Panola County officials made an unorthodox demand of the county’s ambulance service last month: stop picking patients up from the hospital.
Transfers from Progressive Health Batesville to higher-level care by the county’s ambulance services ground to a halt Jan. 20, as first reported by the Panolian. The Panola Board of Supervisors stopped the services, arguing that numerous transfers to far-off facilities have left county ambulances unavailable to respond to emergencies.
They say the problem began in 2023 when the facility became a rural emergency hospital, a federal designation that gives struggling rural hospitals a $3.3 million federal funding boost but forces them to close their inpatient beds. Average patient stays are limited to 24 hours, necessitating transfers to larger facilities if a patient needs additional care.
Experts say they have not seen the rural emergency hospital program provoke similar disputes in other areas, in part because the hospitals that chose to convert to the status had low inpatient volumes, meaning they likely have few patients to transfer.
But Progressive Health of Batesville had a higher average daily inpatient census – by a factor of two – than any other hospital in the nation that became a rural emergency hospital, according to Centers for Medicare and Medicaid data.
Progressive Health of Batesville provided inpatient care to 12 people a day on average in 2022, according to Centers for Medicare and Medicaid data. Most hospitals that later converted to rural emergency status had an average daily inpatient census of two or fewer patients.
Batesville had a relatively high inpatient volume for a rural hospital, said Harold Miller, the director of the Center for Healthcare Quality and Payment Reform. Under the restrictions of the new model, many of these patients would need to be transferred to another facility to receive care.
Facing an ambulance contract increase of nearly a quarter of a million dollars to keep up with service volumes, Panola County officials want the hospital to foot a portion of the bill before they resume paying for transfers from the facility.
This request sets a dangerous precedent for hospitals and could jeopardize patients’ safety, said Quentin Whitwell, the CEO of Oxford-based Progressive Health Group, the company that owns the hospital in Batesville, and five other hospitals across the Southeast.
“We do not believe this policy is warranted, we do not believe this policy is in the best interest of the patients and the community that we serve, and we do not believe this policy is legal,” Whitwell told Mississippi Today.
Transfer volumes from the hospital have increased just 5% from 2023 to 2024, according to a document Whitwell provided to Mississippi Today.
Two other ambulance services – Priority Ambulance and Pafford EMS – are currently providing transfer services to the hospital. Lifeguard Ambulance Services, the company that contracts with the county, still delivers patients to Progressive Health of Batesville.
The Board of Supervisors and hospital management are in negotiations to resolve the conflict.
Panola Medical Center – later renamed Progressive Health Batesville – was bankrupt in 2019 when Whitwell bought the hospital from Georgia-based Curae Health.
But the hospital could not reach a financially sustainable inpatient census and its psychiatric unit was losing money, said Whitwell. It became a rural emergency hospital in November 2023, closing both services but maintaining an emergency room and outpatient care.
Experts say the choice to convert is a thorny one. It means the loss of acute inpatient care, a valued service that keeps people in their communities when they are sick or injured. But the federal subsidies can create renewed financial stability for hospitals that are struggling to keep their doors open.
Nearly 200 hospitals have closed nationwide since 2005. And in Mississippi, 57% of rural hospitals are at risk of closing and 64% have experienced losses on services.
Nationwide, 34 hospitals have converted to rural emergency hospital status since 2023. Most of them are located in the Southeast.
Progressive Health of Batesville has become one of the most robust rural emergency hospitals in the nation by operating a “hospital within a hospital”: a separate long-term acute care facility that has taken the place of the shuttered inpatient floor, said Whitwell.
The challenges presented by the new hospital model can coalesce with other problems, like the rising costs of ambulance services nationwide and low insurance reimbursements for medical transports, said John Gale, a researcher at the University of Southern Maine who studies rural health care and emergency services.
But it isn’t unreasonable for a county to request support from the hospital to cover the costs of ambulance services, especially if the hospital’s lack of inpatient care places a greater burden on the county’s existing emergency transportation services, he said.
The county’s contract with Lifeguard has doubled since the hospital converted to a rural emergency hospital while ambulance services have become increasingly strained, said Panola County Board of Supervisors President Cole Flint.
In the second half of 2024, transfers from Progressive Health of Batesville to larger facilities averaged about three hours, said a spokesperson for Lifeguard.
Medically necessary transfers to higher-level care are typically covered by a patient or their insurer, but the rate an ambulance is paid does not always cover its costs, said Miller.
And there are greater costs to a community if an ambulance is not available when it is needed, he said.
Progressive Health of Batesville has a transfer agreement with North Mississippi Medical Center in Tupelo 74 miles away, but also transfers patients to hospitals in Oxford, Southhaven or Memphis depending on their condition.
Rural emergency hospitals are required to have a transfer agreement with a Level 1 or Level 2 trauma center. North Mississippi Medical Center is the closest trauma center to Batesville.
Before the hospital converted to a rural emergency hospital, Whitwell said he met with county leaders and did his best to communicate the impact the change would have – both positive and negative.
The hospital provides essential emergency room care to Panola County, said Rep. Josh Hawkins, R-Batesville, who represents the county in the state Legislature. But he said the county, with a population of 30,000 people, is too large to go without inpatient care.
“I would rather have a full-service hospital than just a (rural emergency hospital),” he said.
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