Friday, May 24, 2024

Power list interview: Hospital executive Roxie Wells chats with Nido Qubein


Hospital executive Roxie Wells joins President Nido Qubein in Business North Carolina’s Power List Interview feature, a partnership with High Point University spotlighting some of the state’s most influential leaders.


Roxie Wells is president of Raeford-based Hoke Hospital, which is one of eight hospitals owned by Fayetteville-based Cape Fear Valley Health. She’s also past-chair of the N.C. Healthcare Association, which represents 135 hospitals, and just finished a three-year term on the American Hospital Association’s 27-member board. The AHA represents the nation’s  nearly 5,000 hospitals. 

Wells says she used her national role to advocate for 40 million Americans who live in rural communities. “My passion is rural health,” she says.

Wells is a graduate of Fayetteville State University and East Carolina University’s Brody School of Medicine in Greenville. She joined Cape Fear Valley as a family practice physician in 2010, then took her current post in 2014.

This story includes excerpts from Wells’ interview and was lightly edited for clarity.

What are some special challenges for rural hospitals?

When you think about technology, you don’t have broadband in some areas and you have to figure that piece out.  When you talk about the workforce and who will be the EMS workers, who will be the nurses and the workforce, it’s a huge challenge.  But the people who live in the communities tend to wrap their arms around you. They tend to make sure that you have things that you need. There’s a population of professionals who feel that tug and feel that call to a rural community. The people surmount those challenges. It is an amazing experience to work in that environment.

How do you attract medical professionals to rural North Carolina?

It really is the community and how you connect individuals to the community.  Definitely education is extremely important and the  ability to receive health care for their families. When we are looking for work force, we really want individuals, particularly in rural communities, who are community oriented, who aren’t afraid to get out and become a part of the community.

What does a hospital president do all day?

For me, it really is about supporting the people that take care of our community. No, my day does not start at 10:30. It actually starts at about 5 a.m.,  getting reports from nursing, and determining if anything happened during the night that we should be concerned about. We are making sure that we are there smiling as employees are entering the hospital and checking on patients. I spend quite a bit of my time interacting with people, whether they are employees or patients or staff members.

What are your key revenue sources?

It typically depends on the community in which you live.  We happen to be a safety-net hospital which means that a large percentage of our revenue is from government payers, whether it’s Medicaid or Medicare. We do have private payers which would be our insurance companies like Blue Cross or Aetna. We have a pretty significant self-pay population, but you don’t really collect a lot from self pay. Most safety-net hospitals throughout the state are probably about 40% to 50% government payers, another 20% to 30% private pay and 15% to 20% self-pay.

What is the status of Medicaid expansion?

We are one of 12 states that has not expanded Medicaid yet. We have come very very close working with the Senate, the House and the governor and our hospitals.

Why is Medicaid expansion important?

We have about 500,000 people who are uninsured. They don’t make enough money to purchase insurance, but they make too much money to actually be on what we consider regular Medicaid. So we want to make sure we are able to insure those people and so if we expand Medicaid, then they would be covered as well.  

What are the impediments?

From a legislative standpoint, the concern was that the federal government would cover it for five years, and then after those five years would the state be responsible for paying? Our General Assembly members want to be fiscally thoughtful about North Carolina, and so they were concerned about that.  But what we have seen over the years is that the federal government continues to cover it. Our failure to pass Medicaid expansion has been, and will be in the future, a detriment to hospitals across our state.  

So how does that affect Hoke County Hospital? 

I’m a physician by profession, and I love taking care of people. When people don’t have access to health care because they’re unable to pay, then that’s a frustration for me. And so when I think about where we are with the expansion of Medicaid and why we’re having a difficult time, I think about the 500,000 people who don’t have care.  When they put off that care, then they end up sicker when they get to our emergency department.

You were chair of the North Carolina Healthcare Association — a big shot!

I don’t look at it like that. I look at it as a way to advocate for people and to produce policies that will be helpful to the citizens of North Carolina.  And you know, I’m very fortunate, I used to think that health care was my passion, and I learned pretty quickly that people are my passion and health care is how I get to live that passion. 

Do rural hospitals have enough resources?

There’s always the need for additional resources, just because of the population that you serve. We know that people who live in rural communities tend to have more co-morbidity illnesses, so their care is a little more difficult. We are concerned about behavioral health issues, which are exacerbated in rural communities. That’s why the advocacy piece for me has been so important for me. We’re fortunate in North Carolina that our General Assembly understands the needs of rural communities.

What would you tell business leaders about rural hospitals?

Well, if you have means of philanthropy, recognize that those rural hospitals could use those philanthropic dollars. As new industries come to North Carolina, connect with those communities and help ensure that those hospitals are sustainable. A lot of those hospital buildings were built 60, 70 or 80 years ago and a lot of them are obsolete. As the General Assembly looks at tax incentives and those types of things, think about hospitals and rural communities.

What’s the advantage of being part of a larger hospital group?

I get to tap into things that are systemwide. Some of our independent hospitals don’t necessarily have that. When you talk about the size, I like to think of small hospitals as a speed boat, and larger hospitals, I like to think of them as cruise ships.  And, you know, speed boats can move pretty quickly. It’s easier to train staff, so when you want to make changes, it’s easier to do that. If you’re going to make a change in a larger hospital, you’re really at cruise ship speed.

Are hospitals receiving less revenue from COVID illness?

Our hospitals in North Carolina, and across the country, are seeing reductions in revenue. But we’ve seen increases in workforce expenses and inflation from supplies or what have you. The revenue is not keeping up with the expense, which means you have to start thinking about whether to cut services. I think that our hospitals will have a long recovery. We are not going to recover in a year, or in two years. We don’t raise prices like other industries do, you know. 

Has COVID led to more remote work in health care?

One of the things that has come out of COVID is what we are seeing the transformation of health care. We have people who do patient care remotely including our hospitalists at night, who are not in the hospital. The nurses connect with them via telehealth and they take care of patients.

Transformation in health care is going to happen more rapidly than we are used to.  We have nurses and physicians who work remotely. But, of course, we will always need people inside the building taking care of patients.

What do you see for the future of health care?

North Carolina has some of the best medical education in the country, if not the world, because we have universities with longstanding traditions of training doctors, nurses, physical therapists and researchers. So North Carolina has played a huge role in health care for the country. I would like for us to expand Medicaid. That would be helpful for us.

There’s going to be a transformation of health care with new entrants such as Walgreens, CVS and Amazon. Look at how those companies are growing and connecting with primary care. There’s a definite need for hospitals and insurers and new entrants to really work together to provide care for communities. We wonder why some of the smaller countries in the world have better health care and they spend less than we do.  When we look at that, it’s social determinants of health, it’s access, it’s those types
of things.

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