The Other Side of Rural Health Care

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Tom Haederle
The problems facing rural health care providers across the nation are well-documented. Squeezed budgets, lack of insurance, transportation and access issues, dwindling patient populations. One rural provider in Northeast Texas says, yes, all of that is true, but he still wouldn't trade places with any other hospital or health system.

00;00;25;26 - 00;00;57;16
Tom Haederle
Welcome to Community Cornerstones Conversations with Rural Hospitals in America. A new series from the American Hospital Association. I'm Tom Haederle with AHA Communications. Terry Scoggin is CEO of Titus Regional Medical Center in Mount Pleasant, Texas. It serves about 88,000 people and is the last independent system still operating in that part of the state. Scoggin and his senior team hope to keep it that way, independent and able to make its own calls about what's best for the community it serves.

00;00;57;18 - 00;01;22;07
Tom Haederle
Titus Regional is about people, roots and relationships. Scoggin says most people in town have his mobile number, something unheard of for CEOs of larger organizations. Titus Regional is proudly rural, unaffiliated with a larger health system and passionate about the care it delivers. As Scoggin says, every decision we make, we have to think about how it will affect someone we know.

00;01;22;10 - 00;01;45;27
Andrew Jager
My name is Andrew Jager and I'm director of Population Health at the American Hospital Association. I'm here today at the AHA Rural Health Care Leadership Conference in San Antonio, Texas, and it's my pleasure to be speaking with Terry Scoggin, CEO of Titus Regional Medical Center in Mount Pleasant, Texas. Terry, thank you so much for sharing some of your time with me and with the Advancing Health podcast listeners.

00;01;46;00 - 00;01;52;08
Andrew Jager
Could you start by telling us a little bit about Titus Regional Medical Center and what makes the community you serve so special?

00;01;52;14 - 00;02;13;06
Terry Scroggin
Thank you so much for the opportunity to share our story and share the rural story. Titus Regional Medical Center is the last independent health system left in northeast Texas. 35 counties make up northeast Texas. We're the last independent and we're rural. We're 60 miles from the Oklahoma-Arkansas-Louisiana border, right on I-30. So we're the definition of rural.

00;02;13;08 - 00;02;36;10
Terry Scroggin
Titus County is a hospital district. We are PPS. We range a census of about 50 on a daily basis. We deliver babies, about 950 a year; 22,000 a year in our emergency department. But we are independent, so we have the challenges of that. Titus County is 32,000. So we support Titus County and the four surrounding counties total. About 88,000

00;02;36;10 - 00;02;59;26
Terry Scroggin
total is what we serve. The next health system of any size is about 60 miles in all direction. So being independent, we're on our own. So we're always worried about being taking over competition of joining large health systems. Over the last seven years, I've seen four hospitals close within 45 miles of us. The rest of the hospitals joined large health systems.

00;02;59;27 - 00;03;20;20
Terry Scroggin
So you can see I'm passionate about it. We're passionate looking about independence and we rely on the American Hospital Association...Texas Hospital Association...TORCH, which is the law association for many hospitals in Texas for that independence and that ability to stay where we are. You ask what's special about our community? We're rural. You know, it's we've got a lot of hardworking people.

00;03;20;25 - 00;03;40;29
Terry Scroggin
We've got a lot of people who've pulled their bootstraps up on a daily basis. A lot of successful entrepreneurs. So they're supporting us with community standpoint. During COVID ... we're the largest county with COVID per 100,000 in Northeast Texas. How are we the lowest mortality rate? Not even close. And the reason why is we get involved in our communities and our physicians came to the table.

00;03;41;01 - 00;04;01;27
Terry Scroggin
So after COVID, we realized we can do this. We can stay independent. We made COVID decisions in East Texas, not in board rooms in Brentwood, Tennessee, or the East Coast or Dallas, Texas. And we need relationships with those larger health systems, but we need those decisions, final authority needs to be made by me and my board on a minute's notice.

00;04;02;00 - 00;04;24;18
Andrew Jager
Thank you, Terry. I love that sort of local control because because I think one of the thing that's really impressed me over the time that we've had the privilege of working with you and your team is the really innovative approach that you've taken to understanding both the strengths and the needs of the community that you serve. So I wonder if you could tell me just a little bit about some of the leadership tactics that you've used to develop your approach to the data?

00;04;24;18 - 00;04;38;23
Andrew Jager
Right? Both the quantitative elements that I know you all use and such a sophisticated way, as well as the the really useful qualitative type information that you pull in together through the relationships that you have with community organizations and with community members themselves.

