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New PA Gets Exactly What She Wanted at Licking Clinic

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Whitney Young, PA

Whitney Young, PA

For Whitney Young, the perfect ending comes with a new beginning.

As the latest addition to the TCMH Family Clinic in Licking, Young can tick off all plusses to her new position—in the area, close to home, smaller town, rural health clinic, tied to a larger healthcare facility. Check, check and check!

“This is exactly what I was looking for,” Young said with an enthusiastic smile.

Young attended college and graduate school to become a physician assistant, a task that took seven years. She is pleased to have found a job that met all of her criteria, which included a requirement to practice for the first two years in an underserved area.

“I am a National Health Service Corps scholar,” Young said, explaining that the National Health Service Corps (NHSC) requires its scholars to practice in an underserved in exchange for covering loans associated with medical training programs.

Young knew that she wanted to work in a rural setting, preferably close to her hometown of Rolla. When she began looking for a position that met the NHSC requirements in the South Central Ozarks, there were none to be had.

Young contacted TCMH in early 2014, and at the time there were no positions available.

“I decided I would just find a position in the Midwest that met the NHSC requirements, and after I did my required amount of time, I would leave and return home,” Young explained.

As Young began looking outside of the South Central Missouri area, Kimberly Olving, the first physician assistant to work at the TCMH Family Clinic in Licking gave notice that she would be leaving in late July to follow her husband to a new job.

“I knew this was the position I wanted,” Young said about her interview.

Not only did the TCMH Family Clinic position fulfill Young’s NHSC requirements, it was connected to a hospital, too.

“I wanted to work for an organization that had additional resources available for me to use,” Young explained.

To top off the perfect ending to her job search, Young was able to spend her final weeks of physician assistant training working in the TCMH Family Clinic with Olving and Joshua Wolfe, MD.

Olving departed in late July, and Young took and passed her board examination in August and began immediately seeing patients at the clinic.

Patients at the clinic might not guess that Young is a new graduate of physician assistant school. She projects an ease with her patients and their medical conditions. It’s easy for Young to find common ground since she also enjoys hunting, fishing, camping and four-wheeler riding, just like many of her patients.

Young didn’t “grow up” planning to go into healthcare, but she was familiar with the field because she had family members with jobs in healthcare.

Young spent some time shadowing family medicine physicians, a surgeon and a physician assistant, and she knew that she wanted to do something in healthcare other than nursing.

“It was in college that I decided I wanted to pursue the physician assistant career path,” Young said. She attended Westminster College in Fulton where she majored in biology.

Young was able to participate in the cadaver program at Westminster, and she believed that a career as a physician assistant would give her the opportunity to do “hands on” patient care using a “team approach”.

“I liked the way that physician assistants’ worked with a collaborating physician for patient care,” Young said. She also thought that the career path would give her some flexibility in finding a job with hands-on patient care but without hospital inpatients and hospital call requirements.

After graduating from college Young worked as a patient care assistant in the psychiatric unit at Phelps County Regional Medical Center in Rolla. While there, she gained additional experience in healthcare.

Young chose to attend Wichita State University in Wichita, KS for physician assistant training. While in school, she did clinical rotations at rural clinics and hospitals in Kansas, at an Indian Health Service hospital, and internationally in the country of Bolivia.

Because Young planned to return to rural Missouri, she followed a “family medicine” track, training to provide care for patients from birth to end of life.

As a mid-level provider, Young hopes to be able to provide education to her patients when they come to see her.

“I want to have a personal relationship with my patients,” Young said, explaining that she wants to see patients when they are sick, but she also wants to help her patients through preventative medicine and catching healthcare issues early.

“I want to keep my patients healthy, if possible,” Young said.

Young believed that a rural health clinic like the TCMH Family Clinic would provide her with a diverse patient population, and in her first week she saw patients ranging from a two-week old infant to a 91-year old patient.

In addition to preventative medicine, Young has special interest in women’s healthcare and pediatrics. She is also able to provide care for some patients with chronic conditions, too. Young sees patients of all ages—from birth to end of life.

During her eight-week preceptorship at the TCMH Family Clinic, Young was able to meet many of the established patients at the clinic as well as learning the electronic medical records system and other operations of the clinic.

“Kim and Dr. Wolfe were great teachers,” Young said. With a well-established patient base at the Licking clinic, Young was able to “hit the ground running” seeing a diverse group of patients from her first day of work.

“It’s a perfect practice for me,” Young said.

Young is currently commuting daily from her parent’s home in Rolla to Licking, but she hopes to find something closer to Licking in the future.

When she’s not working, Young has plenty of cousins that are close in age and other family members in the area that she spends time with. She enjoys the usual Ozark outdoor activities as well as following college sports and St. Louis Cardinals baseball. She also plays golf and on a church softball league.

Young is accepting new patients at the TCMH Family Clinic in Licking. She sees patients Monday through Friday, and the clinic accepts most forms of private insurance including Medicare and Medicaid. For additional information or to make an appointment, contact the clinic at (573) 673-3011.


King Named Employee of the Month

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Texas County Memorial Hospital has named Lance King of Houston the August employee of the month.

King is a physical therapy assistant in the TCMH physical therapy department. He has worked at TCMH since May 2011. King was nominated for the award by Ellen Willis, physical therapy department director.

“Lance is a great asset to the PT department,” Willis said. “He approaches all of his work with a positive attitude.”

King is known for willingness to help out in the physical therapy department and in other hospital departments when extra assistance is needed.

“Lance always helps out without any expectation of reward or recognition,” Willis said, calling him an “ideal employee”.

