Donovan, Thank you.

It's a pleasure already speaking with you.

And I thank you for your time.

Now, it's my pleasure.

Certainly happy to have you here.

Well, I want people to get to know you and then I want to talk about Pikeville Medical Center, because you have an interesting background to get to where you are and that to help people connect the dots of why Pikeville Medical Center is doing such innovative work.

Tell us about your previous life.

Well, you know, I started my first real career was with actually Lowe's Home Center.

So I was with Lowe's for about 17 years.

I was a store manager and then a district manager lives actually Central Kentucky.

So I managed Lexington, Louisville, Corbin, Somerset, So pretty diverse.

And I lived almost every community throughout Kentucky as well in doing that.

And then I retired and went to work for got ourselves a regional vice president operations of BP.

For them managed four states and I was living in Pikeville.

I was able to move back home.

And then one of the guys that I was working for with me, yes, same for me at Lowe's and then for Oil Gas happens to be the mayor of Pikeville right now, Jimmy Carter.

So Jimmy had just came on the city council and said, you know, I think you would be a great fit for physicians coming to where the city manager you might want to consider.

So after a little thought, I interviewed and I was given the opportunity.

So I spent 13 years in government, loved what I did.

I had a plenty of opportunity to leave eastern Kentucky, but once coming back, my intent was to stay here.

I wasn't want to leave again.

But ironically, I told the mayor, which was at that time it was Frank Justice, a dear friend of mine, that the only place I would ever have interest in leaving in the city for would be Pikeville Medical Center.

And I didn't tell anybody that type of medical center at the time.

My wife was actually around the board of directors and the previous CEO, President Walter Ray, reached out, said, Come over there.

We're looking for transition.

I'm going to have to retire.

And we would like to offer you a position as the assistant CEO with the opportunity transition in to this position.

So now, six years later, with a very diverse background in more business, finance, learning, health care during a pandemic and financial struggles and all the things that health care has had to endure over the past few years.

So here I am.

Well, that is an interesting trajectory, to say the least.

And I think about your city management experience.

How did you parlay that, particularly during the rough times during COVID, when there was so much uncertainty and transition for lots of industries in health care, of course, taking the biggest brunt of the change and transition?

Well, you know, it's interesting because one of the things in working with city government that I had the opportunity to is establish a lot of great relationships.

So, you know, having relationships, you know, not a day or an hour, but in the middle of my job, you know, as city manager is to really work in the middle and to work for the better good of the community.

So having those connections and when I came to work in health care and COVID hit, you know, knowing what branches to reach out to, knowing how in essence the flow politics kind of work, that was my strength on top of having a very diverse financial background, because what hospitals faced all of a sudden was the financial downturn.

It wasn't just a workforce issue that hit us because of COVID.

People had a mask.

You know, kids going to school, coming to nursing was and thinking that.

And then, you know, all of a sudden we we made changes throughout the nation in the state.

Both we cut out our elective procedures that impacted us financially in a very harsh way.

But one thing I was very proud of at the time and still am is that after going to I remember like yesterday, bringing the chairman of the board at the time and and saying, look, you know, I'm projecting probably a $10 million loss in one month.

And I mean, it's you know, it takes a lot of fuel to run a huge hospital such as this.

But we were able not only to do it and obviously we had a lot of help from the state and federal government with subsidies and such.

We still had a tremendous loss as every other hospital and state throughout the region and the nation.

But what I'm very proud of is that we did not lay off we and I'll say this we did let 100 people take voluntary layoff during that time, but it was a time, too, where there were subsidies to the federal government where they could actually go home and make more money than they were working.

But every single employee we were able to bring back within a very short period of time.

We didn't have any services.

As a matter of fact, during COVID, we actually expanded services.

We opened our first children's hospital in the eastern part of the state.

So maneuvering through both using my financial background and then also my knowledge of government.

And then the other piece of this is as any any great leader, it's not about being a great leader, is having great leadership with you, is that I have a very diverse team that is absolutely, you know, that my eight executives understand this business.

So where my weakness, where their strengths work.

So we were able to pick each other up.

And that's the great thing, Rene, about being part of a hospital like Pikeville Medical Center is that we're an independent nonprofit hospital.

