A demographic study and needs assessment of the county hospital was presented to the Board of Supervisors on Monday.

According to the study, compiled without full cooperation of the hospital administration, options range from a total facility replacement estimated at $73 million to $18 million for a series of renovations to address the most immediate needs like the emergency room.

No action was taken by the Board of Supervisors on the report presented by Stroud-water Capital, a national firm specializing in advising rural hospitals.

Stroudwater representatives presented the results of their study and urged elected officials to work with the hospital trustees and other community leaders in developing a strategic plan with measures in place to ensure implementation.

Stroudwater's role from the outset was limited to the assessment.

Stroudwater officials noted that hospital administrators had refused to turn over much of the data they requested, despite an order last year by the previous Board of Supervisors to do so.

Stroudwater's study confirmed a 2004 university study that shows that about 70 percent of the population here seeks healthcare services outside Neshoba County.

The nationally recognized firm presented three renovation and expansion scenarios that could be considered:

• Build a new central plant for the hospital and nursing home; keep existing hospital for some out-patient and non clinical services; build a new bed tower and surgery-imagining-emergency; renovate the existing hospital facility and renovate the nursing home facility (47,000 sq. ft. in the 1965 and 1976 additions) at a capital cost of $40 to $45 millions.

• Build a new central plant for hospital and nursing home; keep existing hospital for all services except beds; build a new bed tower; expand emergency services; renovate only what must be brought to code in existing facility; and do no work on nursing home at a capital cost of between $30 million and $35 million.

• Build new central plant for hospital and nursing home; minimum renovation to existing patient facility; expand emergency services and no work on nursing home at a capital cost of between $18 million and $22 million.

Board of Supervisors President Harold Reynolds said he planned to review the Stroudwater report more thoroughly.

"We've got to do something to get the ball rolling on the hospital," Reynolds said, pointing out that a possible renovation or new hospital had been discussed for three to four years.

"We've got to come together and do something because the people deserve it. We have a good hospital and ER but improvements need to be made and I think it is past time for us to get with the program," he said.

Reynolds posed questions to the Stroudwater officials about compiling a strategic plan and said after the meeting that he would consider calling a work session for the supervisors and hospital trustees to come together once again.

"We need to see what everybody's feelings are," he said.

Reynolds said he was concerned that the hospital administration didn't provide Stroudwater with all the data it needed for its study.

"I don't understand why it wasn't turned over if it was not confidential information," he said.

District 5 Supervisor Obbie Riley agreed.

"It concerns me immensely," Riley said. "Part of a strategic plan is to see exactly what is going on down there. I've yet to have a meeting with the hospital board and administration to see why it was a problem for them.

"It concerns me a whole lot that we would pay that kind of money to have this report done and someone within our administration would not be in full compliance.

"I think they should give the public full disclosure on why they did not comply," he said.

Despite that, Riley was optimistic about the Stroudwater report.

"We need to replace the hospital down there and we have the community to support it. The thing we have to understand is there hasn't been a true plan implemented on how to get this new hospital and how we are going to pay for it.

"The report basically is saying the community needs a new hospital and there is some strong competition from hospitals with newer and more up-to-date facilities. We have got to implement a plan if we want to stay competitive," Riley said, noting that he, too, would like to meet with hospital trustees.

Marvin Page, president of the hospital's Board of Trustees, said Tuesday morning that he had not seen the Stroudwater report but he had heard that it was presented to supervisors on Monday.

Page referred questions about why the hospital administration didn't provide Stroudwater with all the data it requested to administrator Karin Fiducia.

Calls to Fiducia went unreturned.

Other summary points from the Stroudwater report:

• Current utilization and market share data shows significant outmigration for all services.

• Neshoba General Hospital is surrounded by significant competition offering access to attractive up-to-date facility.

• Average age of hospital plant is above the median for peer hospitals, even with the newly renovated nursing home facility skewing this lower.

• Hospital was constructed in 1962, with additions in 1982 and 1992 and has been well maintained but is in need of capital investment.

• Primary care physician supply does not meet community demand, suggesting a need for additional investment to build appropriate primary care base available to serve the residents of Neshoba County.

• External funding options include issuing bonds, attempting to qualify for government credit enhancement (HUD or USDA) before approaching bond market or finding appropriate affiliation with capital partner to support facility and service enhancements.

• Profitability has diminished, with a $208,000 decrease in net assets for the year ending Sept. 30, 2006.

• To achieve the facility and program enhancements to meet community demand, Neshoba General may not be generating enough surplus - to generate its own funds for capital investment or to approach bond market for funding.

After Stroudwater officials were unable to get some of the data it needed to complete its study last fall, supervisors formally ordered the hospital administrator in September to turn over a hospital facility engineering report and other data that would outline the number of patient discharges and diagnoses over the year, as well as data that would show the hospital's market share as compiled by the state Department of Health.

John Peel, senior vice president of Stroudwater Associates, and Bob Wallace, principal, told supervisors on Monday they had to revise their methodology after six of 10 data requests went unanswered by the hospital's administration.

"Accordingly, Stroudwater must provide this report in the context of incomplete information," Peel said. "Projections are based on reasonable industry-based assumptions rather than facts that the hospital could have provided. Therefore the projections may or may not be realized in the future."

The Stroudwater findings showed that Neshoba County has a service area population of 38,214 which is projected to increase to 40,271 by 2017. This provides a significant population base for a rural hospital with the anticipated growth representing a significant opportunity as well, the report said.

Stroudwater officials estimated that it would cost between $65 million and $73 million to replace the current 82-bed hospital.

While Stroudwater received copies of the hospital's strategic plan, Medicare cost report, historic audited financial statements and medical staff roster, its request for PS&R, year-to-date financial statements, patient origin report by zip code, discharges by physician and admission market share by hospital and hospital volumes for last three years by department/modality were not answered.

"We did not get this information. I'm not trying to make judgments, just a statement of facts," Peel said.

"We did the best we could do," Peel told supervisors, pointing out that the Board of Supervisors Attorney Wade White had "done everything humanly possible to get what we requested."

Stroudwater officials encouraged supervisors to meet with the hospital trustees and other community leaders to develop a new strategic plan for Neshoba County General Hospital and Nursing Home as the current plan is over three years old.

After the plan is developed, measures should be put in place that would ensure that it is implemented, they said.

Both Peel and Wallace said they were impressed with the hospital and nursing home, but noted that capital improvements were needed.

Wallace compared the hospital's situation to someone with a size 10 foot wearing a size 8 shoe.

"I'm very impressed," he said, of the current operation.

Both officials challenged the board to act quickly.

"You are the leaders. There's a lot of potential there and ultimately you have to do what's good for your community. If you don't, it's going to get worse and affect your community," Peel said.

Wallace agreed.

"I think you have a bright future," he said.

Quorum Health Resources has managed Neshoba County General Hospital and Nursing Home since 1993.

Last year, trustees renewed a $600,000 management agreement with Quorum that was set to expire in March 2008.

The new two-year contract with Quorum has a stipulation allowing trustees to cancel the agreement at the end of each year with 90 days prior notice.

Last July in a unanimous decision, the supervisors hired Stroudwater to determine the medical needs of Neshoba County and to oversee the public phase of gathering community support of any future project that could entail a new or renovated hospital.

Separately, an architectural firm was hired as was a law firm to determine the county hospital's current borrowing ability.

Quorum Health Services has managed the hospital since 1993.