- (female announcer) Production funding for Behind the Headlines is made possible in part by the WKNO Production Fund, the WKNO Endowment Fund, and by viewers like you, thank you.

- The future of Regional One, tonight, on Behind the Headlines.

[intense orchestral music] I'm Eric Barnes with the Daily Memphian.

Thanks for joining us.

I'm joined tonight by Dr. Reginald Coopwood, President and CEO of Regional One.

Thank you for being here again.

- Absolutely.

Thanks for having me.

- I know we were talking before, we couldn't remember if you'd been here before COVID, but you definitely were here during COVID virtually a number of times.

But thanks for being here.

- Absolutely.

- You're very busy right now with a whole lot going on.

We'll talk about the big expansion, renovation, but we'll start with, and we'll talk about just kind of the state of Regional One.

Regional One means so much to so many people.

It's amazing.

I've been here now almost 30 years in Memphis, and everyone it seems like has the story of the time that they had to go, or a family member, a friend had to go to the Med, I still call it the Med, Regional One.

My father was there and it was an incredible experience for him.

So we'll talk about that as well, just the the state of Regional One.

But let's start with this proposal of making this the hospital, what I think of as more of a teaching hospital and a partnership with UT Health Science Center.

Talk about your vision for that and where you want to go.

- Well, this has been a vision of mine and of the organization's, really, for the last 14 years that I've been there.

I grew up in Nashville, Vanderbilt University was that academic medical center in the city.

When I took this job, I made an assumption that that existed in Memphis because a UT medical school was here.

But I soon found out that there was no real true academic medical center tied to UT Health Science Center.

The Med played a role for the public hospital and had the trauma, and the high risk OB, and the burn center and different assets were at different organizations throughout the city.

And so I've had conversations over these 14 years and really they started to take hold to be able to say that UT Health Science Center needs its own academic medical center to be able to draw the researchers, the clinicians, and to start creating that reputation that UTHSC really deserves.

- And is that about bringing, you mentioned faculty, but also students, residents.

It's the whole...

The people who come in are made up of what?

- Well, from the medical school class, they today recruit top notch medical students across the state and and beyond.

But to be able to start build, bringing in faculty who have specialty areas, who are doing things in this community that individuals leave Memphis for today.

They'll go to an Atlanta, or a Mayo, or Vanderbilt for complex care that's not necessarily right here.

So we want to recruit those physicians that can provide that level of care right here in Memphis.

- The...

I almost called it The Med again.

Regional One is known, you know, to many people, as a trauma center, I mean, first and foremost.

That's my own family's experience with that.

High risk pregnancies, birth, NICU, burn center.

- Correct.

- One, what did I leave out now that is really what the Regional One, you feel like this is where we're excelling?

And two, what are some of those specialties in those forms of care that you think you could deliver locally with this academic partnership?

- Well, you know, we continue to lead the country pretty much, 'cause we're one of the busiest trauma centers in the country.

Not because we're so violent, but because there's no other trauma center for a 150-mile radius from Memphis.

And so we get farming accidents, we get interstate accidents, we get local accidents.

We get the trauma you read about in the news every morning.

So our physicians led by Dr. Andy Kerwin and Peter Fisher are coming up with leading treatments for trauma patients.

We're now growing our cancer program, oncologists.

We have medical oncologists, academic medical oncologists, as well as surgical oncologists led by Dr. Shabada, Dr. Glaser, and Dr. Fleming.

And they're doing cutting edge treatments on people with cancer or metastatic cancer where we're doing some things that only two or three other institutions across the country are doing.

- Does the...

It's right calling it a partnership with UT, right?

- Correct.

- Right, okay.

Does that partnership, does that preclude their work with other hospitals in town?

I mean the big institutions like Methodist and Baptist and St. Francis and so on.

I assume not.

- It does not.

- How do y'all work and play nice together in these kinds of spaces?

- So University of Tennessee has relationships with both Methodist and Baptist that are longstanding.

And we're not here to try to disrupt, or as I like to say, we're not here to do harm to Baptist or Methodist.

They're fine hospitals that provide quality care.

But we're here to really grow that academic environment that raises the community standard for what that care looks like.

And UT will continue to have those relationships with those other hospitals even as they focus on building this academic medical center.

- What work do y'all do with St. Jude?

Obviously, the other big hospital in town, St. Jude, now.

And does this academic component increase, decrease, change any relationship with St. Jude?

- It'll probably enhance our relationship with St. Jude.

We have a relationship with St. Jude.

A lot of the children with sickle cell disease that they treat mature into our sickle cell program at Regional One Health.

We're looking to start a treatment program for hemophilia and have a hemophilia treatment center that will be in conjunction with St. Jude because they're treating the children with hemophilia.

