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From local leaders and hometown heroes to breaking stories and in-depth conversations, the KMAS Podcast brings you the voices that matter in Mason County, Washington. Hosted by longtime broadcaster Jeff Slakey, each episode dives into what’s happening around the Hood Canal—government, education, small business, the outdoors, and everything in between.
New episodes drop throughout the week, featuring interviews, community spotlights, and extended versions of the stories you hear on the air at KMAS.
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Well, how's it going, everybody? Jeff Slakey here. And on the 4th of July, President Trump signed the one big, beautiful bill act into law. And subsequently from there, we started seeing on social media a lot of concern about rural hospitals across the country.
And one of those that we have here in our area, Mason General Hospital, was on that list. And right away, it caused a lot of folks commenting on social media. It caused a lot of questions and concerns about the future of health care, not only in Mason County, but the future of rural health care across the country.
And so I reached out to Mason Health to talk with them and see if we could get some of these answers, questions answered here. And I have with me the CEO, Eric Moll. How are you doing? I am good, Jeff.
Yeah. Looking forward to this conversation. I am too.
And right away, as soon as the bill was passed, there was a lot of folks talking about what was in the bill and the size of the bill and all these things. And then very quickly after that, by that afternoon, I think because folks had that day off, 4th of July, they had time to look on social media and see that Senate Democrats started releasing some information that kind of showed a list of rural hospitals across this country. And Mason was on there.
And that caused a lot of concern. So what did you see right away? Yeah, well, unfortunately, it created a lot of fear. And I think it was fear both in the community and also within the staff at Mason Health, fearful that that letter in particular suggested that the hospital was going to close.
In addition, there was a lot of just media reports just across all the outlets, just really focusing on the impact to rural hospitals in general. And to be clear, the bill does have a disproportionate impact and will negatively impact rural hospitals. But I also want to be clear.
No, Mason Health is not closing. Mason General Hospital is not closing, even under the worst case scenario. So I think that what the letter implied is not reflective of the reality at Mason Health.
Talk to me a little bit about what people were reading into the documentation that would get them to think this. A lot of it had to deal with Medicaid dollars, maybe even some Medicare dollars. And I understand that rural hospitals do receive a fair amount of their revenues come back based on those.
Yeah, and so the reality is rural health care has a disproportionately high amount of Medicaid. And this bill does significantly cut Medicaid. So for a community like Mason County, we have a disproportionately high amount of Medicaid.
For the patients we serve, it's about 25%. I think on average, if you just spread across urban and suburban areas as well as rural, that percentage is closer to 10%. So we have that disproportionately high amount.
And so with these massive cuts, it does affect both coverage within those communities and ultimately affect the reimbursement and the amount of revenue that those facilities receive. But that's where I want to be clear. We have a plan.
There's nothing in the bill that actually surprised me. This was something that we had anticipated for months. We've been working on a mitigation plan.
And I think we have a good plan to navigate. And in fact, actually, if there was a surprise to me, it was maybe on the plus side. I had anticipated that the cuts that were in the bill would be enacted even as early as second half of this year.
And most of the cuts are delayed until 2027, which actually gives Mason Health and other rural communities a longer runway to help prepare and plan. So I look at that as a good because I have confidence both in our financial position going into this, because we're going into these Medicaid cuts in a very strong financial position after a couple decades of really strong fiscal management. And I think we have a really good plan, both in terms of how do we reduce some of our operating expenses without affecting services.
And I think that even with these Medicaid cuts, there's still a really high demand within Mason County. Mason County is still growing. There's a lot of services that are needed.
And I think we still have a path forward to kind of grow and meet some of the access needs. So I think that's really where we're focusing, is where can we trim up a little bit on operating expenses? And where can we continue to expand and grow from an access standpoint? And so that's a lot of the financial mitigation that we've put in place anticipating this bill. It seems to me like as well, you folks here have positioned yourself well in the region when it comes to offering certain types of access and opportunities for folks that would have to then travel from different counties into Shelton particular for that.