So I can make a decision without having to go through a lot of tape.

I am a decision maker and essence and take or not take in certain things, my board of directors.

So we were able to pivot on a dime.

And then the beauty of because of who we were during the pandemic, especially during the time that we were administering the vaccine, we were chosen as one of the ten hospitals in the state that got the vaccine first.

That really set the way because of our regional outreach.

So we played a huge role being the first and really only Kentucky hospital to time to get into different aspects of how we were dealing with COVID.

So it was it was interesting.

But, you know, we made it through it and it made us better.

We made a lot of relationships along the way.

And, you know, certainly our people benefited from it.

$10 million a month.

Yes.

That you lost.

Have you recovered from that?

You know, it's been slow.

And, you know, one of the things that I commend this administration on and it is administration because it's monetary function and certainly the legislators also because you know, during the last session they passed for a trip, which is the advance Medicare payment without that hospital.

So I tell Kentucky, no doubt in my mind, you know, I sit on the executive committee for a study hospital association on the board of directors.

So I get the opportunity to speak to most every large hospital state on a monthly basis.

And I knew their financial position was no different than ours.

So the way we rebounded in essence, was a it Kopitar would be a little sharper with our pencil, so we were able to really make changes that really needed to be made as an organization.

And then on top of that, with the subsidies and then a trip came into play.

So they at the inpatient at first, you know, we were a little bit unique and different.

When you look at Eastern Kentucky specifically, unfortunately, we lead the nation in pulmonary heart cancer, about every disease you can think of, and we have the poorest counties in the nation.

So my payor mix is 77% government paid.

So, you know, get federal government.

State government dictates in essence 70% percent of my income.

So when the trip in piece went into play, it allowed enough revenue to sustain us.

Now, with the outpatient piece, we're finally able to start catching up because we've had you know, we have named our health care workers and they've been phenomenal health care heroes.

But the problem is that they have also sacrificed because a lot of them did not get pay raises along the time.

So we're catching up on a little of those things, as well as making additional investments in infrastructure leverage with a lot of grants and federal assistance as well.

So we're now at the point where we're back out of the red, not not a great deal.

We are stable, but there's certainly a lot of work that needs to be done to make certain that hospitals, especially and again, without a trip and other and other states throughout the nation, is looking at what Kentucky did to see how that they can can kind of emulate that and what the beauty of what was done is that they tied a CMS and working with the cabinet tied quality to this advance payments which are seeing throughout the state of Kentucky.

There's a level of the quality of care continues to go up too.

So it's not really about just money, it's about being better and offering better and more services to those that we serve.

Yeah, we've heard Kentucky Hospital Association a lot during this most recent legislative session.

Nancy has testified and her surrogates have.

And we continue to hear, even during the interim about the nursing shortage and other provider shortages.

So when you think about the specific needs of eastern Kentucky, which as you just laid out for us, are different and more exacerbated when it comes to disease management, what position are rural hospitals in?

I mean, we've heard rural hospitals closing.

Yup.

You doesn't seem like you're in danger of doing that.

But if you look at the landscape, how fragile is the ecosystem?

It's very fragile and the concern is that if a trip was diminished or goes away, hospitals will close.

Absolutely no doubt.

So if you look at Tennessee is a good example, 40% of Tennessee's hospitals run now, especially in rural communities, are at risk.

When you look before a trip, Kentucky had, I think around somewhere around near 2018, 17 hospitals that are at risk and that's down to four now.

So a trip has had a tremendous impact.

But it's also again, and it really isn't just about the financial piece because quality readmission rates, keeping people out of the hospital, keeping them healthy is a huge piece of this.

And it's an investment.

Again, the sickest people in the nation right now who really need help the most.

So, you know, they can't say enough good.

They've really been great at lobbying and really telling the message because there is concern.

There is concern, especially in rural health.

If you look at eastern Kentucky, you know, we represent half of the city of Pipe for one of the most progressive cities occupational tax.

So without us know they lose a substantial amount of pay.

So it's about also economic stability.

When the coal industry was impacted, health care rose and represents about 17.4% of the overall economy in eastern Kentucky.