So there's that graduation of individuals who are treated in a pediatric academic medical center that graduate into this adult center with similar type of researchers and clinicians so that there won't be any let down in what the care is or availability of cutting edge treatments.

- The cost associated with this.

I mean there's, you know, new people, new staff, new, I assume, resources and so on at the hospital.

And then this probably begins to segue into, you're looking to put upwards of a billion dollars into a big renovation and rebuilding of the whole physical facility.

So I assume there's some overlap in these, but what, look, if we can in round numbers, I mean the cost to grow this into an academic center is give or take what?

- Well, that one's a hard to to say because investing in physicians, we spend a day, you know, upwards of almost $80 million in physician salaries and support.

Some of that is offset by the revenue that they create.

But we'll need to continue to grow out other specialties in cardiology to enhance our involvement with orthopedic, complex orthopedic cases, and neurosurgery cases into the new facility.

So it'll probably be in that $100 million range of investment that we'll need to make in the clinical side and programmatic side of an academic medical center.

- And that's probably a hundred million a year, 'cause that's a lot of salaries and so forth?

- Correct.

- That is paid for by what?

- It's paid for by, partially by the professional fee revenue that the physician, the clinician creates.

And it also is provided through dollars from our operations that we and all hospitals do to subsidize their faculty that are part of those hospitals.

So it comes out of our operating budget and it's a big chunk.

- But are you looking, I guess... Are you looking for more federal money to do this, more state money to do this, grants, local county or city money?

Like just in the buckets of sources for that, beyond the, you know, the insurance payments or out-of-pocket payments that patients are making?

- Well, we're not looking for more money from the county or the state to facilitate operations.

And that comes from operations.

We are looking and appreciative of the county stepping up on the capital side for the building of the institution.

And we're working with the state on dollars capital, potential capital dollars to help with that as well.

But on the operational side, our goal is to be able to do it through operations, to find grant funding, but not depend on governmental funding for daily operations of the organizations.

And that clinical component falls in the daily operations.

- We'll definitely come back to the academic side, but let's segue into the, am I right saying the goal is a billion dollar renovation, upgrade, rebuilding of the Regional One complex.

That's over multiple years, - Correct.

- I mean 8 to 10 years, correct?

- The county, and I should note, we're recording this on Wednesday and County Commission is in session, which is why Bill Dries is not here today.

So there's gonna be some movement potentially that won't be captured in this episode.

But go to Daily Memphian and you can learn more.

The county is, as of this morning, as you and I sit here on Wednesday morning, was in for... What was the number?

- $350 million.

- Three hundred and fifty million towards that.

Mayor Harris is putting forward that more of the wheel tax could go towards this project and get the county's contribution up to?

- Five-twenty, as I understand.

- Okay.

You've talked to County Commission.

I mean, I don't wanna put you on the spot.

They vote, what, in June on this?

- The final budget will be probably end of June.

- But are your indications good from County Commissioners that this is something they want to support?

- Well, they've supported the initial $350 million.

This is something that Mayor Harris has proposed to do, and he feels comfortable and confident that this also will be supported by the County Commission.

I have not lobbied them to support the increase.

We will be in discussions between now when the budget is approved.

But this is something the mayor feels confident, I believe that he can get done.

- You've been talking to folks at the state, but you've not made a formal ask of the state legislature.

But your plan, I think is to go back in January of the next legislative session and try to get state money.

Is that state money to fill the remaining what could potentially be, you know, the other $500 million or so?

- So yeah, so we started the process in this legislative session, met with the governor's team, we met with legislators mainly from West Tennessee and leadership.

Well-received.

And you know, the state had the issue with the franchise excise tax that they decided to pay back, which took a lot of their discretionary funds off the table that they've had in the past couple years.

And so with that behind, our hope is that there'll be more discretionary funds in the upcoming session that we can convince them to tap into to support.

And it can be over multiple years.

But you know, the number was, we're asking for a matching 350.

You know, now we may have to ask for a matching 500.

[both chuckle] - The case you make when you have these discussions with, whether County Commission or state legislators is what?

- From the county, Regional One, The Med, John Gaston, has been a county asset, city and county asset for many, many years.

And the county values what we do and what we've done over this period of time.

and that level of investment comes with, like you said, there's people know who family members, friends, neighbors, church members who have been in the trauma center, the burn center, have had a high risk delivery and a patient in the NICU.

From the state standpoint, it's how do we grow the University of Tennessee, which is obviously a state-owned school.

And how do we grow and enhance that relationship and investment in a UT/Regional One Health or UT/county partnership for a facility that will help UT achieve some of its goals to increase its academic presence.

- When we talk about funding, it is Regional One and that includes other states, you know, people, like you said, the 150 mile radius is not just Tennessee.