So maybe that also kind of helps protect you a little bit. It does. It does.
Because I think one thing that we've long done is we've really focused on what are our core competencies. And we really stick to our knitting because I think health care is very complicated. It's easy to start to branch out into other aspects of public health and other types of areas that eventually do affect health care.
But we've really stayed very, very focused on providing health care and kind of looking at what are some of those highest community needs, whether it's primary care or some of the basic surgical services, certainly OBGYN and both our birth center and GYN services. And then we try to partner with certain areas that there's a huge need like oncology. And so partnering with VISTA Oncology, a general oncology group that's willing to come into the community and provide really high quality services with a lot of access locally.
So we try to partner with some groups. And then recently, we've worked with a cardiology group that we've now partnered and integrated actually within the clinic and into the hospital. So we're looking at some of those high need areas where we can either continue to expand like primary care, behavioral health, general oncology where we partner or even contract around like cardiology.
So it's really maintaining that focus on what are those greatest needs. Now, there's more and more needs both in those service lines and there's additional service lines that we don't offer. But I think relative to have what's typical in a rural community, we've way punch above our weight.
And so the kinds of services and the range of services that we offer is much more significant than what you'd find in a typical rural community. As you look out to, and I did see that as well, that the bills, a lot of the main portions of the bill won't be enacted until the end of 2025 going into effect in 26. So as you look that far ahead, some of the other things that I think the hospital has been able to take advantage of since COVID is more of that telehealth kind of things.
Are those the types of things too that you're looking at as not only the population gets more comfortable using those services, but the age of the people who would use those services are more familiar with technology like that. Is that something that would help or part of this plan? Yeah, I think it is. And it's really all the above.
It's not, you know, we'll continue to focus on what's typically referred to as bricks and mortar, you know, and so within kind of the hospital and the clinic walls, we'll continue to focus on that for sure. And we'll continue to, you know, broaden our telemedicine, telehealth platform, you know, and one of the limitations still in rural is just the fiber access, which is getting better and better every year. And so that actually is reducing that barrier.
But then I think there's a huge third opportunity that we're exploring. And I think really the fire districts under Bobakken's leadership has really identified more of the home health service. And it's a gap within Mason County.
And so I think partnering both with the fire districts on the integrated mobile health program that they have, but also looking at, you know, there's a home nurse program that we're evaluating as well as just looking at how can we expand more home care and looking at hospice, which is another, you know, kind of deficit within the community. So there's a lot of different models that are very complementary to kind of the care delivery, but, you know, help kind of provide more avenues of access. And I think that's what your question is really getting at.
So yeah, eyes wide open. I think that over the coming year and years, that's where we're looking to try to expand our reach beyond just the bricks and mortar. So explain to folks who, for whatever reason, may have, you know, I think about this too when it comes to education, people will be in schools and then they're out of schools for a long time and things change very rapidly when it comes to learning and how learning is delivered and things like that.
So if somebody, you know, spent time or they had to go to the hospital or they visited their primary care physician and then took five years even off without visiting or 10 or more, explain kind of how healthcare has evolved into ways, just like you're saying, to be able to get more into the home or through telehealth or things like that. Folks coming into Mason Health go, well, this isn't how I remember a hospital or something like that. Yeah.
Well, I think actually I'll go to just, you know, the most current, you know, transformational transits across all industries certainly is artificial intelligence. And I think that's probably the biggest thing that I think will be most striking for folks is how that already is starting to get integrated into healthcare. And so one example that we've now adopted and it's become pretty much the standard is if, you know, with patient's consent, of course, then the physician office visit then becomes recorded.
And then the AI is actually translating the office visit into the physician notes, saving the physician just a massive amount of time. You know, we estimate that that saves as much as an hour plus of documentation time per day, which then creates more, it creates more space for the physician to follow up on some of, you know, there's a lot of messages that come in and it just allows them to follow up and do more with that time. And possibly see more patients as well because they're not spending all that time, you know, trying to document their notes.
