Doctors Hospital continues growth

“I’d say at times we felt like we were out on a limb that had been sawed off and why weren’t we falling to the ground?” said Paul Taylor, the hospital’s administrator and one of the 23 original investors in the venture.

Doctors Hospital hasn’t fallen despite being a small, for-profit hospital in a health-care environment skewed toward not-for-profit behemoths.

Instead, the hospital weathered early bankruptcy and changes in government medical reimbursements to emerge as a scrappy – and growing – alternative to CoxHealth and St. John’s.

Since 2000, the hospital has expanded from a staff of about 150 to its current staff of 650. It has opened three clinics, in Nixa, Webb City and Mount Vernon. And in October, Doctors Hospital will open its fourth satellite campus in Rogersville, with hopes of opening three or four more in the future.

Despite this, the hospital remains a small operation, and that fact, among others, appeals to Noland Durnell, a Doctors Hospital patient since 2004.

“You don’t have the turnover of personnel,” Durnell said. “You can get to know your nurses, and they can get to know you.”

That size also appeals to the health care providers.

“We are still basically a physician-patient-centered organization rather than a system-patient-centered organization,” said Dr. William Campbell, a family practice physician at Doctors Hospital South in Nixa and one of the original investors.

“… I’m thrilled to be a part of it, and I sense a time when there will be a more level playing field (in health care). I see our potential growth as explosive,” Campbell said.

The past

Looking back to 2000, explosive growth was not on the Doctors Hospital agenda. Survival was its focus.

The hospital opened as a primary care facility with 33 physicians and 45 beds, by far the smallest hospital in Springfield. In health care, size can be a challenge, since insurance companies typically negotiate plans with the biggest hospitals in a market.

“Cox and St. John’s have spent more on their parking garages than we have on our entire hospital,” Taylor said.

Though Doctors Hospital is included in Cox’s managed health care plan, Medicare, Medicaid and Tricare – the military’s health care system – cover 80 percent of the hospital’s patients. Unlike patients covered by private health insurance plans, those covered by government plans face no restrictions in choosing their doctors.

Being dependent on government reimbursements, however, also means being vulnerable to changes in the system.

When Doctors Hospital filed for Chapter 11 bankruptcy reorganization in 2002, the hospital cited Missouri’s cutback in Medicaid reimbursements as a key catalyst.

The bankruptcy filing also highlighted another fact: Doctors Hospital owed real estate taxes, something Cox and St. John’s avoid as not-for-profit operations.

“What’s really interesting is that we’re for-profit, but we’re mainly serving the underserved,” Campbell said.

The future

Increasingly, Doctors Hospital also is serving the uninsured.

Before CoxHealth announced that it would convert its north-side emergency room to an urgent care center, only 10 percent of Doctors Hospital’s emergency room patients fell into the so-called self-pay category.

Since the announcement, about half of them have.

That has forced the hospital to make an important change.

Before, the emergency room treated all patients regardless of ability to pay. Now, Doctors Hospital, like CoxHealth and St. John’s, will screen self-pay patients according to federal guidelines.

“It’s unfortunate, but I can’t handle 50 percent self-pay patients in my emergency room without getting paid for it,” Taylor said.

This shift in Doctors Hospital’s client base points to a challenge – and potentially an opportunity – on the horizon.

The hospital expects the government-health plan demographic to remain a central part of its customer base, but as the nation’s health care crisis deepens, that demographic could change substantially.

“I do believe the country is going to have to do something that will change the scenario not only for the uninsured but will also have a dramatic impact on health care providers,” Taylor said.

In the meantime, however, Doctors Hospital is focusing on current growth.

The hospital plans to add a sleep lab by the end of this year, after it recently added a neurologist and a pulmonologist to its staff.

Taylor also would like to add three or four locations. But, Taylor insists, the plan is not to eventually grow as big as a Cox or a St. John’s.

“Our focus is primary care. We’ve gotten bigger, but we have not changed our core mission,” he said.

Doctors Hospital: Then and Now

2000

Full- and part-time staff (not including physicians): 125

Physicians: 33

Licensed beds: 45

Location: Springfield

Operating loss: $3.5 million

Gross patient charges: $8 million

2006

Full- and part-time staff (not including physicians): 600

Physicians: 50

Licensed beds: 45

Locations: Springfield, Nixa, Webb City, Mount Vernon and Rogersville

Operating revenue: Breaking even (officials declined to disclose the amount)

Gross patient charges: $90 million