So when you look at not just the economy, you look at the number of jobs that's created, you know, I have 3100 employees.

RH Who's my, my, my.

They're our friends, our competition.

They have a.

Loud Appalachian regional.

Appalachia.

And Holly Phillips is a dear friend of mine.

So we are the health care systems.

I'm a different type of hospital.

The one Holly is I have a higher level of care.

We take the transfer patients from A or H, They administer great care in the communities that they're in.

But the concern is, again, is that it is extremely fragile when you look at specifically eastern Kentucky, know who we are.

We offer almost every service that a UK or you avail offers.

You know there's three medical schools in say, Kentucky you pike has one of them we have a relationship with that medical school as along with our optometry school and soon to hopefully be dental school.

So when you look at what we're offering, we're offering all the same services.

But things like our specialty services such as endocrinology or rheumatology, those services did not exist ten, 15, 20 years ago.

I have r.a.

I travel to Lexington all the time now.

I've got great physicians here.

So the reason that's important is that the financial stability of rural hospitals without protection is that those are services that aren't profit maker for us.

We provide those services because it's the right thing to do.

If we don't have financial stability, then those are the services we end up cutting first.

So those are, again, our citizens within eastern Kentucky that are then denied access to care that end up back in central Kentucky, which is already overburdened.

You saw UCS just announced a $2 billion expansion project in trying to create more beds because those higher level of care that's needed, they're running out of beds also are transferred to them or they're transferred to hospitals like ours.

So it is very, very fragile right now in where I think, well, not just think the numbers prove that we would go without this financial stability.

So each rep has played a huge role in who we are and what we're becoming.

The recruitment of talent of specialists.

Is that more of a challenge for you because of the region?

It absolutely is for two reasons.

One, because of the region we're in, is hard to convince somebody that's graduating in New York or Chicago to come to rural eastern Kentucky.

But there's also when you look at and you mentioned earlier, the, you know, there is a crisis right now in the US, hands down a crisis now we created a new product that I call the product because that's what it is and that's what I do.

So four years ago I created a program called Project Heart, which is an acronym for Health Care Education, real regional Training.

So when you look at me, I have a thousand nurses and I'll I'll come back to your point of doctors because they kind of correlate.

So when you look at nurses, I have a thousand right now.

Becker's reports that by 2025 and that the nation will have 40 550,000 nurse shortfall in Kentucky.

A recent study that was done through shows that we currently have 3000.

And if you look at projected 2035, if nothing happens where we only gain 100 nurses.

So there is a this is a huge issue and it impacts our finances also because of the traveler.

When you look back at April last year, a good example at the number of travelers I had a have in my organization, those travelers cost me $3.8 million a month more and every hospital was going through this.

So now that again, the travelers are going down because the demand of COVID is kind of impact us, but we're still have we still have nearly 100 travelers in our organization.

So what is that?

Traveling nurses, just traveling nurse travelers.

This is our own internal terms so we know what we're talking about.

I apologize.

But we also have travelers in other positions as well.

Really?

So lab techs, respiratory, you know, because there is a huge national shortage.

And when you live in eastern Kentucky and there lies the problem.

So I had multiple meetings in Frankfort and what Project Hart did.

So if you look back four years ago, three years ago, I have a thousand nurses, a national attrition rate and health care was about 17% at the time.

So at any given time, I need about 150, 270 nurses in Pikeville.

We had two nursing schools.

The University of Pikeville and A and U.

Between the both of them, they were producing 80.

And if you look at the success rate of the boards only producing actually 60, so I need 150.

Then all of a sudden that's before COVID, right?

So now the crisis hits.

So realizing that that was coming worked with my federal and state partners.

And so we've got to do something.

I want to launch something different.

So we create a program on the project card.

We have multiple leaders, and I'll leave somebody out if I start mentioning.

Sure.

But the bulk of them are in higher ed.

So we went from we so partnered with UK, a part with Garland College of Nursing or partnered with KCTCS with the Big Sandy Campus, a partner with National University.

So National University in Garland are actually buildings on my campus now.

We actually built them nursing schools.

So we worked with Big Sandy and you and a couple of others to where we now have the for the first time, a allied health program at Eastern Kentucky.

