The Future of Healthcare in Marshall County

In November of 1999, I assumed responsibility for what is now Alliance Healthcare System with one clear mission: to preserve local healthcare access for Marshall County.

For more than 25 years, through economic downturns, workforce shortages, regulatory shifts, and financial pressures that have forced many rural hospitals across Mississippi and the nation to close, our hospital has never closed.

We have remained open because rural healthcare is not optional infrastructure. When a hospital disappears, a community loses emergency access, local jobs, economic stability, and the ability to attract new industry and families.

However, in recent years, significant financial pressures directly led to the closure of our emergency room and the reduction of hospital services.

First, the rapid expansion of Medicare Advantage plans reduced reimbursement and increased payment denials and delays. Rural hospitals operate on extremely narrow margins, and these reductions materially weakened our ability to sustain full-service operations.

Second, the county entered into a contract with an ambulance provider that does not routinely transport patients to our emergency room. Emergency departments depend on patient volume to remain viable. When ambulance traffic is diverted away from the local hospital, it becomes financially impossible to sustain 24-hour emergency services.

To properly staff and operate an emergency room requires 24-hour physician coverage, along with nursing, laboratory, radiology, and support personnel. The cost of doing so is approximately $3 million per year.

Unlike most businesses that operate on a single 8-hour shift, an emergency department requires three fully staffed shifts every single day. Without sufficient patient volume and structural support, those fixed costs cannot be absorbed.

In response to these mounting pressures, in March of 2023 we converted to the Rural Emergency Hospital (REH) designation under CMS, a federal program designed specifically to stabilize struggling rural hospitals.

Under that designation, the federal subsidy was slightly over $3 million per year.

That number is not arbitrary. It closely aligns with the approximately $3 million required annually to operate a 24-hour emergency department. Federal policymakers recognized what rural operators already know that it takes roughly that amount to sustain emergency services in small communities. The subsidy existed for that purpose: to keep emergency rooms open and, by extension, to help stabilize rural hospitals.

However, CMS later determined that, for regulatory classification purposes, our facility did not meet their definition of rural, despite the distinctly rural population and geography we serve. We were forced out of the REH designation. The loss of that federal support had a tremendous negative financial impact on our hospital and removed a stabilization pathway intended for facilities like ours.

In January of 2025, I presented a comprehensive plan to the Marshall County Board of Supervisors. That plan outlined not only a pathway to reopen the emergency room, but also a long-term strategy to stabilize and expand healthcare in this county, including construction of a new $18-$20 million hospital facility.

Financed over 30 years, that investment equates to approximately $100,000 per month.

For comparison, the county currently pays approximately $162,500 per month to the ambulance service.

In other words, the county is spending substantially more per month on ambulance services alone than it would cost to finance a new hospital building, and after 30 years, there will be no county-owned asset to show for those ambulance expenditures.

Meanwhile, the county allocates $200,000 annually to the hospital for indigent care. Several years ago, taxes began being withheld from that amount, effectively reducing the hospital’s support to approximately $100,000 per year, less than $10,000 per month.

For 25 years, we asked the county for nothing.

We maintained and operated an aging, hill-burdened facility on Highway 4 East that continues to experience structural and infrastructure problems, generator failures, plumbing issues, leaking walls, and ongoing maintenance challenges. To date, we have not received financial support from the county to maintain or modernize that building, even as those burdens have increased.

During our January meeting, I made a simple comparison: if the board of supervisors were the landlord and Alliance Healthcare System were the tenant, they could not have asked for a better tenant over the past 25 to 26 years. We preserved healthcare access, carried the financial burden, and kept the doors open.

However, there comes a time when partnership becomes necessary.

To date, we have received no substantive feedback or forward movement from the board regarding the plan presented in January.

Alliance Healthcare System has never closed. We are still here. We remain committed to Marshall County.

But rural healthcare cannot survive indefinitely without alignment between hospital leadership and county government. This is not about politics. It is about stewardship of public funds and long-term sustainability. It is about whether we choose to invest in infrastructure that protects our citizens and strengthens our economic future, or whether we continue spending substantial public funds without building lasting assets for this community.

We remain ready to work toward a solution.

The question now is whether the county is willing to engage.

Financing a new $20 million hospital over 30 years would cost approximately $100,000-$110,000 per month. We believe a coordinated ambulance service — either hospital- operated or aligned through contractual partnership — could be secured so that the combined cost of both hospital financing and EMS operations would total approximately $200,000 per month.

For roughly $37,500 more per month than the current ambulance contract, Marshall County could have:

• a new hospital facility

• a coordinated EMS integration

• restored emergency services

• a permanent county healthcare asset

• long-term healthcare sustainability

The current structure spends nearly $2 million per year without creating a permanent infrastructure asset.

The proposed structure builds one.

This is not a personal issue. It is not political.

It is a structural governance question.

Should EMS and the hospital operate independently, without consultation, or should they operate in alignment for the benefit of patient care and fiscal stewardship?

Alliance Healthcare System remains ready to collaborate.

The question now is whether Marshall County leadership is willing to align its healthcare infrastructure strategically and sustainably.

Where is Marshall County’s healthcare investment going?

CURRENT COUNTY SPENDING

• six Ambulance Contract - $162,500 per month, or $1,950,000 per year

• no hospital ownership

• no facility asset created

• no emergency room restored

• hospital “Indigent Care” support - $8,300 per month, or $100,000 per year (after taxes withheld from original $200,000 allocation) What could be done instead?

• finance a new $20 million hospital (30 years at about 4.4%) - $100,000-$110,000 per month, $1.2 million to $1.32 million per year

The county gains permanent healthcare asset, a modern facility and economic development support

• New Hospital + Ambulance Service (Combined Projection)— about $200,000 per month (estimated) or about $2,400,000 per year (estimated)

• New hospital facility

• Emergency services restored

• Local ambulance partnership

Sustainable healthcare infrastructure

THE COMPARISON

Monthly Annual

• six current ambulances at $162,500 or $1,950,000 million a year

• new hospital financing — about $100,000 to $110,000 a month or about $1.2 million- $1.32 millon a year.

• Hospital + Ambulance (Combined) about $200,000 a month or about $2,400,000 a year.

THE QUESTION

Marshall County is currently spending nearly:

•$1.95 million per year on ambulance services alone

• for roughly $450,000 more per year, the County could potentially have BOTH: a new hospital, emergency services, Ambulance coverage and a permanent county asset.

The bottom line, for 25+ years, Alliance Healthcare System asked the county for nothing.

Now the question is, will Marshall County invest slightly more to build something permanent, or continue spending nearly $2 million per year without creating lasting infrastructure?