It's Mississippi, it's Arkansas, it's Missouri, I assume it's even Illinois sometime.

- Or whoever's passing through I-40 - And whoever's passing.

It's been a conversation over many years about would, should, could other states help fund Regional One.

- So when I came here, that was a big part of the conversation, 2010, that if Mississippi did more, Arkansas did more, The Med wouldn't be in the situation that it is.

We went and talked with the leadership and the governors of both Mississippi and Arkansas back in 2010, 2011.

Prior to that, our US senators, in that time it was Alexander and... Oh... - Yes, that one.

[laughs] - Yeah.

- We'll fill it in after, don't worry.

We'll look at it.

- Who stepped up and worked with the Mississippi senators and we were able to participate in their disproportionate share funding for their state.

So we get funds from Mississippi based on the uninsured that we take care of.

We get funds from Arkansas in support of our trauma program, 'cause we're one of their designated trauma centers for Arkansas because we sit on their border.

So those states from probably 2009 to today, have really stepped up in their level of funding and they take a good percentage of the burden that we have for individuals in their states who are uninsured.

- I think a lot of people don't know that.

- Corker.

- Corker, it is Cocker.

- Yes, it is Bob Corker.

There you go.

We got that.

We'll fix all that.

I think a lot of people don't know that.

I think there is this kind of legacy assumption, for what it's worth, that the folks from Mississippi and Arkansas come are somehow not, you know, that Tennessee, Memphis, and Shelby County are paying for their care.

- I've been here 14 years.

Whenever I go out and speak, that's always the first question.

- Yeah, yeah, yeah, yeah, yeah.

The old habits die hard.

Speaking of Mississippi, and I think I read this correctly this morning, Mississippi is considering Medicaid expansion, right?

Which is kind of a shocking thing, given back when you came here and Obamacare, Affordable Care Act and Tennessee, and Mississippi, and many of the conservative states rejecting The Medicaid expansion, which I think the federal government, I forget how much it is, but it's sort of 95% the first year, 90-80.

It's a huge amount of that Medicaid expansion is covered by the federal government if you opt in.

Tennessee has said it won't.

Mississippi surprisingly now seems to be moving in that direction.

Again, given that there's a sizable number of people from Mississippi who are coming to Regional One, do you look at that and say that will help?

- Oh, absolutely.

Because you know, Arkansas expanded originally and so we don't get as many uncompensated or uninsured individuals from the state of Arkansas.

So if you, if Mississippi and the legislature who is pushing this, if they're successful in expanding Medicaid in the state of Mississippi, then it'll take the burden of the people that we treat that don't have any insurance.

It'll allow them to come into the state, have at least a Medicaid coverage, which takes a lot of the burden of our uninsured or self pay off the table.

- When you're at the, I've seen you at the legislature, I mean, all the local hospital administrators are up there and you know, I'm up there with the press association periodically.

Is it just a non-starter issue in the legislature?

I know it used to be.

It was almost a point of pride for many legislators to say that they'd rejected it.

Is there still that thought and that attitude about Medicaid expansion?

- You know, there's small conversations that are starting to happen in the state of Tennessee.

I think it is still a strong no.

And you know, with Tennessee Hospital Association, which I'm on that board, it's a desire of ours to expand Medicaid in the state of Tennessee.

And we every year will incrementally bring up bills and opportunities to see if we can't make happen.

Whenever the climate changes enough, hopefully we'll have a bill ready to go.

- Yeah.

Eight, nine minutes left here.

Another major.... Well, where do I wanna go?

Post-COVID.

We were talking about you being here.

COVID had, I mean obviously, huge impacts on the whole country, the whole world, all of us.

We were joking about the time warp before we started here, but also, I mean the hospitals, the medical profession, the impact, the burnout, the changes that came out of that.

How are you now, what, are we, you know, years since at least the deep pandemic.

But only a few years from, you know, Delta, and Omicron, and some of the follow on effects.

How are you all still marked by that experience, if at all?

- I think the biggest thing that we all are still dealing with, and thankfully we're dealing with it a lot less.

And that's the cost of labor.

During COVID, the cost of labor, nursing, respiratory therapists, you name it.

Because individuals being paid to go all over the country, high dollars amount, it created a need for us to raise our cost of what we're paying for these nurses and professionals.

And that was a big burden, a big financial burden on us.

A big financial burden on pretty much all hospitals across the country.

As people are settling down, the mobility is not that big of a issue.

We've been able to take a lot of those costs, travel nurses out of the organization to where we are now, pretty much back to all salaried nurses, salaried respiratory therapists, salaried radiology technologists.

And that is, we're just in our budget season right now.

And to be able to do a budget where we're budgeting people based on a regular base salary is a huge lift for us.

And as hospitals extract more and more of that high cost labor as well, - Again, the traveling nurses, the contract people just tend to be more.