And so, and then the other benefit that we're just now starting to learn in the industry is actually there's a lot of nuances in the exchange between the physician and the patient. And especially when the, you know, the physician is able to completely focus on, you know, that interaction and not be trying to document at the same time, that artificial intelligence is actually picking up more nuances and more accurately reflecting the diagnosis. And so that's just one area that people will start to see is there's, you know, they'll start to see just that technology.
And so, and that technology is starting to also factor into scheduling and making things more efficient for the patient in terms of how they schedule into office visits. So I think these are the things that are coming, you know, both here now and coming. And I think that that becomes ubiquitous, whether it's you're coming in person or you're doing a telemedicine, you know, type of office visit.
And then what that's also able to do is the information that's then reflected back to the patient, you know, is I think more specific and customized to the patient. And so the kind of information that they're getting is a lot better in terms of, okay, what do I do? I have this diagnosis. What's my follow-up plan? And having that more tailored to them specifically, I think will be something that will be much different and probably written in a way that is more easily understood than probably some of the discharge instructions that they received, you know, a decade ago.
Yeah. That makes a lot of sense. Those 15, 20 minute visits, that's not all that is within the patient-doctor relationship there.
There is all the, in the past, all the writing down and remembering. And that makes a lot of sense to be able to have a better kind of, you know, eye contact connection with the patient to really fully understand and maybe pick up on some cues that they're not 100% comfortable sharing fully, but then they can kind of open up a little more. That's really interesting.
Yeah. Back to the bill that was signed on the 4th of July, if these cuts do come through and there is that reduction in the services by people who use Medicaid, will they see any reduction in their ability to get service? That's the complicated part. Very complicated because we're estimating as much as 5,000 people in our service area.
So 5,000 people in Mason County will lose coverage. And that's a material amount in a community of 60 plus thousand. And so there are state laws that give them protection.
You know, the charity care law that was passed in, I believe, 2021 significantly expanded coverage. So, you know, if folks, if they're uninsured, would still have the ability to come into the hospital and in clinic and seek services. So, but, you know, that's, you know, that still creates barriers because you still have to apply for charity care.
You have to kind of go through, you know, through that. And not all, you know, medical groups, you know, have the same requirement as like a hospital system does. So a hospital system, that may be a way that you could do that.
But if you're trying to seek, you know, more specialty care with a group that's not part of a hospital system, your ability to access without some level of coverage is going to be significantly reduced. So I'm concerned for, you know, certainly the folks that will become uninsured. And I think then, you know, conversely, of course, I'm concerned for the hospitals because, you know, you're going to have a very significant portion of folks where not only are you having that reduction of services, but they still may be coming and still need to come receive that care.
So you're providing that, you're maintaining all the costs, but now you're not having any of the reimbursement. So it's kind of a double hit, especially for rural, where it becomes more disproportionately high. So those folks then would go into the ER? Well, they could go into the ER, but there's also, you know, how the current charity care law, that's how, that's traditionally what would happen is you'd have that shift and you probably still will have the shift.
I anticipate that just because it becomes easier and there's lower barriers to just go into the emergency department, you know, and seek basically your basic, you know, medical care. But it also, with this expanded charity care, it also means that, you know, if they have some other condition that requires surgery or something else that's maybe even non-emergent or non-urgent, they, you know, still would have that ability and access to that care, you know, and, you know, on a human level, you know, I think they should. But then that becomes very hard to, you know, if you're trying to maintain, you know, financial viability of these nonprofit organizations and you're providing all this additional care, it's really hard to balance that and maintain that and, you know, keep your doors open.
So I think that becomes the challenge. Now, again, I'm confident MasonHealth, we will navigate this, but I think you spread that out to more fragile, vulnerable rural hospitals in particular, but I think you could also apply this to inner, larger inner city hospitals, I think are going to be very vulnerable to this as well. They may not be able to navigate, you know, this big transition in 2027, 2028.
