Implementing Change with Bappa Mukerji

Bappa Mukherji: They said, "Look, we've got five weeks to figure this out." And I said, "You really don't have five weeks to figure it out. You really have about two weeks to figure it out. As soon as people have heard this announcement, they're looking for other jobs." And I said, "If we don't have a solution for them in the next couple of weeks, there's going to be so much momentum to close the hospital that there's not going to be any way to keep it open."

Host: You just heard from Bappa Mukherji, the chief executive officer of Java Medical Group, the organization that manages Lakeland Hospital. He was brought to Haleyville, Alabama, in November of 2017 where he was asked to create a plan that could keep the hospital from closing. In this episode, Bappa walks us through the process of bringing together the Haleyville community from residents to legislators to nurses all to help Lakeland stay afloat.

Bappa: We went to the local hospitals in the neighboring towns that were offering these people jobs, and we said, "Hey, look, you know what the situation is. We're really trying hard to keep this hospital open. If you make a job offer to them, would you just hold it for 30 days?" And amazingly, everyone said, "Yes," they would do that. For really no gain at all.

Host: This is Health IT on the Record, presented by MEDHOST, a show that dives into how innovations in health information technology impact every aspect of a health system for multi-hospital networks down to individual patients. In a moment, you'll hear Bappa discuss changes real hospitals need to implement in order to stay relevant. He'll also explain the importance of using a variety of resources for financial support. Enjoy the conversation.

Bappa: Hello, my name is Bappa Mukherji. I'm the chief executive officer of Java Medical Group, and we manage Lakeland Community Hospital in Haleyville, Alabama, on behalf of the Health Care Authority.

Host: Excellent. If we were to start somewhere, kind of on a timeline, rewind me back, when was it you first got connected to this place and what were the circumstances?

Bappa: Let me think about that for a second. It was the last Sunday before Thanksgiving.

Host: And the year is what?

Bappa: That was last year, so 2017. Got a text message from one of my business partners that he had seen a press release that a hospital in Alabama was going to be closed on December 31st. So five and a half weeks later. And he lived in Alabama. He had gotten a phone call from the state representative that represented the area where that hospital was located. Said, "I know you're in the hospital business. Is there something that you can do to look at the situation to see if there's something you can help?"

I called him back on that Sunday and he said, "Well, what do you think?" And I said, "Well, we can talk to them. I have no idea. I don't know where Haleyville, Alabama, is honestly. I don't know anything about the hospital. I've never heard about this hospital." Just saw the press release and said, "It'd be a shame if 200 and some people lost their jobs, and a city of 5,000 people lost their hospital, so sure, let's at least talk to them."

My background previous to that, I started out as an attorney, and I did a lot of mergers and acquisitions, much of it in the healthcare space. Quit practicing law in 1997 and got into business for myself where we had gotten into buying hospitals, surgical centers, ancillary centers, diagnostic centers, and so forth. And so we had had experience working in the rural healthcare space before, and we were currently managing a hospital in Manchester, Tennessee, in, again, a small, rural hospital.

So on the following day, that Monday, my business partner got us in touch with the chairman of the county commission and their attorney and they kind of explained the situation that they out of the blue were told that the hospital was closing. Had been given no previous warning. There were no warning signs for months before saying, "We are considering this," or anything else. That they saw the press release at the same time everyone else did.

But they said that next day, Tuesday afternoon, the CEO of the hospital management company was coming in to explain what was going on and asked if I would make myself available to come down to that meeting and just give them some options, listen as an advisor, and tell them what they could do. And so we did.

I met my business partner in Huntsville, and he drove me here. I still did not at that point know where Haleyville, Alabama, was, despite the fact I was in Haleyville. I didn't know where I was on a map. Drove by the hospital on the way into the city council meeting where they were going to talk about the hospital, and that was my first, really, introduction to this hospital in any way, shape, or form, and heard the story, the challenges that they were facing. Why the hospital management company had decided to close this hospital.

And as you can imagine, there was a lot of concern. At the meeting, they had the mayor. You had all the city council members. You had all the county commissioners. You had senators, state legislators. You had folks from Washington, D.C. in. I mean, you had a large collection of people that were concerned.