So we have lab techs, we have respiratory, we have rad techs, all these positions.

So why that's and then we've created scholarship opportunities where the hospital's actually paying students while they're in high school.

So we have a workforce innovation center that we just launched.

We have all these high school students that come to us.

We actually get as far down as the kindergarten where we do these sessions, and as a result, we pay them to go to school with a commitment that as they graduate, that they will come to work for us.

And if we choose not to hire them, then they can go to work for my competition.

But they still get the economic benefit.

So through all that work and through these partners, I just said we had 80 health care seats.

Now we have 540.

So we're now, you know, and one of the things that really aggravated me even coming into this position is that there was a story on a national network that interviewed a few high school students as get ready to graduate.

And they were gymnasium and they were interviewed and they asked them, you know, what are you going to do?

And the answer was, the same is that we're drug infected.

There's no job opportunities.

You know, look, I grew up in Chicago.

I'm from this area.

My dad was from this area.

I know what drug you know, they're not saying there's not a pandemic.

It's in a lot of communities.

But unfortunately, you can take this couple labeled as such.

And then if you look at the number of job openings, I'm sitting here in any given year, I've got, you know, three or 400 job openings and begging people to come to work.

So COVID aspirated that to a point to where we've got to be able to present opportunity, because statistics will show that if you have a student that's from the area, they're committed to the area, they go to school in the area, they'll stay in the area.

So you get continuity of care also.

So we see it as an opportunity that is an investment as a trip moves forward.

The intent is, is that we will start and uptake is a great example.

You Pike When I first started five years ago, about 35 nursing seats, three nursing sits.

I'm sorry now they have 140.

So we are now moving students through the system of that.

In the next year we will start graduating that first batch.

So we'll have close to 300 nursing seats in our community that will be graduating, that will be able to offer these opportunities to.

And it's not just for us, it's for RH and other providers as well to kind of fill the gap and to kind of again, lower the overall cost of a for the travel, nursing or in travelers.

But more important, you're putting people to work in eastern Kentucky, you create jobs, you create secondary families that go to work for the other service areas in the area.

So all that's great.

Well, the same problem we have when you look at the national statistics with physicians.

So there's a huge shortage of physicians nationally.

And when you look at eastern Kentucky specifically, is that we are underserved traditionally in certain fields.

So trying to recruit somebody away from a UK or to avail their good friends is difficult because of the amenities that are offered.

But the beauty is, is that I was just telling the story a little while ago is that the easiest recruitment tool that we have is that our hospital has really advanced technology, so our heart and vascular program really is all second to none in the state.

And we traditionally ranked third or fourth from number of open hearts that we do.

So when we have a physician that comes as a cardiologist say, walk our facility, I cannot believe I have more cath labs in the hospital state of Kentucky.

We just opened a $35 million expansion of a heart vascular center.

So cancer, heart, orthopedics, etc.. We have the most advanced and technology that's offered.

So once a doctor walks, they are absolutely blown away.

And my cell is is that, you know, eastern Kentucky and I make this joke, Renee, and I'm sure you smile.

My wife tells me I'm not funny, but I think I have.

But, you know, rush hour, I live down by Wal Mart up on the hill.

So it's literally it's about a ten minute drive.

And I said, you know, the difference here grow up in Chicago is rush hour.

For me, It's a difference between 10 minutes or 12 minutes.

So you don't have to worry about all the hustle and bustle.

But also, if you look at where people are located, I'll ring.

You can be in Johnson City, Kingsport, Ashland, Lexington, Winchester, about any major market within an hour, half to 2 hours.

So you're right, by airports and infrastructure and all those things that you want to be by, but you still get that hometown feel to work when you walk in the Texas Roadhouse, everybody's going to know you.

And that's phenomenal.

And that's the selling point.

The closer.

It absolutely.

And it's why I'm here.

This is home and this will always be home.

And it's because the people of eastern Kentucky and what I have had the privilege and honor to do, not just with the city, but now taking care of our many patients.

So let's do by the numbers because let's get the stats on how vast this medical complex is.

Tell us about that.

Piper Medical Center is a huge organization.

We have about 2 million square feet of space.

We're the only level two trauma center in eastern Kentucky.