And I think that's where there is a real fear that, not just a fear, but a reality that, you know, as things are currently situated with both the cuts at the federal level and then the state laws as they're currently written, I think that just sets it up where you will have hospitals that likely will not be able to continue. You know, they continue operating in that environment. The state has a distressed hospital grant pool.
It's $10 million, which across the state, in my mind, doesn't sound like it's a lot of money to be spread across, but is that something that you've looked into or talked with your counterparts in other rural hospitals about and what would that go to? Yeah. So, you know, I don't want to name, Mason will not touch that, you know, because we won't need that. And there are hospitals that will have a more urgent need, you know, to touch that.
And, you know, I don't want to name names, but I can think of probably about half a dozen rural hospitals that will need that. I can also think of a few that have already tapped into that fund, you know, in the last year or two. And, you know, what that will mean is, you know, it might give them another month or two of meeting their payroll, but it's a drop in the bucket.
And I think, you know, the state will need to add, you know, probably another zero or two in order to truly help, you know, maintain, you know, access within these communities. And I know in the feds, they're looking at rural transformation and they are trying to give some additional monies, but it's not close to kind of offsetting the cuts that are happening over the next 10 years. And so I think if the feds are truly committed to maintaining access in the rural communities, and I actually think they are, I think they're going to need to do more and kind of revisit the approach that they at least started within the bill that was passed.
So, and again, that's why it's valuable to have this runway, because I do think, you know, both at the state level and at the federal level, there actually is a lot of support and political support on both sides of the aisle to keep rural healthcare and maintain rural access and rural healthcare. So I think it's just both at the state level and federal, I think they're going to need to do more and I think they're going to have to get more creative than, you know, the current situation. What you were talking about, I think, is that rural hospital stabilization fund, about $10 billion that they were, that does start in 27.
You guys have been pretty aggressive over the year in your expansion efforts to meet your patients in brick and mortar, elsewhere outside of just Shelton property, you got the Hoodsport facility, you have a physician who works closely with the Skokomish tribe and things like that. As you look at these potential cuts in the future, does that put a pause on your continued expansion efforts at all? Yes and no. I mean, where the pause would be is on, you know, further capital investments, you know, the current round of capital investments.
So for example, we have to replace an open MRI. If we didn't make this $10 million investment, we would no longer be able to provide, you know, MRIs and open MRIs and that's just a basic need now within any community. And so we will slow down our capital spend for the next year or two as we kind of assess things.
So it just means we won't be expanding facilities. We're still going to be replacing things. We're not going to stop spending money.
We're just not going to do any further, you know, campus expansion probably for the next year or two as we assess things. So that's where there might be a micro pause. But at the same time, so that's the yes and then the no part, you know, of the yes and no is there's still a massive community need.
So we just finished a market study, you know, looking across different service lines and just to give you an idea, primary care. Mason County needs another 11 plus primary care physicians, you know, just to get to kind of average, you know, kind of the average number of primary care providers per thousand residences, just to put it in that perspective. And so even with a significant reduction in Medicaid coverage, we still need more, you know, primary care providers to meet the needs.
So we need to continue to expand primary care. I think that the other area that, you know, where you look at vulnerabilities, well, you can look at, you know, you know, obstetric services where, you know, that with, you know, delivering babies, disproportionate Medicaid, I think in any community, rural or urban, but in a rural community like ours, you know, that tends to be 80 plus percent Medicaid. You know, younger population tends to, you know, be more covered by Medicaid, especially for those delivering babies.
And so that absolutely will have an impact to us, you know, with that reduction. However, the other side of that is one is we still think there's that obstetrics and deliveries are going to continue to grow. We think that we can continue to grow that percentage of market share that we provide, and we've been doing that over the last decade.
And particularly the last couple of years, we've really grown market share, meaning more people are coming back to Mason County to deliver that might have been delivering outside the county, you know, typically in Olympia. More and more people are coming back here, and we think we can continue that trend. The second side of that is it's OBGYN.