Host: Right here in –?

Bappa: In Haleyville, Alabama.

Host: And for context, it's a small town. This is a classic, rural community. You're talking about driving in, there's this amazing, beautiful forest area, a park, that you drive through, and it's like a vortex to this beautiful community.

Bappa: It is a beautiful community. It's a small town. It's about 5,000 people that live in Haleyville. There's about 12,000 people that live in the county. It is very isolated because of the forest. It's surrounded by Bankhead National Forest, so it's hard to get here. And you don't have any major state road that comes right through Haleyville, so it's a little bit isolated.

It also created concern on the healthcare side that if something happened here, even though you may only be 35 miles from the next closest hospital getting to that hospital can take 45 minutes or so, and that's a lot of time in a critical situation. The city council kind of heard the story, what the challenges were. They were forecasting that the hospital was going to lose 2 and a half million dollars the next year and, frankly, the hospital management company said they couldn't afford to keep it open.

And after that meeting, the local elected officials called me in and said, "Well, what did you hear? What do think?" And I said, "Look, I don't know anything about it. I heard one announcement and one presentation. A lot of what they're saying makes a lot of sense. I mean, operating hospitals in a rural environment is a challenge right now, and I certainly understand a lot of the concerns and a lot of the things that they were talking about, but there were also things that I didn't hear as to what they had tried to fix it.

And they said, "Well, can you help us?" And I said, "I'm not sure what you want me to do." They said, "Well, we want you to buy the hospital." I said, "I know nothing about this hospital. I haven't ever walked into it. I haven't seen a single financial statement. All I've seen is a press release and a 30-minute presentation by somebody about how bad the situation is."

Host: That's pretty convincing. That's a great opportunity. You've got to get in on the ground floor on that one.

Bappa: So they said, "Would you at least spend some time looking at it and give us some options?" And I said, "Look, I hate to see a hospital shut down." There is a lot of concern in the room. Everyone was there to try to solve a problem.

Host: And if it is at the point of shutting down and if would have shut down the likelihood for it to reopen?

Bappa: Nil. There was no chance.

Host: There's no chance, right?

Bappa: No, and this is something that they realized. And they said, "Look. We've got five weeks to figure this out." And I said, "You really don't have five weeks to figure it out. You really have about two weeks to figure it out. What's going to happen is as soon as people have heard this announcement they're looking for other jobs and they're going to start taking those other jobs."

Host: They have families, and this is around the holidays.

Bappa: Exactly. It's right before Thanksgiving. Literally, it was the week before Thanksgiving that they were making this announcement. And said, "If we don't have a solution for them in the next couple of weeks, there's going to be so much momentum to close the hospital that there's not going to be any way to keep it open." And on top of that if this hospital closed because it was built 40 years ago. It was actually built exactly 40 years ago. It's not up to today's codes and regulations.

Host: Yeah, with air quotes, right?

Bappa: Right. So you would have to bring it back up to today's, and that's costing you probably tens of millions of dollars, and realistically it makes a lot more sense to build a new hospital. No one's going to do that if they just saw a hospital fail in this community. So once it closes, you really don't have an option to open it. Not a realistic option to open this again.

We said, "There's a variety of things that you can look at. You can look at really scaling down the level of services, so you could at least take care of critical situations like heart attacks and strokes and kind of stabilize those and get them moved on. That will lose money forever. That does not have any chance ever of making money, so there would have to be some kind of subsidy to maintain the hospital, as it were, during that period of time. Alternatively, we can look at other solutions."

And so the next week I got all the financial information. Spent a lot of time pouring over it and found the plan that I thought could work. And it was pulling together a lot of different programs, and it was going to take some help from the community in order to turn it around.

So that next week I went back. Called that same group of people together, and said, "Look, it's not going to be an easy solution, but if somehow or another the city, the county, whoever, can put together some financing that will help give the hospital some money, so they could effectuate a turnaround plan, here's a turnaround plan that I think can work. And it's going to take two and a half years and it's going to take $5 million, but at the end of it, not only will the subsidy not be necessary, this hospital will be profitable on its own and it should have long-term viability."