It's an independent contractor.

They tend to be a lot more money, but they're here for short periods of time.

Is that kind of the basic thing?

- Correct.

They're not committed to the vision of the organization.

- Getting more people salaried, committed employees, is that a result of more people coming to the profession, people getting tired of traveling?

What is it that you would say made that possible?

Because it's a big shift and a lot of hospitals are still struggling with that shift.

- Well, I challenged my leadership team that, you know, there's one thing where people will go for money.

You're paying $5 more over here.

I add that up, that's a lot of money, so I'm just gonna go to this hospital.

But at some point when you created an environment and a culture where that $5 isn't that exciting, because I'm gonna go over here and work for $5 more in an organization I don't really care for, I don't really involved in the mission and vision of that organization.

So I challenged 'em, I said let's create this environment where people want to stay.

And we aggressively did that and it paid off in multiples where we had nurses who in this city were, had the ability to earn five, sometimes $10 more an hour, but chose to stay at Regional One Health because of what we do, and the patients we take care of, and the value that they placed on it.

- That has been one of the things you talked about, I think from when you started, is making Regional One not just the place you go in these extreme situations, but also a hospital of choice for your care.

Has that progressed?

Is that part of your, the number of patients you see and so on, where it's more routine things, not the incredibly important traumatic things?

- It absolutely has.

That was, as you said, one of the things that I said coming in the door, that we have to become a hospital of choice.

Just today, if I can give a little shameless plug, Leapfrog announced its scores where we have not historically scored well as an institution, but we got a B today, and we're proud of that.

We're celebrated.

We'll only be eclipsed by the celebration when we get our A.

- And that Leapfrog is an independent assessment- - For all hospitals.

- Yes.

- And so, that's evidence that the culture is changing to what we want to be.

And the people are seeing that, and people are choosing amount of elective surgery that we do today is multiples of what we ever thought it would be.

- Another sea big change in the last almost two years now since we've talked is the end of Roe, the Dobbs decision.

I don't wanna get into a political conversation.

I wouldn't do that to you and put that... That's not what you're here for.

But you all do a lot of emergency care.

You do pregnancies, high risk pregnancies.

Has your work changed since the Dobbs decision?

- I can't say that it has, you know, because a lot of what... We're in the business of taking care of high risk moms who want to preserve their pregnancy as long as they can and to deliver a baby that has a viability that we can get into our NICU and grow them ultimately into a healthy adult.

So that's been our focus.

And so, we don't deal with, in situations significantly where individuals want to terminate the growth of their baby versus those who are trying their best to hold on to them until they get to an age of viability before they can live outside the womb.

- There is, not to get too wonky, but there's a big federal Supreme Court decision right now.

EMTALA.

Did not write down what it stands for.

I should have.

But it's about the duty, the responsibility in the '80s where all hospitals that get Medicare money have to treat patients.

And before that, this was not an abortion thing.

This was just, if you came in with burns or a broken leg, and it was a private hospital, and they didn't wanna treat you 'cause you didn't have insurance, they could... And they were examples where private hospitals, I'm not picking on Memphis, it was just a national phenomenon.

They were kicking 'em out, go to the public hospital.

That changed.

- But a lot of that happened in Memphis and a lot of the EMTALA when it came through was for how Memphis managed patients.

- Fair enough.

Fair enough.

But now there's a federal case we won't get into, people can read about it if they're interested, but it must be a case, and it's about where abortion and states with abortion restrictions intersect with this duty to provide care.

This this federal law.

Are you watching that and what impact that may have on y'all?

- Not directly.

Ultimately these will be case by case decisions.

Our staff and our physicians are there to do what's in the best interest of the mother and the baby.

And because Tennessee is a state that has kind of banned abortions, a lot of that traveling to other states and other hospitals will happen in states that haven't taken a similar stance.

So, it won't be a touristic type of thing to come to Tennessee.

It'll be where people will go to those other states.

- And Tennessee is a state with the, where you have protections of the mother, life of the mother.

Is that correct?

- I do believe.

- Yeah.

Okay.

So we're in this gray area.

Again, I didn't want to get into the politics of this, but I think people are wondering in this federal case is happening right now.

It's obviously a big issue, So thank you.

We're out of time.

Thank you very much.

Appreciate you being here and thanks very much.

But we will be back next week with Bill Dries, I think, hopefully, to save me when I get things wrong.

And again, just a reminder, everyone, we record this on Wednesday so you know, things are happening at County Commission relative to Regional One right now.

If you missed any the show today, go to wkno.org or download the full episode as a podcast from the Daily Memphian site, iTunes, Spotify, or wherever you get your podcasts.

Thanks very much.

See you next week.

[intense orchestral music] [acoustic guitar chords]