficult battle.

Discord was synonymous with Jefferson Regional in the late 1980s. Dissension and a lack of communication within the hospital's governing factions threatened what had been a smoothly run operation.

In-house squabbles and political conflicts aside, the financial health of the medical center became the prime concern of the administration.

The 471-bed hospital lost $2 million during the 1991-92 fiscal year, during which officials witnessed an 8 percent drop in patient figures.

That same year, the hospital shelled out more than $51 million to treat Medicare and Medicaid patients and charity cases. It received $40 million in reimbursement.

The fiscal health of Jefferson Regional was a major concern not just to the hospital's administrators but to the community.

The hospital employs more than 1,400 people, second in Pine Bluff to International Paper Co., and has a payroll of $40 million. In all, the health care facility serves 10 counties.

With more problems on the horizon, hospital board members ordered an organizational study by the national management and accounting firm of Ernst & Young.

It identified sweeping changes necessary to provide quality health care to the southeast portion of the state. The four-volume study concentrated on internal operations, patient care and overall hospital performance.

One of the first step taken toward implementing the changes proposed in the study was the restructuring of management.


"One of the things they identified was a need for streamlining the management of the hospital," says Robert Atkinson, who joined the hospital as president and chief executive officer in May, shortly before Ernst & Young initiated the study.

The "organizational enhancement" led to this: Nine executive-level positions were cut to five; 29 department director positions were cut to 21; and 88 so-called "first-line" management positions dropped to 49.

Nine hospital executives were fired, while others were reclassified, their titles and responsibilities reassigned or reduced.

The study also called for changes in the hospital's attitude toward patient care. An emphasis was placed on the responsibility of the center's nurses. Changes also were made in purchasing practices and inventory management.

The moves are expected to save Jefferson about $4 million.

Atkinson, 45, predicts the hospital will make more than $1 million in the coming fiscal year.

Now that the management realignment is complete, improving patient care is at the top of the hospital's "things to do" list. Two examples of that commitment are the restructuring of the nursing staff and the recently completed renovation of the women's service wing.

"We're implementing a new model of nursing," says Atkinson, who oversees the hospital's school of nursing.

Teams of nurses, each headed by a registered nurse, will take on more individual responsibilities in terms of patient care.

"It's a reassignment of who does what so we can get the nurses to the patients," Atkinson says. "Now a doctor can ask, 'How's my patient?' and he'll know who to ask. Whereas before he might have had to ask four nurses."

The rooms of the women's service wing have been remodeled with entertainment centers, love seats and Oriental rugs. They offer a stark contrast to most of the hallways, which feature tile walls and linoleum floors dating back to 1960, the hospital's first year of operation.

Desperately Seeking Doctor

After caring for the patients, caring for the hospital's 125 physicians is of utmost concern, says Atkinson.

So, Atkinson has hired a full-time physician recruiter who is in contact with residency programs across the country, interviewing and screening potential candidates who could help reduce the workload of the hospital's doctors.

And it is a workload.

According to national averages, most doctors see 3,500 patients in an 18-month period. Those at Jefferson Regional see an estimated 10,000 patients during that same period.

"We actually had one surgeon leave town because his practice was too full," says Atkinson with a touch of remorse. "I'm sure we could absorb 20 physicians without any trouble."

Atkinson replaced Larry Barton to become the hospital's fourth chief administrator.

Barton resigned in September 1991 in the midst of financial troubles and dissension among nurses. During the final 18 months under Barton's direction, hospital revenues declined drastically. It forced the elimination of 200 jobs; 85 people were laid off.

Net income at the hospital fell from $3.1 million in 1990 to $27,679 in 1991.

Atkinson came to Pine Bluff after five years as chief executive officer at Slidell Memorial Hospital and Medical Center in Slidell, La.

Although Atkinson entered into a beehive of financial and political problems at Jefferson Regional, he insists the quality of health care at the Pine Bluff hospital has never suffered.

"It sort of shook the community and probably raised unnecessary fears about the hospital, because at no time was patient care ever criticized," Atkinson says.

Dr. Thomas Townsend, a Pine Bluff pediatrician and one of three doctors on the hospital board of directors, agrees.

"In no way have I ever lost confidence in the care of patients in the hospital," Townsend says. "It's a little early to judge Bob Atkinson. He's only been on the job for a little while, but he's been correcting problems and will continue to correct problems."

Dr. Walter Wilkins, one of the nine administrators dismissed by Jefferson, says the problems the center has encountered, which at one time led local physicians to discuss building a separate hospital, are reminiscent of the concerns of virtually every hospital in the nation.

Competition from outside operations, federal cutbacks and slow returns on reimbursements led to a drop in profits, which in turn led to turmoil among the center's personnel. Wilkins, who was the hospital's medical director for six years before being dismissed in June, says the turmoil was on a small scale and not characteristic of the entire staff's attitude.

A Pine Bluff native, Wilkins, 72, remains complimentary of the center, which he planned to leave this year. He attributes his firing to budget cutbacks, which led to his position being dissolved and his duties reassigned.

"I may disagree with a couple of administrators, but it's a wonderful organization," says Wilkins, who has been associated with the hospital and its predecessor, Davis Hospital, almost 40 years. "As far as the physicians, as long as the cost containment doesn't interfere with patient care, they're all for it."

As medical costs escalate each year, so do the problems connected with providing affordable health care, particularly in rural areas like southeast Arkansas.

More than 50 percent of last year's $129 million in patient charges was attributed to Medicare patients. As admissions decrease, insurance requirements increase and federal reimbursements are cut, the ability to provide affordable care becomes increasingly difficult.

"The cutbacks in Medicaid in recent years have had an impact on profits of the hospital," says John Garrison, who retired in September 1991 as hospital board chairman. "A lot of times that leads to a morale problem. But Jefferson Regional is a healthy hospital."
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Title Annotation:Jefferson Regional Medical Center; Robert Atkinson
Author:Taylor, Tim
Publication:Arkansas Business
Date:Sep 28, 1992
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