There's two level wants a difference between the level one.

Level two is we're not an educational facility.

So if we were like a UK, we would be a level one.

We have nine centers of excellence.

So when you talk about orthopedics and cancer and heart vascular, all those are separately branded.

I mentioned earlier we have over 45 facilities, really, if you want to count the outbuildings, where it's 52, I think is what we're up to.

When you look at our staff, we have 3100 employees that Rupert that's represented in four different counties, three in Kentucky.

We serve a 450,000 people and a diameter of the, again, basic needs and more advanced needs.

We have a four clinic.

We have an 11 story clinic that has about every specialty and subspecialty that you can think of.

You know, sounds like a pick on you.

Can you have all good these are good friends of mine that we serve on the same board together.

But pretty much we offer almost every service that a UK or U of L offers outside of.

We don't have a burn unit and we don't do transplant.

But outside of that, you know, there are more advanced cases that a university has to do.

But for the most part we have the technology, the ability to be able to do that.

So we do about 400 I'm sorry, 503 rounded up a thousand encounters a year as an organization.

So if you rank us by size in the state, we rank around a 10th from the standpoint of size hospital out of 120.

So and there's a lot of you know, obviously a lot of system hospitals that do a phenomenal job.

So we're we're we're the largest employer or single employer in eastern Kentucky.

We represent, as I mentioned, a significant amount of the tax base.

So it really is about access to care.

You know, I mentioned earlier, we have the first children's hospital that we opened up in eastern Kentucky, the Metro Children's Hospital, named after a dear friend who's a board member who's been in pediatrics.

Jody met too.

And then on top of that, we've made a significant investment in pediatric care as well.

That's been my passion.

We opened up the the ABA Center, which is the first ABA center in eastern Kentucky, and has a near and dear to me because my my granddaughter is on the spectrum.

And it was named after her, Ava And which, you know, she's absolutely phenomenal.

She's and she's just graduated kindergarten class.

She's absolutely brilliant and she's pop ups baby girls, what I call her.

But we have eight graduates today.

I've got in that center just to talk about the needs in eastern Kentucky.

Currently, we have 570 kids are waiting list.

There's a huge national shortage for Backblaze or the clinical component, but that's the problem throughout the entire state of Kentucky.

So I'm working with higher ed to see if we can open up more opportunities.

And what is BCB.

A is a behavioral analysis of what in essence, what they do is they're the ones that actually put together the health plan for Abby, a therapy for a child on the spectrum.

We said kids in our program between the ages of two and ten, and then you opt out at 12.

But most of all, we call them learners.

Most of our learners in the program are between two and six per average.

But, you know, it's unique because 110 year olds are far at that age.

You can really help them become the best that they can possibly be and give them the greatest oppor that are nonverbal, that use audiovox or we teach them to talk using a mechanical voice.

So if you can imagine wanting to drink water or having to go the bathroom and not being able to say so and I say this frequently is that, you know, health care is not a disability.

It's a different ability.

And you have to learn to be able to bring ability out and to see so many accomplishments here in a five year old, say, I love you for the first time, brings tears to your eyes.

And living through it personally also has been rewarding in a sense because it also lets me understand the significance of that.

But it's outside, even in the AVA Center, and we opened our first satellite in Preston, Hamburg last year also.

So we're going to have by the end of this year about 130 learners in our program.

Wow.

Which is phenomenal.

But we also have done things like we were the first pediatric ready hospital.

So you could like with our ED with Autism Certified, we opened up an Ed Ward for for pediatric specifically, we launched our Telehealth Healthier School Initiative that put telehealth in every single by county school system.

We offered them to these Asian counties as well.

So now access to care.

So a child that's in school giving them access is extremely important.

So when you look at Pike County's largest geographic county, you know, you look at you know, we're Phelps is it's almost an hour away drive time.

So you give a child at Phelps the opportunity they want to have any regular cold.

I can give them a a physician or a nurse on telehealth that gets them care so allows the parent to can you working without having to miss work.

And so it does a lot of other things to kind of bring the community and the region together as well.

So our Nick you we just graduated to a level two advanced Nick, you two years ago.