As employee of the month, King received a certificate honoring his achievement; a pin; $100 cash; a special parking place in the TCMH lot; one day of paid vacation; a membership in the TCMH Fitness Center; a $50 gift card, and gift certificates to Paws N Claws, D&L Florist, Janstiques and Blissful Nirvana Massage. A reception will be held at the hospital in honor of King.

King is eligible for the 2014 TCMH employee of the year award.

Lance King (right), Texas County Memorial Hospital August employee of the month, with his supervisor, Ellen Willis.

Lance King (right), Texas County Memorial Hospital August employee of the month, with his supervisor, Ellen Willis.


Licking Clinic Approved Site for Vaccines for Children

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The Texas County Memorial Hospital Family Clinic in Licking has been approved as a “Vaccines for Children” site by the Missouri Department of Health and Senior Services.

The Vaccines for Children program is funded by the Centers for Disease Control and Prevention and provides free vaccines to children who qualify.

The Vaccines for Children program is designed to help protect all children against vaccine-preventable diseases. Unfortunately, many children are not vaccinated because their parents either do not have health insurance or their health insurance does not cover vaccines.

Children are eligible to receive free vaccines before their 19th birthday who meet one of the following criteria:
• are Medicaid-eligible;
• do not have health insurance;
• are an American Indian or Native Alaskan; or
• are underinsured.

Underinsured children must receive their vaccine at a Rural Health Clinic like the TCMH Family Clinic or at a Federally Qualified Health Center. Underinsured is when a child has health insurance but the plan doesn’t provide vaccine coverage; doesn’t cover certain vaccines or covers vaccines but with a fixed dollar limit. Underinsured does not include those with unmet deductible or who are unable to pay the deductible.

The TCMH Family Clinic in Licking joins the TCMH Medical Complex in Houston, Cabool Medical Clinic and TCMH Mountain Grove Medical Complex in participating in the Vaccines for Children program.

All vaccines are free through the Vaccines for Children program, but parents may be charged a small fee from the clinic to cover the office visit and cost of administering the vaccine.

Dr. Joshua Wolfe, a board certified family medicine physician, and Whitney Young, physician assistant, see patients at the TCMH Family Clinic Monday through Friday. For additional information or to make an appointment for a vaccination, contact the clinic at (573) 674-3011.


TCMH Tops in Nation for Efficiency of Patient Care

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Texas County Memorial Hospital is in the top five percent of hospitals in the nation for providing efficient care for Medicare patients, hospital board members heard at their monthly meeting on Tuesday.

Amanda Turpin, quality management director at TCMH, presented new data to hospital board members regarding a “value-based purchasing score” from the Center for Medicare Services (CMS) that means TCMH will collect an additional 1.16 percent of payment for Medicare patients in fiscal year 2015.

“We have not received a value-based purchasing score until this year,” Turpin said, explaining that TCMH has not had enough surgical patients since value-based purchasing went into place for the hospital to receive a score.

Since 2012 CMS has looked at hospital data related to patient experience, patient outcomes and clinical process of care, but TCMH has not had enough patients in the various areas for the hospital to be given a value-based purchasing score.

In 2013 CMS began looking at “efficiency”, or the cost of care associated to Medicare inpatients at TCMH. The score TCMH received for efficiency was enough to qualify the hospital for a value-based purchasing score.

“Our average spending per Medicare patient at TCMH was $16,227. The state average was $18,783, and the national average was $19,253,” Turpin said.

Turpin explained that CMS awarded points for either improvement over past scores, or achievement compared to other hospitals. CMS awarded to TCMH 9 out of a possible 10 achievement points available for efficiency. CMS also awarded achievement points to TCMH in 7 out of 8 areas for patient experience. CMS awarded to TCMH 8 and 5 points out of a possible 10 points for mortality and safety of patients.

“All of these numbers were combined to give us a value-based purchasing score of 69, which is well above the state and national average,” Turpin said.

For fiscal year 2015, the average value based purchasing score for the state of Missouri is 44 and the average value based purchasing score across the nation is 41.

“In a time when healthcare dollars are so important, our patients can know that they are getting the most care for the dollars they spend,” Turpin said.

With the value-based purchasing program, Medicare has taken 1.5 percent of reimbursement from hospitals across the nation. The 1.5 percent cut to all hospitals is then redistributed to hospitals based on their value-based purchasing score.

Some hospitals lose the 1.5 percent in reimbursement for the year. Some hospitals get a portion of the funds back. TCMH will receive the 1.5 percent and an additional 1.16 percent for fiscal year 2015 for all Medicare patients.

“Every hospital has a goal of breaking even, but this value based purchasing score will actually reward us for the care that we have provided our patients,” Turpin said.

The actual dollar amount the additional 1.16 percent in reimbursement will likely equal approximately $60,000 in the upcoming year depending upon the number and acuity of Medicare inpatients at TCMH.

“This is great news,” Wes Murray, chief executive officer at TCMH, said.

Dr. John Duff, senior vice president at CoxHealth in Springfield called the scored “tremendous”, explaining that CoxHealth works diligently on their own value-based purchasing score.

“Achieving that score is not easy to do,” Duff said. “You are gaining back dollars from other hospitals.”

Murray noted that the hospitals that are losing Medicare funds in the next year will “want it back”, creating additional work for TCMH in the upcoming year.

“In the past we have not been rewarded for managing our patients and expenses well,” Murray said, “So this score is a great reward for the things that we have done well for many years.”

Turpin noted that the Customer Quality Team at TCMH continues to work on ways to improve patient experience within all areas of the hospital from medical staff interactions with patients to overall inpatient stays to ancillary services provided to patients.

“Most of our hospital inpatients receive a survey after their stay, and we need patients to complete those surveys and return them,” Turpin said.

About 30 percent of patients at TCMH return their inpatient stay survey, which is on par with the national average for inpatient surveys returned to hospitals.

