NHS Sequoyah working to restore positive reputation

Aside from its opening in 1949, one of the most prominent landmarks for Sallisaw Memorial Hospital occurred in 2017 with a name change to Northeastern Health System Sequoyah. The agreement with NHS infused new life into the hospital.

Despite an inventory of cutting-edge equipment and care as the hospital sought to maintain the small-town values and community model its patients had come to love and respect, NHS Sequoyah continued to experience financial strife. Massive layoffs in 2018 weren’t the solution, and it was revealed that the hospital had not been profitable for many years, losing more than $7 million during the previous five years. By June 2024, it was revealed that Sequoyah Hospital Authority owed NHS more than $8.1 million for contracted salary and benefits, management fees and other services.

Auditors even expressed “substantial doubt about the hospital’s ability to continue as a going concern.”

But Stephanie Six, CEO/administrator for the hospital since 2018, says the hospital has “been standing completely on our feet for over two years,” and has a viable plan for meeting its financial obligations and paying old debt, “but that’s a slow process.”

And reclaiming the positive reputation the hospital had for decades requires trying to change deep-seeded — and often undeserved — bias, along with the hospital, ambulance service and 911 working together “to make sure that we are all sending the same message,” Six says.

Accentuate the positive

“I think the perception is much more positive than it was six to eight years ago. I think we do have a positive perception in the community at this point,” Six says.

“Rarely, once we get someone in our facility, do you get a negative complaint. It’s something that happened 20 years ago that is still in their thoughts, probably there’s not even a soul here that was here at that time. But it’s still very real to them, and I understand that.

“But one at a time, people come in and it changes their whole mentality, because we are very local, we’re family friendly,” Six says. “Usually, if you’re here, someone knows you or there’s a connection that makes it more personalized. When you’re at the bigger facilities, you may not know a soul.”

Six is pragmatic about the hospital’s reputation, and has devoted much of her efforts to repairing the hospital’s image.

“When I came in 2018, the hospital had a bad reputation — a negative reputation. The ambulance service had kinda gotten out of the habit of bringing people here. We really went to work with them, and their reasoning was it was just easier to go to Fort Smith because we didn’t keep a lot of people here in the hospital. So if people needed to stay, the was an extra trip for the ambulance, they felt like, to bring them here and then come back, pick them up and take them someplace else. So they kinda got out of that habit of bringing people here,” Six explains.

“We worked really hard that first two to three years — and we still work really closely with the ambulance service, and if there’s any issues or complaints or concerns, then we can put those out really quick. I’m not saying we don’t have room for improvement, because I think we all do every single day.

“The community often thinks that 911, the ambulance service and the hospital are all one entity. They’re three different entities. So if one of those three makes a mishap in any way, the whole crew is condemned. All three do different pieces, different management — we work together, but we are not connected. So we have to work really hard with both of those entities to make sure that we are all sending the same message and we’re only as good as the weakest link,” Six says. “We do work together, we have meetings. All three of us work simultaneously together.

“At one time, the ambulance service only had three trucks trying to cover Sequoyah County. So when an ambulance took 45 minutes to get somewhere, we all got that bad name. I think that’s changed over the past eight years for sure. We’ve now got four trucks in the county, and they work diligently.

Eliminate the negative

“In 2018, we didn’t get but probably 25 ambulances a month through our doors. We get well over 100 now. That makes a huge, huge difference. It’s not those people that complain, it’s not the people that come in on ambulances or the families that come in the back of the trucks,” Six believes. “The people that complain are somebody who comes in with a sore throat and it takes them a while to get in. Those are the people that feel like they’re not getting the services they need. They don’t understand that, and I get it. You’re sick, you don’t feel good, you’re what’s important right that minute. That’s hard.