The beauty of that is is because of the type of specialties that we have here and the services that we have, we're able to take care of babies at a lower birth rate and or that are premature to our for years and years that child was flown away and separated from its mother or family.

And that doesn't have to happen Now.

There are rare occasions where we have to do that because of a higher, higher level of care.

So I'm very proud that that's what I was trying to say earlier, is when you look there and coming at a time to where hospitals have struggled, we have struggled also working with our federal partners.

We have received a tremendous amount of various grants to be able to leverage our cash that we didn't have on hand to make investments that are giving a greater return.

So the AVA Center, for example, also employs 70 new people in Pike County that never had a job before that are in this field.

So it is had a great impact.

But our biggest challenge still yet is, you know, I just had a meeting this morning with our chief medical officer, Dr. Crum, talking about the the need in a recruitment of bringing more physicians because there is such a need within the area.

And we do struggle.

Typically, it's kind of unique because which heard me say is that rural hospitals oftentimes or the poorest parts of the county or the state, and so they have a higher payer mix.

So with government pay, so we don't get a lot of commercial insurance, but yet we pay our people more because of the demand.

So to recruit somebody here may cost 10 to 20% more.

And we have to justify that because there's guidelines and rules that we have to follow as well.

So it's, you know, imagine during the time of COVID, too, where inflation hit you, the transport piece hit you.

On top of that, your workforce salary is up 30%.

And I'm not a retail guy anymore.

I can't raise prices because the federal government still pays me what federal government does.

So that's why things like a trip is so important.

You know, there's a huge issue coming up in the in the legislators, I'm sure this year because it was last year oversee your and.

Certificate of need.

Certificate of need reform.

You know there's a recent poll that I've done.

I was involved in that only 3% of those polled knew what to see when is should typically need.

So, you know, it's extremely important to protect the integrity of the see when and I met with three legislators this week as a matter of fact explaining that when we talk about free market, it's not really free market because again, imagine you're saying there's free market, but through I'm Taylor I have to accept patients through my ID Well they can pay or not a private person doesn't have to do that 77% of my payment is dictated what you want to pay me.

But yet we've made investments.

USDA, I tell people I drove.

USDA actually owns a hospital because of the debt service that we're carrying.

But without the protection of See you end then there's many services you may be able to bring in one competitor, but there's 15 services you're going to give up because the one service they're going to cherry pick from that standpoint and really pick your heart where it impacts your profitability, which overall impacts your market.

So if I end up having to lay off 100, 200, 300 people, the net impact of Wal-Mart, that impacts the ratio across the street, etc..

So it is a huge issue in trying to really help educate folks to what those need to be in the know the importance of preservation and why CNN is so important.

And it's interesting because I think that you in conversation started with northern Kentucky, which we signed Elizabeth then and then that area, Jay Williams, who represents that area.

So we don't think about that really.

I didn't think about it at the time, how it would affect rural Kentucky, particularly eastern Kentucky.

Absolutely.

It, again, in my opinion, is very strong language I used with legislators in saying it wipes us out because we are we're not underserved.

We have all these services that we felt we had built this facility because we have the highest pulmonary disease, the highest can introduce.

Well, imagine if they change the process.

It allows unfair competition and it doesn't have a 77%.

They don't have to take Medicare.

They can take on the commercial.

Right.

So they cherry picked the good stuff.

Medicare and Medicaid either either.

Yeah.

So Medicare mainly, right.

So they don't have to accept they don't have empower.

They don't.

So if you're not taking Medicare patients, then I have a 77.

So the 10% a commercial payers, they're going across the street.

I lose that income.

There's no way for me to raise prices.

So I have to then fulfill my fiduciary responsibility and start cutting the services that don't make money.

Well, as places things like Trauma and Children's Hospital that don't make money, it's the right thing to do.

So we do this business in order to be able to pay for this business that all rural hospitals across the state.

So how it impacts the local economy is just again, we the city of Pikeville is the economic engine.

Again, the industrial park, the university, the banking community, education, communities all housed here.

Imagine if CPI were to lose 25, 30, 40% of their income from the largest business in eastern Kentucky.

Kind of what happened to us there, Nicole, when our we went away and the the war on coal took over is that and I was the city manager at the time and knew how that impacted our finances also.