In other news, the hospital board unanimously passed a resolution to put a compliance policy in place to meet United States Department of Agriculture and Rural Development loan guidelines. The resolution is the final piece that TCMH board members and the Texas County Commissioners must approve to close the $19.1 million low-interest loan TCMH received from USDA and Rural Development to expand the hospital in 2013.

The compliance policy allows TCMH to be audited annually to ensure that the hospital is using the federal funds for tax exempt purposes only.

“This resolution is simply putting a policy in place to do what we said we would do when we took out the loan in the first place,” Murray said.

In the July financial report, Linda Pamperien, chief financial officer at TCMH, reported that TCMH received $516,585 in Medicaid cost report settlement for 2006 through 2009. Although the funds do not get added to the current fiscal year’s bottom line, the funds can go into the hospital’s funded depreciation account.

“We are still owed over $1.2 million for Medicaid cost reports from 2010 through 2013,” Pamperien noted.

Pamperien reported that new physicians providing surgical care at the hospital—Dr. Christopher Baldwin, Dr. Linda Milholen and Dr. Leroy Wombold—sent outpatient volumes up at the hospital for the month of July.

Inpatient volumes were low at the hospital during July. TCMH ended the month with a loss of $134,840.36 and a year to date loss of $875,651.36.

Pamperien explained that the monthly losses were partially due to increased depreciation expense related to the construction completed in 2013 and the new equipment and fixtures purchased for the new construction..

“We have incurred $1.1 million in depreciation expense in the first seven months of the year,” Pamperien told board members.

Murray explained to board members that TCMH could not “go down this road forever”.

“It’s a big number, and we do need to make that number back so we can reinvest in our facility and in healthcare in our county,” Murray said, describing the losses as “unsustainable over several years”.

Pamperien reported that cash flow is still positive and hospital reserves are strong.

Pamperien also explained that bad debt or uncompensated care at the hospital continues to rise. In July, $566,269.80 was written off as bad debt. Some of those funds will be collected down the road through a collection agency, but the majority is “lost”.

“In July 59 percent of our bad debt came from patients that came in through the emergency department,” Pamperien said, equating that percentage to $332,000 of care given to uninsured patients.
Pamperien reminded board members that TCMH cannot turn away anyone regardless of his or her ability to pay for care.

“This is where expansion of the Medicaid program in the state of Missouri would greatly benefit TCMH,” Murray said.

Murray explained that 82 percent of people that would qualify for expanded Medicaid coverage in the state are employed, working full-time or part-time jobs.

“Many of those people that come to the ER to seek care cannot afford to pay for their care and wait until they have acute healthcare issues before they seek treatment,” Murray said. “There are a percentage of patients that came through the ER in July and that we will continue to see that would receive healthcare coverage through Medicaid if the program were expanded.”

Omanez Fockler, chairperson of the TCMH board of trustees, commended TCMH for educating staff and members of the public regarding Medicaid expansion needs in the state.

“These are the nuts and bolts of the issue that the community wants to know,” Fockler said.

Present at the meeting were Murray; Pamperien; Duff; Fockler; Dr. Schaun Flaim, chief of staff; Doretta Todd-Willis, chief nursing officer, Joleen Senter Durham, public relations director; and board members Janet
Wiseman, Dr. Jim Perry,OD and Mark Hampton.

Board member, Russell Gaither, was not present at the meeting.

The next meeting of TCMH board of trustees is Tue., Sept. 28 at 12 p.m. in the hospital board room.


First Certified Nurse Midwife Joins Staff at TCMH

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Tracey Arwood is first certified nurse midwife ever employed by Texas County Memorial Hospital.

Tracey Arwood, CNM

Tracey Arwood, CNM

At TCMH Arwood has found what she calls “the perfect relationship”—the opportunity for women to receive their healthcare from a certified nurse midwife, an obstetrician/gynecologist or a family medicine physician.

“There are three different options for women’s health and obstetrical care,” Arwood said. “That’s very uncommon for a rural area, and I’m happy to be a part of it.”

Arwood is familiar with rural America. She grew up in Wichita, KS, and after graduating high school, she moved with her family to Missouri.

Arwood has always leaned toward healthcare and providing education to the patients she served. She pursued a bachelor’s degree in health science at Truman State University in Kirksville, MO. Her degree had a community health concentration, and she also minored in psychology and women and gender studies.

While in Kirksville, Arwood found two things that would become a key part of her future. She met Chris—who would later become her husband, and she took a test at the university career center that pointed her toward the field of midwifery.

“I wanted to do something that was more individualized and personal than the traditional community health worker role,” Arwood said, adding that in her time in community health in Kirksville, she came into contact with midwives that worked in the area.

“It’s a special opportunity to be present with a patient and their family at the beginning of life,” Arwood said, explaining that she felt a calling to be the healthcare provider present when new lives entered the world.

The Arwood’s moved to St. Louis where Tracey completed a fast-track nursing program through Barnes-Jewish College of Nursing. After getting her bachelor’s degree in nursing, Arwood began pursuing a master’s degree in nursing through Frontier Nursing University in Hyden, KY. Arwood trained in the Community Nurse-Midwifery Education Program at Frontier.

“I was always interested in the field of women’s health,” Arwood said, adding, “Women’s health is an area of need because many healthcare providers do not choose to specialize in women’s health.”

Arwood believes that when women’s reproductive health is overlooked in the healthcare field, it becomes hard for women to access quality reproductive healthcare and information.

Frontier Nursing University, a school located in rural Kentucky, was founded in 1939 by Mary Breckenridge. Breckenridge was concerned with improving the health of children in rural Kentucky, but she quickly realized that improving a child’s health actually began with the mother of the child, before the birth of the child.

