Hospital leaders describe rural care pressures: payer mix, recruitment and local volumes

Jerry Heisman, chief financial officer of Ascension Regional Medical Center, and Sean Howard, chief medical officer and CEO, briefed the Sampson County Board of Commissioners on the hospital’s finances, staffing and clinical capacity.

Heisman described the hospital as a largely government-payer institution, saying Medicare accounted for about 47% of patient volume on the hospital’s financial statements, Medicaid about 20%, commercial insurance about 24% and self-pay about 7%. He said the county’s rural Medicare wage index reduces federal reimbursement compared with some neighboring hospitals that have reclassified into higher wage-index areas. “Our starting salary at Sampson Regional Medical Center is as high as or higher than many at the Raleigh hospitals,” Heisman said, explaining the local cost pressures of competing for clinicians.

Howard described clinical demand and staffing. He said the hospital treats many patients who are sicker on presentation because of lack of timely access to primary or specialty care. He outlined recruitment outcomes from the last two years: the hospital credentialed 30–50 physicians a year and recruited 43 providers in the last two years, of whom 13 are full time and 30 are part time or PRN. He said retention across the recruited cohort has been about 74%.

Howard highlighted the hospital’s physician-residency program with Campbell University. He said there are 22 resident physicians affiliated with the hospital; the program has supplied several local hires, including primary-care physicians. “Statistically, most physicians practice within about 50 miles of where they finish their training,” Howard said, arguing that local residency training helps recruitment.

Heisman gave operational figures: the hospital has about a 46‑bed acute facility, roughly 2,500 inpatient admissions per year with an average length of stay near four days, and emergency department visits of roughly 30,000 annually. He reported about 4,000 surgeries, 8,800 CT scans and 2,200 MRIs last year across hospital and outpatient diagnostic centers. He described outpatient growth in primary care and recent additions such as nephrology/dialysis services that previously required travel out of county.

Hospital leaders described efforts to control costs through direct contracting for physician services (rather than third‑party staffing firms), group purchasing arrangements to lower supply costs, active staff-to-volume management and targeted service additions to retain care locally. Heisman said Medicare Advantage and other commercial contract negotiations affect payment levels and that observation-versus-admission designations continue to influence reimbursement for inpatient episodes.

Howard and Heisman invited county officials to consider partnerships on workforce development and community health planning; they said the hospital currently supports nursing and allied-health training with the community college and participates in local emergency-preparedness and child-advocacy committees.

Ending: Hospital leaders requested continued collaboration with the county on workforce and community-health efforts and offered to provide additional data to commissioners on volumes and service lines upon request.