But luckily, health care has risen to the top.

And the beauty of that is this is not about it.

It really isn't, because we talk a lot about economics right now, because that's the that's really where we're at as a nation.

You hear a lot about the shortage, but it really is about access to care and quality of care.

Well, just one final question, and it's kind of dealing with like behavioral health.

So we think about we know that at one time northern Kentucky was called ground zero when it comes to the drug epidemic.

But also eastern Kentucky shared that identity.

We do know that there is you've mentioned I was thinking more mental health trauma, but we know there's a lot of mental health needs that are going unmet.

Where is Pikeville Medical fitting into that or can it have a role?

And helping there?

The answer is yes.

But just you know, the complexity of this issue is, is that there's not a lot of mental health professionals that are available out there and that's a it's another crisis in the state.

So one of the things we're doing to try to combat that is that we're working I've had multiple meetings with directly with the governor.

I've got a meeting coming up with President Stivers.

And what we're trying to do is to put together a residency program that will offer psychiatric residency here in Pikeville.

So there's only one psychiatric program in Kentucky, in Louisville.

We'd like to be the second one.

The problem, which speaks to the issue, is that all hospitals and professional organizations like the university, etc., to do psychiatry is a very, very expensive venture.

You're going to lose money.

But the question is, is it the right thing to do?

So looking for possible partnerships, subsidy, not saying we're not willing to partner because we realize that is such a huge issue and our partner in this endeavor is also AAC.

So Tim Robertson with Art.

Addiction Recovery Center.

Used to acronyms.

But that's okay.

So in working with Greg Mae and Tim Robinson with what he's doing around the state, there is a component to where they need psychiatric care as part of the drug recovery component.

So our our offer is, is let's all kind of partner together the state drug recovery, and then it will also allow us to address our concerns, which is the mental health.

You know, we we face it also as an industry, knowing what we've gone through, you imagine in health care, you know, our people, we're still the only ones left that we're in masks and we're still working 12 hours a day watching people, unfortunately, perish because of a bad epidemic.

So, you know, we we've had issues internally that we've had to had to deal with and offer care.

So we have code lavender.

So we have a more you know, we're a Christian organization.

It's how we were founded upon.

We still are.

We open every morning with prayer and it's who we believe and what we believe in.

So our ministry plays a huge role in the holistic killing component of what we offer and do.

And of course it's patient choice, but also in ministering and attending to our own staff has become somewhat difficult at times because of what they face and what they deal with.

So again, it's like everything else I think that COVID has brought forward, it's really increased the need.

The problem is, is and I started say this earlier, I did say, but I will because it speaks to it, is that when you look at our educational infrastructure and I'm a huge proponent for education and what our facilities offer here in the mountains, I mean, they do a wonderful job.

However, we're behind times when you look specifically multiple meetings with KCTCS and saying, look, you know, I'm I'm the number one employer in eastern Kentucky, but do you know how many health care programs you have at Big Santee?

Zero, Not one.

But we're still looking at things like these and mechanics and those type of things.

And they're great.

You know, it's not that it's not a great organization.

You've got to be able to pivot.

So our our educational infrastructure isn't where it needs to be to support rural hospitals, specifically because most of our graduates are coming out of the UK right out of Galen's, out of Louisville.

So that was part of where Project Heart kind of folded into all this, is to say, okay, let's really put focus and put dollars, because if you really if you make investments where there's a true return and you don't just throw money at me, make it meaningful.

Let's put money into scholarships, let's let's put let's create legislation that pays a teacher that want to want to stay.

Because right now, the problem that health care faces is that when nurses when you have a nursing program and you can go travel or work in a hospital now for three times the amount you can work when you're teaching, they're going to make that decision for the family.

And I don't blame them.

So there has to be a subsidy to be able to fix there, because if not, if you don't pay the teacher, you're going to pay the hospitals, you're going to pay this absorbing cost.

So there is a way of making smart investments.

And that's what we want to see with the same thing with with psychiatric care and the mental health crisis is that it's not just about creating programs, but it's about creating meaningful programs, will have a long term last and will have a return on whatever investment that we're making.

So we're committed to doing it, but we're going to have to have help to get there.

Sure.