While completing her education, Arwood grew her women’s health and obstetrics experience through positions she held in various hospitals in St. Louis and Kansas City. Arwood worked in the mother-baby, behavioral health and women’s care units. She also worked independently as a doula, helping women prepare for and carry out plans for birth as well as providing postpartum and breastfeeding support.

Arwood was a National Health Service Scholar while in school, so after completing her midwifery training, she had to find an underserved area that met certain criteria for her employment. She and her family moved to Garden City, KS where Arwood went to work as a certified nurse midwife for the United Methodist Mexican American Ministries, a healthcare outreach program to the residents of Southwest Kansas.

Arwood collaborated with a family medicine and obstetrics trained physician, and she cared for patients in four clinics in four different rural communities.

“I very quickly began to do deliveries,” Arwood said, explaining that she delivered her patients at three hospitals in Southwest Kansas–Garden City, Dodge and Liberal.

Arwood cared for a lot of immigrant patients and had a very busy practice.

“I saw everyone,” Arwood said. “Many of my patients were uninsured, and I was the only healthcare provider that would see them.”

A combination of administrative issues at the clinic where she worked and the failing health of a parent caused the Arwoods to begin look back toward Missouri for a new home and a place for Tracey to practice.

Arwood also describes her new position at TCMH as “perfect”. They are close to her parents in Marshfield and Chris Arwood’s family in Clinton, MO.

“There was definitely a need for an additional obstetrical provider, and everyone at TCMH was very nice and excited to have me,” Arwood said about her interview at TCMH.

The Arwood’s liked the “small town feel” of Houston and Mountain Grove. Tracey was also not intimidated about providing obstetrical care to patients through the two clinics–Houston and Mountain Grove—25 miles apart.

“Everything about this position is an improvement over my previous job,” Arwood said. “At TCMH there seems to be good communication between everyone, and there’s a positive feeling of collaboration in providing care for the patients.”

In order to bring Arwood to TCMH the hospital medical staff had to amend their by-laws to allow a mid-level provider to practice in the obstetrics department. TCMH also recruited Dr. Christopher Baldwin, a board certified obstetrician and gynecologist, to collaborate with Arwood.

“It was an easy process coming here,” Arwood said, adding that she “likes the vision” of TCMH chief executive officer, Wes Murray. “He believes in promoting the hospital and its services and understands how important healthcare services are in rural America.”

Arwood is also pleased with the opportunity to collaborate with Baldwin.

“Dr. Baldwin has a great deal of experience,” Arwood said, adding, “He’s friendly, and he stays very calm about patient care.”

Arwood is passionate about women’s healthcare, and she relishes her role as mid-level provider that allows her to spend more time with her patients. She believes that the field of midwifery is growing as more women seek a midwife to oversee the birth of their child.

“Midwives are key globally in saving the lives of moms and babies,” Arwood explained. “In the US certified nurse midwives have low Cesarean section rates and better breast feeding rates.”

Arwood noted that in her practice she likes to spend time with her patients explaining healthcare choices and discussing the risks and benefits with those patients.

“My approach to care is to collaborate with patients and their family members,” Arwood said. “Each woman receives individualized care.”

Arwood believes that focusing on the woman and her pregnancy experience creates a better experience overall.

“I consider the woman’s overall health, how she’s taking care of herself and any social issues,” Arwood explained, adding, “The better the pregnancy experience, the better the bond between the mother and the baby.”

Arwood noted that many studies are finding links between chronic issues in children and the lifestyle habits of the mother when she was pregnant with the child.

“Women are more likely to make positive changes to their lifestyle and health habits during pregnancy than at any other time in their lives,” Arwood said. “I want to be the healthcare advocate and educator that my patients can connect with and trust to help influence those positive changes during pregnancy.”

Arwood will provide care for low-risk obstetrics patients, and she plans to take call and provide one-on-one support during labor for her patients whenever possible. Arwood is trained and experienced in assisting with breastfeeding initiation, newborn care and any complications that may arise postpartum.

Arwood can provide care for infants in the hospital, and after birth, babies will be referred to Dr. William Wright, a family medicine physician in the TCMH Medical Complex in Houston.

Arwood also provides complete women’s healthcare from 13 years of age through menopause. She provides birth control counseling and care, infertility treatment and low-risk obstetrics care. She will see her patients in Houston at the TCMH Medical Complex on Monday and Wednesday and patients at the TCMH Mountain Grove Clinic on Tuesday and Thursday. She plans to attend to her own patient deliveries as much as possible.

The Arwood’s have two children—Jaeda, age 3, and Corbin, age 5. They enjoy spending time in the outdoors together.

“I grew up doing outdoor stuff, and we enjoy camping, hiking and biking as a family,” Arwood said, explaining that they spent a lot of time with extended family, too.

Arwood also enjoys reading and watching movies.

“We are really excited there’s a drive-in here,” Arwood said. “And we’ll spend a lot of time at the library, too.”

Arwood is accepting new patients in Houston at (417) 967-5639 and in Mountain Grove at (417) 926-1770.


Dr. Linda Milholen Takes the Helm at TCMH Surgery Department

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Linda Milholen, MD grew up in rural America—35 miles west of Hot Springs, AR, to be precise.

Milholen knows what it’s like when there is only one doctor in town. As a teenager, Milholen babysat for the county doctor when he and wife went out for their weekly bowling outing.

“It was not uncommon for the doctor to come home to five or six people waiting to be seen in cars in the driveway,” Milholen explained. “I would triage the patients in advance before the doctor got home.”

Although Milholen didn’t set out from high school to become a doctor, those teenage years spent working for the county doctor and a post-high school job spent working with oral surgeons prepared her for a future that would take her down the path of hospitals, operating rooms and anesthesia.