“If you think about what the hospital looks like to the public, you get someone who comes into the emergency room, they don’t get treated within 15 minutes, they feel like they have not gotten the care they deserve. So you have a lot of people, they’ll holler it’s a Band-Aid station. However, if you stop and think about it, we’re the place you wanna be when the police are hauling somebody in in the back of a truck doing CPR, they’re glad to get them here where people can go to work on them. We’ve seen that more times than one, and we’ve saved those lives. That’s big,” Six says.

While ambulances and emergency rooms and 911 and operating rooms and recovery and nurses and doctors are the way many view healthcare, Six notes that there are a lot of other, maybe not-so-prominent services that contribute to the hospital’s reputation in a very positive way.

“The physical therapy program, which is very much a part of our hospital, is spot-on,” Six points to with pride. “We get a lot of ortho patients back in after total hips and total knees that come out of our Fort Smith physicians. I think it’s rock solid.

“We have a hospice program that is flourishing, because we have a hospice room in the hospital that sets us apart. There are several hospice in our community, and they really do an amazing job. What sets us apart is we do have a room that end-of-life people can come into and spend those last three to four to five days with their loved ones without providing the care. Someone else does that. That’s huge, huge, huge.

“We also have a swing bed program. In 2018 when I came, that had been paused. We opened that back up at the end of 2018. The swing bed program is to bring people in that have had a hospital stay that they’re no longer acute, but they’re not ready to go back home. It could be that they need IV therapy or wound care or physical therapy to get strengthened up, many different reasons you could be in that program, but they’re just not quite ready to go home. I think that’s one thing that sets us apart as well, because you can do that in a nursing home, but a lot of people don’t wanna go to the nursing home. To them it’s just the perception, the mindset. So they come into the hospital, they like that better. I think that’s huge. We do an amazing job,” Six says.

Fighting to survive

In the 75 years the hospital has been in Sallisaw, the successes have been many, but often barely noticed, while the failures — in the front office moreso than clinically — have been unrelenting. That’s something few in the community consider when evaluating the hospital.

“We fight every day to survive, and I think that’s important for people to know that it’s not easy. Every person that comes through our door for whatever service it is is extremely important to the survival of this hospital,” Six says. “It’s easy to go to Fort Smith or Tulsa for your care when you’re feeling good, but when it’s truly an emergency … I’ve been thankful myself to come through those emergency room doors with a family member to get help, and I can only imagine trying to drive to Fort Smith in those circumstances. I’m very thankful myself many times. In order to keep those doors open, we have to have the support of the local community for every piece of it.”

NHS Sequoyah is like many other small, local hospitals. They all depend on support from the communities they serve to not only pay the bills, but to be there in time of need. In addition, there are limitations that impact the financial health of hospitals that are, in fact, rural, but that are not recognized as rural when it comes to critical reimbursements from federal health insurance.

“Hospitals have gone through a lot of financial issues,” Six acknowledges. “You go back and look at the news article that was released a couple of months ago saying that we owed the $8 million. That is true, that is from 2017 and ’18 that those dollars are out there, where when Tahlequah became a management system for us, that this hospital at that time was very far behind on accounts payable and literally could not make payroll. Northeastern Health System came in as a management company and took us on as employees where they could legally make our payroll.

“There was a good year there that it was rocky, rocky, rocky. But we’ve been standing completely on our feet for over two years. The hard part is trying to go back and pay the old debt, and we’re working on that, but that’s a slow process.

“Being a rural hospital — we are not considered rural, however, we know we are, but we’re not considered rural. Rural hospitals — if they’re classified as rural with Medicare, CMS (Centers for Medicare and Medicaid Services) — they get more reimbursement because they’re rural. Those hospitals flourish, because it’s cost reimbursement, so they do well. You’ve got to be more than 32 miles from your closest hospital to be considered rural. We’re not. We’re 25 miles from Baptist [Health in Fort Smith], and that hurts, that hurts a lot. We stumble with that every single day. It doesn’t matter that you have to go across state lines or that there’s railroad tracks blocking or …,” Six trails off, accepting that legislative changes are about all that can change the way reimbursements are doled out.