00;04;38;26 - 00;04;59;29
Terry Scroggin
So to be independent, you have to understand your community and know a little bit about Titus County. That 32,000 people is 45% Hispanic, 44% white, 9% African-American. So you can see we're very different, a lot of cultures, and you have to take that into consideration. I focus on mortality a lot, and we look at it in Mount Pleasant, Texas.

00;04;59;29 - 00;05;21;03
Terry Scroggin
I'm going to live five years less than Dallas, Texas, seven or eight years less than my son in Austin, Texas. And that's what we focus on. So we talk about data. We're really wanting to turn from the normal benchmarks using the past and focus on outcomes data. And focus on the different segments, the Hispanic community, male, female, uninsured.

00;05;21;03 - 00;05;46;12
Terry Scroggin
We're 33% uninsured adults in our community. Texas is not extending Medicaid. We feel that on a daily basis in the rural health system. So we need to look at data in that way. What is the diabetic rates in issues for all different segments in our community? African-American, Hispanic, white, uninsured, insured? Data is not just a number anymore. Data has to be broken into.

00;05;46;14 - 00;06;14;04
Terry Scroggin
We're a primary heart attack center and a Level Two NICU, a Level Two maternal services and a primary stroke center. Each one of those groups on their joint commission accreditations are really now focusing not just on numbers anymore, but breaking the segments and outcomes. So really focusing on, you know, what's the rates for maternal that affect each one of our segments, African-American women, Hispanic women, and trying to understand those cultural differences.

00;06;14;06 - 00;06;38;20
Terry Scroggin
So data's changed. You know, I had the opportunity to participate with AHA years ago. Got to know the guys at my topia. They have a great software and he will become a friend of mine. Now and communicates. We use his data to really get into understanding our community. Mt. Pleasant is 16,000 people. It's small. You'll live more than ten years less on the south side of the town than the north side of the town when you break your town into census.

00;06;38;20 - 00;06;55;10
Terry Scroggin
And so there's so much data in there. Hardest part is where do you start? And that's where our challenge is daily. And we look to the experts and friends just to find out, you know, what are they looking at, how are they making it work, and then try and make it work for a community. You ask about how we interact for a community?

00;06;55;16 - 00;07;17;17
Terry Scroggin
We had a health fair on Saturday in our hospital. React quicker, save your ticker, our cardiac. Found out that for Black History Month, one of the churches was doing something. So about 2 hours in, I drove over the church and I knew the pastor and knew some things, but they were having a group on just the task force, and I sat down with them for the next two and a half hours.

00;07;17;19 - 00;07;35;26
Terry Scroggin
That's what's different. And, you know, had the opportunity to sit down with our leaders and our African-American population and understand about maternal services and the history of midwives in northeast Texas. It's totally different when you really go back 100 years and understand that. But if you want to know rural, you better know your history. So it's a little bit different.

00;07;35;28 - 00;07;49;13
Andrew Jager
Yeah, and you said it so well that right data is more than just numbers. So having that context and you're doing the measurement and the hard metrics, but having that contextual information to make sense of it is so important. So I really appreciate that.

00;07;49;20 - 00;08;09;09
Terry Scroggin
I want to give a shout out to University of Texas. I'm an Aggie class of '92, Texas Aggie band and core of cadets. I'm an Aggie. Had the opportunity to go to University of Texas this year from a master's in science in health care transformation and what the Dell Medical School and the Institute for Values are doing at Texas right now is unbelievable.

00;08;09;16 - 00;08;26;28
Terry Scroggin
Elizabeth and Scott are doing some great things in there. And I'm 53 years old. One of my board members asked, why am I going back to school? And you have to. I mean, have to understand and look at it differently. They're focused on outcomes changing our delivery system. And over the last six months, I still have six months to go

00;08;26;28 - 00;08;46;05
Terry Scroggin
so I may not pass, but, you know, it's been able to open my eyes and look at the different things about how we're doing it, how we're talking to our patient. What are those disparities across our health system? Rural is a disparity, let's be clear. But it's also economic status, gender. It's all the different things. So I'll give a shout out to

00;08;46;05 - 00;08;55;12
Terry Scroggin
University of Texas, they're doing it right. Dell Medical Schools partner with them and meeting some great people. But that's how we're going to change that and that's what we're going to do, is we have to look at the future differently.

00;08;55;14 - 00;09;22;25
Andrew Jager
Yeah, I appreciate that shout out there. There's so much impressive work going on there. So thank you. Speaking of impressive work, there's so many impressive speakers here at the AHA Rural Health Leadership Conference. And this morning in one of the plenary sessions, one of the speakers posed what I thought was a really interesting question. And that's, you know, what can America's rural hospitals teach their counterparts in urban areas or in large academic medical centers, about really understanding the needs and priorities of those communities that we serve?