Linda G. Milholen, MD

Linda G. Milholen, MD

Milholen’s husband, Bruce, has been a key figure in her life. They met when she was 3 and he 6. They married three weeks after Linda Milholen graduated from high school.

Both Milholens attended Georgia Institute of Technolgy in Atlanta. Bruce Milholen pursued a degree in engineering, and Linda Milholen studied applied mathematics.

“I wasn’t really sure what I wanted to do when I started college,” Milholen said, explaining that applied mathematics was the ‘general degree’ for undeclared students at Georgia Tech.

The Milholens both held full-time jobs while attending college, and due to her previous healthcare experience, Linda Milholen got a job as a tech in a local operating room.

“Within nine months I was scrubbing in on open heart surgeries,” Milholen said. She continued her studies in math at Georgia Tech, taking as many science electives as possible with plans of attending medical school after graduation.

Milholen continued to work in the OR through four years of medical school at Emory University in Atlanta. While in medical school she knew she wanted to practice medicine as a surgeon.

After medical school Milholen’s internship year was spent at Charity Hospital in New Orleans, LA, and she completed her general surgery residency at the University of Louisville in Kentucky.

While doing an endoscopy residency rotation at a small hospital outside of Louisville, Milholen learned that the hospital—Fort Logan Hospital in Stanford, KY—was seeking a full-time general surgeon. Milholen took the position. During that time, she also worked on active staff at Garrard County Memorial Hospital in Lancaster, KY and Casey County Hospital in Liberty, KY.

Milholen recalled a time that one hospital had a patient that had been trampled by a horse and another hospital several miles away needed her assistance with a patient requiring a Caesarean section.

“I saw the patient that had been trampled and ordered tests; while waiting for the tests to come back, I traveled to the other hospital to do the C-section,” Milholen said, adding “Everyone had a great outcome.”

Milholen didn’t mind splitting her time between communities.

“It wasn’t difficult to drive from one to the other to take care of patients,” Milholen said.

Milholen cared for patients in multiple hospitals for 22 years until financial pressures forced one hospital to close. Milholen learned of a job opening at Citizen’s Memorial Hospital in Bolivar, and she and Bruce relocated to Southern Missouri.

Milholen practiced in Bolivar for several years until her partner retired. Not wanting to practice on her own in Bolivar, Milholen took a position with St. Francis Hospital in Mountain View in 2009, where she worked until July of this year.

Milholen learned that Texas County Memorial Hospital was looking for a general surgeon in the spring of this year, and she inquired about the position.

“This is a good, solid community hospital,” Milholen said about TCMH.

TCMH extended a contract to Milholen, and she began full-time employment at the hospital on July 28.

“Wes shares my vision for providing healthcare services in rural America,” Milholen said about TCMH chief executive officer, Wes Murray. “We are here to provide a service that people need.”

Milholen explained that many patients cannot afford to or may not have a way to travel to Springfield or Rolla for surgical services.

“Even people that can travel to larger hospitals for surgery are better served by having their surgery locally,” Milholen said. “They can be taken care of by people that know them, and they are close to home.”

Milholen noted that in her years in healthcare, the hospital is “a vital part of the community”, especially in small communities.

“A hospital is a good employer in a community, and it’s a vital component to attract industry to a community,” Milholen said, describing TCMH as “a fine little hospital”.

As a general surgeon at TCMH, Milholen will do laparoscopic and open surgery and upper and lower endoscopy. Milholen has special interest in breast surgery, and she does ultrasound guided breast biopsy and breast conserving surgery. She removes skin lesions and does skin grafts.

Milholen’s clinic office is located inside TCMH in a newly remodeled area, the Outpatient Surgery Clinic. The outpatient clinic is outfitted with a procedure room for small surgical procedures, and the new clinic location gives Milholen easy access to the hospital’s surgery department and hospital inpatients.

The Milholens are relocating to Houston with their two cats, Gabby and Sprinkles.

Bruce Milholen is a self-employed electrical engineer, and he works regularly at Truman Medical Center, too.

When Linda Milholen isn’t working, she enjoys reading and needlework. She practices tai chi and is interested in finding a local tai chi group.

Milholen recently began serving as the priest at Church of the Transfiguration in Mountain Grove, her home parish since moving to the area in 2009.

Milholen grew up as Methodist, but as a teenager, she had a very positive experience at an Episcopal funeral service. Milholen joined an Episcopal church after completing her residency. She was ordained as a deacon in the Episcopal Church in 1996.

“I had no intention of becoming a priest,” Milholen said, but when retiring Father Brad Ellsworth, the priest at Church of the Transfiguration, approached her about the position, Milholen thought carefully about it, and ultimately went to a school for ministry in Topeka, KS.

Milholen was ordained as a priest in the Episcopal Church in April, and she has taken the unpaid position at the parish in Mountain Grove.

“I have strong lay leadership to help me; they know that I cannot always be available because I also need to work at the hospital,” Milholen said, explaining that the lay leaders can lead sermons and visit the sick in her absence.

Milholen describes her role and the role of others in the church as “very much the model of the early church”.

“I love these people,” Milholen said of the congregation, which “felt like home” from the first time she stepped through the church door.

Much like the congregation that she is committed to, Milholen feels a strong connection to the patients in rural Missouri.

“I grew up in a farming community,” Milholen said. “These are people I understand.”

Milholen is accepting new patients at the TCMH Outpatient Surgery Clinic at (417) 967-1252.


Healthcare Foundation Awards Fall Scholarships

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The Texas County Memorial Hospital Healthcare Foundation has awarded $8,000 in scholarships to area students to assist with their educational costs for the 2013 fall school semester.