Well, we know that the cost of the physical, the physiology is affected by the mental right.

And so those people who deal with those severe mental illness issues also probably have a higher propensity for all those cardiovascular diseases and every other thing that costs a lot of money to try to.

Fix what really you know, that's a whole different thing we could get into.

I won't dwell on, but that's part of what we face, especially in eastern Kentucky, is the number of co-morbidities that people have on top of what we're trying to treat.

So you can imagine, again, the way that comes, you know, the way that we're paid, and that's a problem.

So when you look at readmissions, so we could actually demand for readmission if we let somebody out of the hospital too soon and they come back, then we actually get Dean for that and make less money.

So I've got the sickest patients in the nation.

But, you know, when you look at somebody in California that's healthy and you look at the payer right now, again, there's regional way that they pay.

So I don't want to be I don't want to give somebody the false impression.

But, you know, we can a drug payment which is a certain limit of time, that the patient can stay, that we're paid anything past, that we don't get paid for it.

Well, when you've got somebody that you know may have their gall bladder, bladder taken out, but they also have COPD, I can't get them out of hospital that three days.

So because of those co-morbidities there's a there's additional stress on a specifically our part of the region because people are not just simply not healthy especially in their older age.

Now things are changing health change and that's why the quality argument is so important is that if we can educate our youth, can educate and change kind of the, you know, the eating habits and all the things that, you know, I grew up being the cornbread and all those things and we eat.

But as we change those things and we are changing, then it will get better.

But for the long term, it's either look it and I say all the time, either you can pay me now or you can pay me later.

And that's where we're at is either you can take care of a patient now and help them get through it, or you can pay for them.

Long term.

It's going to cost the state and the federal government a whole lot more money.

And that's still the problem with mental health.

That's right.

You know, we can fix it now or they're going to if you don't fix, it's going to get worse.

And as delay of care happens, then it's going to cost the state federal government a lot of money as we go forward.

Right.

Well, this has been really enlightening.

I mean, I appreciate it.

I was just curious like, can you can you not make the can you not fix certificate me in a regional way?

I mean, is there not a regional approach if if northern Kentucky in Cincinnati have this issue, which I see both sides of every issue.

So I see that for them.

But if it's a disadvantage for another region that it's already kind of disadvantaged, Can you not create a more peer to system?

Absolutely, you can, and it's a good point to make.

So the Kentucky Hospital Association, we just had our retreat.

We spent three days talking about suing.

So the KKK has put together, in essence, a plan to present to the legislators all the things that just we're just aren't willing to let go, because if it does, it impacts assets, assets, access to care, it impacts quality, and it's backed rural health care in general, the state.

And we've got to be able to have a strong voice to be able to tell that.

But to your point, when you look at the again, more urban metro versus roll market, it's a different argument.

Not that I'm a firm believer that because of investments that are made that have already been made in the cycle, what that we were in, you're going to hurt health care if you tried to do too much at one time.

Because if you even if you go in and see when even in the metro market in the interim, what all takes place is going to impact care.

It's just it's just going to.

Yeah, well, this has been fantastic.

Anything you'd like to share that I didn't ask you real quickly, though.

I've enjoyed this thoroughly.

You know, it's obviously this is a business in I'm very passionate about what I do and who I get to serve.

But, you know, coming through.

And I guess that's where all and my comment is, is realizing as administrator coming through.

When I first took over the hospital, it was financial turmoil.

We got past a lot of that.

Then we hit Kobe, we got past that.

We're in the workforce issue.

We got past that.

Now we're the CEO.

And so it's you know, our job is to offer quality of care and access to care for the for the citizens that we serve.

But there's always something that you feel like you're under with when all you're trying to do as a nonprofit entity is to provide a service and allow the quality of life of people in to save lives.

And that's what we can't lose focus of.

That's what we're here to.

And so, you know, we've got great legislators.

You know, I'm not not upset with that.

I know I've talked about education, I've talked about health care, talk about our industry.

People want to do the right thing.

It's doing what you do.

And I appreciate you, Renee, because when you put when you educate people and you let them see they saw the story, people can make good informed decisions with good facts and what you're bringing forward.

So thank you for that.

Thank you.