00;09;22;27 - 00;09;36;05
Andrew Jager
So I guess I'd ask you the question, what could your urban and larger academic medical center colleagues learn from a hospital like Titus Regional Medical Center about engaging and understanding and really just kind of co-producing health through the community?

00;09;36;07 - 00;09;54;16
Terry Scroggin
The biggest thing for those larger health systems to understand is: they need to know what's personal. In a rural community - I've lived there 18 years and lived in Austin for 12, but I've moved Mount Pleasant 2004 to raise my boys when they were, 2,4,6 and 8. Now, no, it wasn't their home. They're gone. It's just me, my wife now, but it's our home now as well.

00;09;54;16 - 00;10;14;03
Terry Scroggin
It's personal. I go to church with these people. I see them at Walmart. I coach their kids. I was a concession stand. Booster club, school board. And these are the people you see at the grocery store, church on a daily basis. So when they have questions about their bill or they weren't able to get in or the doctor didn't, things didn't go right or somebody didn't treat them, they're picking up the cell phone and call me.

00;10;14;06 - 00;10;34;26
Terry Scroggin
The majority of the town has my cell phone. Most urban CEOs are not giving out their cell phone on a daily basis. At the health fair and actually at the Black History Month on Saturday, I walked around and gave these people I don't know some of the people, they have my cell phone now. If there's a problem, they're confused on a bill or they've got somebody who can't access, they can reach out to my cell phone.

00;10;34;29 - 00;11;02;00
Terry Scroggin
You're not going to see that, it's personal. We also don't have the ability to make a mistake. I don't have ... We're financially okay. Okay. We don't have anything to fall back on. If we do something stupid or we don't pay attention, it'll cost my community their independent health system. My team, which is amazing...I'm blessed to have an amazing staff and team members and friends around me and their physicians, but we don't turn it off. 24/7

00;11;02;03 - 00;11;24;15
Terry Scroggin
that's all we think about is our community. No matter where we go, you can't get away from it. It's tough sometimes, but it's a mission and you're able to affect people's lives. So that's the one thing I would tell our people is every decision we make, we have to think, how is it going to impact Darrell, Kirk, Amy, Michelle. It's just not segments of people.

00;11;24;18 - 00;11;40;06
Terry Scroggin
You know, we've got to understand how it's going to impact those individuals. And and I'm appreciative. I think I'm blessed to have them. I'd also tells urban people, as we need them to be successful. We need to get the people who used to work in some of the urbans and have some of the skill set around, especially quality.

00;11;40;08 - 00;11;59;03
Terry Scroggin
And we're a Leapfrog A now. Before COVID, we were Leapfrog C. See, we realized patient safety and quality through the high reliability organizations and a lot of stuff AHA does the importance of that. And we made a change, and I've invested a lot of money, money we don't have, in quality and patient safety, and we're Leapfrog A and we're doing some unbelievable things.

00;11;59;03 - 00;12;19;29
Terry Scroggin
And my CNO is thinking outside the box and trying to change the thing. So I'm appreciative of what she's doing. My CEO is doing some great things and physician groups, we're all having to be innovative and just hired a new CFO, excited to have him join us, but he was a board member. He also live in the community 50 plus years.

00;12;20;01 - 00;12;40;18
Terry Scroggin
He understands what we're trying to do. So having a financial mind who can work with all of us and knows the importance of what we are to the community. We're excited about our team and where we're going. And then you can't do without positions. I don't know if the urban counterparts really believe it and understand it. I think they think they can replace a physician.

00;12;40;25 - 00;12;58;17
Terry Scroggin
I can't. So I balance every day making that sure that physician has what they need, but also understands our mission vision. And we have to do a better job of recruiting and we recruit. We have to make sure. Do you understand what it means to be a physician in this community. So that's the long and short of it.

00;12;58;23 - 00;13;13;24
Andrew Jager
Yeah, I mean, it's personal, right? And it's personal. These are 24/7, but it's personal. And kind of living your values and your mission every day is the way you get it done. So I just want to thank you for your leadership, for the crucial work you do every day in your community. It's made all the difference. So thank you so much.

00;13;14;01 - 00;13;15;29
Terry Scroggin
Thank you for the opportunity for us to tell our story.

00;13;15;29 - 00;13;35;01
Andrew Jager
Yeah, this has been a lot of fun and I just want to let folks know we're listening that to learn more about some of the work that we're doing at the AHA to support hospitals, both rural and urban, in their population and community health efforts, please visit our websites at AHA.org/pophealth or Healthycommunities dot.org.