Receiving $1,000 scholarships from the TCMH Healthcare Foundation were Joshua Kane and Kalli Pruett of Houston; Cameron Kuhn of Salem and Emily Smith of Licking.

Kane is in the paramedic training program at South Howell County Ambulance District in West Plains, MO. Kane is employed as an emergency medical technician in the emergency medical services department at TCMH.

Pruett is in the licensed practical nursing program at Texas County Technical College in Houston. She is also an aide for TCMH Home Health of the Ozarks.

Kuhn graduated from Salem High School in May 2014. She is attending Ozarks Technical Community College in Springfield where she plans to pursue training as a physical therapy assistant.

Smith graduated from Licking High School in May 2014. She is attending College of the Ozarks in Point Lookout, MO where she plans to pursue a Bachelor’s degree in nursing.

The endowed Dr. Joe L. and Judith T. Spears Memorial Scholarship Fund awarded three $1,000 scholarships area residents, two of whom are from Cabool–Shelby Brown and Haley Kelly. John Sawyer of Houston also received a Spears Memorial Scholarship.

Brown is pursuing a Bachelor’s degree in nursing through Drury University/Cox College of Nursing in Cabool. Brown works as a certified nurse assistant in the obstetrics and home health departments at TCMH.

Kelly is a student in the radiologic technologist program at Rolla Technical Center. She works as a student technologist in the TCMH radiology department.

Sawyer is attending Cox College of Nursing in Springfield where he is pursuing a Bachelor’s degree in nursing. Sawyer is a registered nurse and night supervisor at TCMH.

Andrea Turner of Success received the $1,000 Dr. Eugene Charles Honeywell Memorial Scholarship, chosen by the Healthcare Foundation directors and Carol Honeywell, the widow of Dr. Eugene Honeywell.

Turner is pursuing an accelerated licensed practical nurse to registered nurse degree at Texas County Technical College. She works as a nurse at TCMH Hospice of Care.

“Educational scholarships are one of the focus areas of the TCMH Healthcare Foundation,” Jay Gentry, Healthcare Foundation director, said.

The Healthcare Foundation holds an annual golf tournament to raise funds for educational scholarships for area students. The Healthcare Foundation also received $2,500 in matching funds from Healthcare Services Group Foundation (HSGCF) that was added to the funds awarded by the Foundation for the fall 2014.

The HSGCF program provides matching financial assistance to students awarded financial assistance by hospitals that are members of the Healthcare Services Association and insured by the Missouri Hospital Plan. Specifically, HSGCF matches scholarships or healthcare related tuition reimbursement provided by non-profit member hospitals throughout Missouri. This scholarship program is designed to facilitate, attract, and retain healthcare providers in Missouri.

“The matching funds from HSGCF enabled us to boost the amount of our fall scholarship,” Gentry said. “Every dollar helps these area students with their educational costs, and we’re grateful for the additional funds to award.”

The Healthcare Foundation awards educational scholarships for students pursuing additional higher education each spring and fall. With the recent scholarship awards, the Foundation has awarded $56,000 in scholarships to area students since the program began in 2007.

“The Healthcare Foundation administers the scholarships for the endowed funds, and the scholarships also go to employees working in healthcare-related fields in Texas County and surrounding areas,” Gentry said. Members of both families provided input to the Healthcare Foundation in choosing the scholarship recipients.

Gentry explained that 25 area students applied for the Healthcare Foundation scholarship for fall 2014.

“We had a lot of great applicants, and we hope that those that did not receive a scholarship this time will apply for a scholarship in the future,” Gentry said.

According to Gentry, the Healthcare Foundation intends to award two more $1,000 scholarships prior to the spring school semester in 2015. Applications for the scholarships are available through the Foundation or on the TCMH website.

“The Foundation board of directors recognizes the growing need for healthcare providers in rural America,” Gentry stated. “It is the hope of the Foundation that these scholarships will assist in attracting and retaining qualified residents to work in the local healthcare fields.”

Shown here at the scholarship check presentation are (left to right): Wes Murray, TCMH chief executive officer; John Sawyer; Kalli Pruett; Cameron Kuhn; Emily Smith; Andrea Turner; Shelby Brown; Haley Kelly and Joshua Kane, scholarship recipients, and Jay Gentry, TCMH Healthcare Foundation director.

Shown here at the scholarship check presentation are (left to right): Wes Murray, TCMH chief executive officer; John Sawyer; Kalli Pruett; Cameron Kuhn; Emily Smith; Andrea Turner; Shelby Brown; Haley Kelly and Joshua Kane, scholarship recipients, and Jay Gentry, TCMH Healthcare Foundation director.


Steele Named Employee of the Month

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Texas County Memorial Hospital has named April Steele of Houston the July employee of the month.

Steele is the administrative and medical staff secretary at TCMH, and she has worked for the hospital since November 2012. She was nominated for the award by Grace Pruett, infection control nurse manager at TCMH.

“April is always willing to go out of her way to assist employees, patients and visitors,” Pruett said.

Steele is known for providing a friendly and welcoming environment to everyone that comes into the administrative offices at the hospital.

“April epitomizes what TCMH is all about and where the organization is going,” Pruett said.

As employee of the month, Steele received a certificate honoring her achievement; a pin; $100 cash; a special parking place in the TCMH lot; one day of paid vacation; a membership in the TCMH Fitness Center; a $50 gift card; gift certificates to Paws N Claws, D&L Florist, Janstiques and Blissful Nirvana Massage, and cd of the month from Big Country 99. A reception will be held at the hospital in honor of Steele.

Steele is eligible for the 2014 TCMH employee of the year award.

April Steele (left), Texas County Memorial Hospital July employee of the month, with Grace Pruett, TCMH infection control nurse manager.