We have a massive opportunity on the gynecology side, and gynecology tends to be older patients, tends to also be, you know, Medicare eligible or age patients. And so we've been expanding significantly on the GYN side with some of the recent changes that we've had in that service line, and I think that's another area as we continue to focus on that piece and serving and seeing that massive need within the community, because the over 65 part of the population is what we're projecting over the next five years to grow like 11 plus percent, you know, whereas the rest of the, you know, under 65 is probably going to be about flat within Mason County. So there's a huge growth, and it's a huge opportunity to, you know, service that area.
So that's how even within service lines, we're looking at how we can shift and mitigate some of these Medicaid cuts. Finally, let's talk kind of on a little more positive note about the rest of this year and next year for the hospital, some of the other things that you're excited to talk about and share with the community that's going on here. Yeah, I mean, I think we're, so what we're really, you know, it's this deep focus on doing what we do, which is care delivery.
Sounds pretty obvious, but I actually am very excited. We're continuing to expand cardiology, you know, we're continuing to expand within some of our current service lines like primary care. We're currently actually trying to add and expand into a new location just because we're in the process of, with this latest round of construction, we're completing, we had shelled, you know, 11 exam rooms in the Mason Clinic, the large, you know, 60,000 square foot clinic.
We're now finishing that out, and we're already, you know, have recruited the physicians that will be filling that space. And so we're looking at another auxiliary space where we can start to move and continue to expand primary care. So it's really focusing on that.
And then I think there's some other areas where, you know, I'll just go back to some things that I mentioned. As we're looking at where we can improve, you know, access, I think there's a deep focus on just engaging back within our medical staff. We have amazing medical staff.
They're really high quality individuals. They're very committed to the community. And so we're working back with them on to creatively, how can we continue to expand access? One thing that through the early conversations that surfaced is a recognition that we weren't doing lung screening through CT scans.
We're having to send those patients, which it was roughly 1,000 patients a year that we were sending outside the county because we hadn't had the program set up to be able to do that. You need to have a lung navigator and some other types of things that you have to have in place to be able to do these lung screens. We've now, as a result of really just laser focus on access, that surfaced as an opportunity.
We quickly mobilized a team. We've put that program in place and we already within, I think it was a little over two months, we were able to put that program in place. So that's 1,000 patients that aren't going to have to go outside the county.
That's, you know, roughly a million dollars in net revenue that stays within the county. And so there's those kinds of opportunities that we're really looking at, you know, how do we continue to, you know, create that local access, you know, serve our community. So I'm just plus plus about that and just staying focused.
And that's where it's like both short term, you know, I think we have, you know, a lot of, yeah, we have a lot that we're going to have to navigate, a lot of challenges, no doubt. But I also think there's a lot of really good opportunities, even in the short term. And so staying focused on those opportunities, you know, and then, you know, medium term, yes, navigating the turmoil in 2027 and beyond.
But then long term, it's like, gosh, I told staff this, but I would absolutely bet the house on the future, a long term future of Mason Health. You know, I think it's a very bright future. The organization's well positioned.
I think that's where we're going to keep our focus on that over the short term. Good conversation here. I think a lot of folks, as we mentioned, saw the bill come out.
And right as it came out, people were scouring through it, finding different parts that they keyed in on. And the Senate Democrats in D.C. put out a list of hospitals that and Mason Health was on there, including a couple others in Washington State. And without fully understanding all the impacts and repercussions, kind of focused in on that name there.
And rightly so. You see it. You get a little concerned.
You wonder what's happening to your local hospital. But the good fiscal stewardship over these last many years, I think, has really positioned you guys good. And this was a great conversation for folks to better understand that the hospital will be here now and into the long term with continued care and continued expansion where and when appropriate.
So thank you so much for the time, because I know you're a busy man and there's a lot of people out there asking these questions. And so I think this is really going to help. Oh, thank you, Jeff.
This is really important. I really appreciate you taking the time to actually shine the light here on this and help us have this kind of conversation. I think it's really important.
So thank you. Yeah, thank you.