“There’s lots of things going on in legislation to try to get that changed. The big thing they’re looking at is state lines. So if that is ever changed it’ll back a big impact on us. You go right down the road and Poteau is considered rural, and they do financially some better than us because of just that. It’s not the [patient] volume that sets them apart or the management, it’s strictly because they’re considered rural and the reimbursement that they receive. It makes it a complete different ballgame when you’re looking at that.

“Right now we’re battling trying to go back and pay the old debt, and stay afloat with what we’re doing,” Six says.

Serving the community

NHS Sequoyah offers many of the services you’d find in a Fort Smith or Tulsa hospital, it’s just a lot closer.

The hospital has survived the loss of revered physicians, but has been able to recruit doctors that keep the local standard of care high.

“Dr. Robbins was here for over 40 years as a physician employee of the hospital, his clinic was part of the hospital, a pillar in the community. And when he left, that was a hard day. But we left the clinic open for about a year, and now we’ve got two mid-level practitioners in the clinic with Dr. Winn’s oversight. That clinic is doing really well for our community,” Six says.

NHS Sequoyah also offers:

• General surgery

• Nephrology

• Neurology

• Rehab therapy

• Home health

• Nursing

• Outpatient infusion

• Emergency services

• Laboratory

• Inpatient services

• Observation

• Respite care

• Skilled nursing

• Hospice

• Pulmonology

• Radiology — computed tomography (CT), radiography, ultrasonography, mammography, bone density deja scan, magnetic resonance imaging (MRI)

• Cardiopulmonary — Sleep studies, pulmonary function test, EKG, echocardiography, heart monitoring

NHS Sequoyah is licensed for 41 beds, which Six says was particularly important during the pandemic, so that health agencies knew how many beds were available “that you had oxygen for, that you had the electrical hookups for, you actually had the beds for and could staff if it came down to it.”

Six admits “there’s a lot of Covid going on, but it’s not the same world we lived in three years ago. Covid today is more like the common cold, with cold-like symptoms. There’s an occasional person that gets it that becomes more aggressive, but there are a lot of people coming through the emergency room currently with Covid.”

That’s why vaccines are available, but Six observes that not everyone wants to receive the vaccine.

“I think that is a personal opinion. So many people have different opinions and views on that. We definitely have the vaccines, and are more than happy to administer those. That can get into political things when you start talking about that. But it’s definitely here, and a lot of people definitely want the vaccines and feel like that has made a huge difference,” she says. “I will say that during the heat of Covid when the vaccines first came out, we had lines of people lined up to receive those vaccines, and we had the staff here to administer those.”

It’s during crises that the community hospital is important. “It just depends on the need whether it’s important or not,” Six says.

“We’re very proud of our hospital. I would love people to come in, and I invite the public in and let us show you what we have, because I don’t think people truly know,” Six says.

Next week

Let NHS Sequoyah CEO/administrator Stephanie Six peer into a crystal ball, and there’s no telling what she might see for the hospital’s future.

“I do feel like, if I had a crystal ball and I’m dreaming, I think in the next eight to 10 years, if not sooner, we’ll have a new hospital. That’s definitely our goal. I think that at some point that will come to fruition.

“I do believe at some point, with the state legislation, that we will be able to be deemed rural, which will change our reimbursement. That may be five, six years down the road, but it’s something we’re not going to give up on, because it would change the working environment for everything we have, our finances would be in a much better place.”

Speaking of finances, the hospital is facing an $8.1 million shortfall. The hospital has a promissory note to payoff long-term debt within 12 years.

But with auditors expressing “substantial doubt about the hospital’s ability to continue as a going concern,” will the hospital be around a dozen years from now.

“We’re actively paying on that,” Six says. “Currently, if we continue to pay the way we’re paying, it would be paid off in about 12 years. We see light at the end of the tunnel. It’s way out there, but we do have a plan, and we’re working diligently toward that.”