April Steele (left), Texas County Memorial Hospital July employee of the month, with Grace Pruett, TCMH infection control nurse manager.


Missouri State Senator Sees Dim Prospects for TCMH Financial Relief

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“I cannot give you any false hope that Medicaid expansion will pass in the state,” 33rd District State Senator Mike Cunningham told Texas County Memorial Hospital board members at their monthly meeting on Tuesday.

Cunningham was invited to the meeting to speak with board members about healthcare from a legislative point of view. It was Cunningham’s second visit to TCMH, one of four hospitals in his congressional district.

Cunningham told those present that he grew up in a small town in Northern Missouri and was familiar with small town healthcare needs.

Wes Murray, chief executive officer at TCMH, explained to Cunningham that TCMH does not receive support through a local tax nor does the hospital receive “cost plus” reimbursement for Medicare and Medicaid patients because TCMH does not have a critical access hospital designation.

“It is becoming increasingly difficult for small hospitals that aren’t critical access to break even when providing care to our patients,” Murray said. He projected that TCMH’s gross revenue will be reduced by $5.8 million in 2013 and 2014 due to reimbursement reductions.

Cunningham explained that of the 34 state senators, one-third support Medicaid expansion, one-third support Medicaid expansion with certain provisions in place, and one-third are completely against Medicaid expansion.

“There’s a less than 50 percent chance Medicaid expansion will pass in Missouri,” Cunningham said.

Cunningham noted that he would support Medicaid expansion with provisions in place such as a sliding scale, co-pays and deductibles.

“The Medicaid system is broken, and it needs to be reformed,” Cunningham said.

Murray agreed that some changes need to take place in the overall system, and he reminded Cunningham that TCMH must “play by the rules” of Medicaid regardless of who makes them.

“We are required to care for everyone that comes in our door or that calls an ambulance,” Murray said, explaining that 80 percent of the people that would benefit from Medicaid expansion are working but unable to afford insurance.

“We regularly care for and absorb the cost of patients that could receive healthcare coverage and help to pay their hospital bills if Medicaid were expanded,” Murray said.

Murray presented a new report from the Hospital Industry Data Institute (HIDI) showing economic and financial stresses on Missouri hospitals. Texas County and all of the hospitals in Cunningham’s district are experiencing the “most stress”.

2013 Missouri Hospital Stress Test, Average Hospital Rank by Region (lower ranks indicate higher average stress).  Texas County Memorial Hospital is in the South Central Region.

2013 Missouri Hospital Stress Test, Average Hospital Rank by Region (lower ranks indicate higher average stress). Texas County Memorial Hospital is in the South Central Region.

The stress test looked at all acute care hospitals across the state and the hospitals’ payer mix ratio; operating margin; uncompensated care as a percent of gross revenue; cumulative cuts through 2019 as a percent of operating revenue and percent change in inpatient volume from 2009.

Hospitals in the South Central region are experiencing the most stress based on financial data collected in the Missouri hospital annual licensing survey, utilization data included in the HIDI inpatient discharges database and future reimbursement reductions that hospitals will experience as a result of the Affordable Care Act and the American Taxpayer Relief Act.

“Small hospitals write off more patient care as a percentage of their gross revenue than all of the medium and large hospitals throughout the state,” Murray said, adding that at TCMH the percentage of uncompensated care is even higher than the percentages from other small hospitals.

The average small hospital has 7.1 percent of uncompensated care as a percentage of the hospital’s gross revenue. At TCMH, the uncompensated care is 8.7 percent of gross revenue.

“Our uncompensated care is up eight percent at TCMH in the past two years, and our inpatient volumes have dropped by14 percent,” Murray said. “We are losing money every month, and it’s scary.”

In the past two years TCMH has cut services and employee hours to trim hospital expenses. Hospital administration took a pay cut, hospital managers have not received a pay raise, and all other hospital employees were awarded very small raises. Hiring freezes for additional positions are in place, and capital purchases are on hold.

“We have numerous employees that would qualify for Medicaid if it were expanded in our state,” Murray said, explaining that a high number of working individuals in Texas County and the surrounding area cannot pay their hospital bills and choose to not seek healthcare services until they are critically ill.

“Expanding Medicaid coverage would provide a percentage of the people that we see a way to pay their healthcare bills,” Murray said. “It could be the difference between a positive and negative bottom line for us.”

Dr. John Duff, senior vice president and chief hospital officer at CoxHealth in Springfield, explained that Cox Health hospitals in rural areas such as Monett also care for a high number of “in between” patients that work at lower wage jobs but cannot afford healthcare.

“These small rural hospitals are serving valuable healthcare needs, but they are at risk without Medicaid expansion,” Duff said, adding, “We wonder how many rural hospitals in Missouri will close their doors before something is done.”

“I am one person of 34, and I cannot convince those dead set against it any more than they sway me,” Cunningham said.

Cunningham explained that there are numerous senators representing the 1-70 corridor, which he described as the area where “80 percent of the people of our state live within 20 miles”.

Cunningham described “the major problem” as “the unknowns at the federal level”.

“What will happen on the federal level with this program?” Cunningham asked. “We don’t want to take that chance.”

Murray reminded Cunningham that in the past the state of Missouri has taken chances with education and transportation funding.

Cunningham said that only about 40 percent of the people that contacted his office were in favor of Medicaid expansion, and 60 percent of the people that contacted his office were against Medicaid expansion.

Cunningham described those in favor of Medicaid expansion as the same constituents that have contacted him in favor of “gay marriage and humane society”.

“I don’t believe that statistic,” Murray said. “I do believe there are people that are against Medicaid expansion in the state, but in the time that our hospital has supported this issue, not one person has spoken against it to me.”

At the February 2013 board meeting, the hospital’s board of trustees unanimously approved a resolution in favor of Medicaid expansion in the state of Missouri.

“We support this expansion in light of what it would mean for providing care for the citizens of Texas County and what it means for our hospital revenues,” Omanez Fockler, chairperson of the TCMH board of trustees, said when the resolution passed.

Board members questioned Cunningham and expressed the need for expanded Medicaid coverage to help TCMH.

Dr. Jim Perry, OD, TCMH board member, cited a recent University of Missouri study which showed a $9 billion loss to the state without Medicaid expansion.

“Do you discount the University of Missouri study?” Perry asked.

“I do,” Cunningham said.

Cunningham questioned how South Central Missouri could have more “stress” than the urban areas of Kansas City and St. Louis where they have “large indigent populations” and “unwed mothers”.

Murray explained that the urban areas have more resources to help those without access to healthcare including healthcare providers.

Perry explained that large population areas have larger industrial base of employment with healthcare benefits which offsets the number of patients without health insurance.

“There are many people in this area that work at jobs that do not provide any healthcare benefits,” Perry said, adding, “We need you to represent us to your colleagues in St. Louis and Kansas City.”

Murray requested that Cunningham “fight” on behalf of the hospitals in South Central Missouri.

“By rejecting the Medicaid option, the state has lost a billion dollars so far this year, and we’re on the hook for another billion through the end of the year,” Murray said, reminding Cunningham that at TCMH and other hospitals uncompensated care is growing higher and faster than ever before.

“I cannot give you false hope that Medicaid will expand,” Cunningham said.

“This hospital and any other rural hospital in the state are subject to close in the coming years,” Murray said. “Our hospital doesn’t receive ‘cost plus’ reimbursement for Medicare and Medicaid patients because we aren’t critical access. We don’t receive local tax dollars. There’s no other hospital in this area. There are no other healthcare providers. We are the largest employer. If we close our doors, $16 million in annual salary goes away from our local economy, too.”

“I am being honest so you all can plan your future,” Cunningham said. “There is no quick cure.”

“But there is a quick cure,” Murray said.

“This hospital cannot plan their future,” Duff said. “The state is driving the bus. The state is deciding the future for hospitals like TCMH.”

Murray pointed out that the state has lagged behind many other states on progressive measures to benefit the state’s citizens such as passing a 9-1-1 cell phone tax.

“Missouri is also lagging behind on attempts to expand Medicaid coverage,” Murray said. “To receive this kind of outlook for our future is just devastating to hear.”

On behalf of the TCMH board of trustees, Perry asked Cunningham to “try to represent us more in Jefferson City”.

In the June financial report, Linda Pamperien, chief financial officer at TCMH, reported that inpatient volumes continued to slide at the hospital, resulting in a $98,010.55 loss for the month with year to date loss of $742,172.56.

Present at the meeting were Murray; Duff; Perry; Fockler; Pamperien; Dr. Schaun Flaim, chief of staff; Dr. Jon Beers, vice-chief of staff; Doretta Todd-Willis, chief nursing officer, Joleen Senter Durham, public relations director; John Casey, Texas County commissioner, and board members Janet Wiseman, Russell Gaither and Mark Hampton.

The next meeting of TCMH board of trustees is Tue., Aug. 26 at 12 p.m. in the hospital board room.


First Certified Nurse Midwife to Join Staff at TCMH

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Tracey Arwood, a board certified nurse midwife, will join TCMH in August, becoming the first certified nurse midwife to join the hospital’s medical staff.

Arwood will deliver babies and provide obstetrical care in the hospital. She will also provide obstetrics and women’s healthcare at the TCMH Mountain Grove Clinic and at the TCMH Medical Complex in Houston.

Arwood comes to TCMH from Garden City, KS where she provides women’s health and obstetrical care as a certified nurse midwife for the United Methodist Mexican American Ministries in Southwest Kansas.

Arwood has a bachelor’s degree in health science from Truman State University in Kirksville, MO and a bachelor of science in nursing from Barnes-Jewish College of Nursing in St. Louis. Arwood’s Master’s degree in nursing came from Frontier Nursing University in Hyden, KY where she also completed the Community Nurse-Midwifery Education Program.

By moving to South Central Missouri Arwood will be closer to her parents in Marshfield. As a National Health Service Corps Scholar, Arwood is able to receive student loan repayment through the National Health Service Corps by working at TCMH clinics which are designated as an “underserved area” by the federal government.

“Obstetrics has always been an important and needed service at TCMH,” Wes Murray, chief executive officer said. “We believe that Tracey will help ease some of the obstetrics load on our physicians as well as bringing a new element of obstetrical care to our patients.”

Arwood has found that nurse midwives are more available and sought out in some rural areas, and she believes that with the shortages of physicians, more women will seek a midwife for their pregnancy.

“I am thankful for all that TCMH is doing to bring me on board,” Arwood said. “I am looking forward to working in an environment that is welcoming and supportive.”

Arwood will collaborate with Christopher Baldwin, MD, a board certified obstetrician and gynecologist at the TCMH Medical Complex. She will divide her clinical time between TCMH patients in Houston and in Mountain Grove.

“Tracey will provide obstetrical services at the TCMH Mountain Grove Clinic, a community where there are currently no OB providers,” Murray said. “Tracey will be a great asset to our hospital and clinics.”

“I take pride in providing specialized care for my patients,” Arwood said. “I plan on being available for them whenever they need me.”

Arwood’s practice is for women of all ages—from birth control to menopause—and she will practice low-risk obstetrics, too.

Arwood will relocate to the area with her husband, Chris, and their daughter, Jaeda, age 2 and son, Corbin, age 4. Arwood will begin working at TCMH on August 4.

Tracey Arwood, CNM

Tracey Arwood, CNM


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