So I said, "But it's not easy." And they looked at the plan, and we can talk about the specifics, but the first step of the plan is, "You've got to find money." And they said, "Look, we're willing to pass a sales tax increase and institute a property tax increase in order to raise some revenue in order to move this thing forward." And said, "Okay. Well, then what you need to do is create a Health Care Authority, and you've got to do it quickly. We really don't have a lot of time. We've got to create a Health Care Authority to buy the hospital."

I said, "And if you did the Health Care Authority that was going to be an extra $200,000 of Medicaid money that the hospital receives." I said, "We could buy it. I'm not sure I'd want to buy it right now, but if we bought it, it's one thing. If the Health Care Authority buys it, it's an extra $200,000 a year, which is eight percent of the amount that the hospital was expected to lose, so you're already making a pretty significant cut add.

So they managed to within the next two weeks decide that they were going to create a Health Care Authority and created a Health Care Authority. They had looked at a sales tax, and they said, "Well, here's what we're going to do. We're going to pass this sales tax. It's going to sunset in ten years." And I said, "Look, we're going to have a problem. If we sunset the sales tax that's not going to show any financing sources if there's a long-term commitment, so push back on that." And they said, "Okay. We understand. We're not going to sunset the sales tax."

So as this thing progressed, the city got involved, the county got involved, and we had state government involved. We had the federal government involved. And at all levels, everyone at least got behind the idea of, "We need to find a way to keep the hospital open. People of Haleyville, the citizens of Winston County, Alabama, deserve to have this hospital. It's a necessary component of the fabric of the community as well as obviously the healthcare and the well being of the community."

So we really had nobody push back against the idea of trying to keep the hospital open, which is an important component of it because we needed help. We were on a very abbreviated time frame in order to make anything happen. After two and a half weeks, we were able to announce a tentative plan in order to keep the hospital open.

So we went back to the existing hospital management company and said, "Look, there's a lot we need to do. We've got to have a Health Care Authority, we've got to have a sales tax, we've got to have a property tax, we've got to have all these things happen. And it can't happen between now and the end of the calendar year. Would you be willing to keep the hospital open another month in order to allow us to show you that all these things were moving forward?"

Long story short, they agreed to keep the hospital open provided the city would agree to fund any losses that the hospital incurred after the December 31st date that they were going to close. So we went back, negotiated that out, agreed to keep the hospital open at least another month in order for us to effectuate the next steps of this plan.

Now, the hardest part was trying to keep the hospital staff during this period of time. Obviously, for weeks, if not months, prior to there was no hiring going on because the hospital was going to be wound down and closed. On top of that, you really in good faith are not able to hire people and say, "We don't know if this hospital is going to be here more than seven or eight weeks. Why don't you change your life and come and take a job with us?" So it was hard to find anyone from a management perspective, or even from a nursing perspective, or any job to come in and say, "Hey, we don't know if we're going to be here or not."

So we were really, really reliant on the staff that was already here that had stayed with us that long. And boy, did they do an incredible job of working to keep this place open while we were going through this. Something I failed to mention that first night when we were leaving the meeting and I was driving back to Nashville, and I was driving with my business partner, and we were driving again past this hospital, I said, "Hey, we should probably walk in there." We were talking about it. "We should probably just walk in there and take a look at what this place is."

And it's huge. You can see it from outside. It's a three-story building in a small town. It's probably the biggest building in the town. So it's a massive structure. Anyway, we walk in, and it's late at night, and on the bottom floor here, it's really administration, so there's nobody on the bottom floor. And we're walking kind of into an empty building.

But as we walked in, said, "Wow, not only is this place large, they've kept it up incredibly well. It's a beautiful building." You couldn't tell it was 40 years old. I mean, the floors looked great. The walls looked great. The hallways looked great. Everything looked really, really good. So it was really well maintained. You could tell that some people took some pride in the hospital.

And so we went up to the third floor, which here is where med-surg is, and went to the nursing station. And we didn't tell anyone who we were, but we were dressed in suits, so they probably had some idea. And we just said, "Hey, we'd come from this meeting and we heard they were shutting this hospital down."

This was probably eight o'clock at night, and there's a handful of nurses sitting at the nurses' station, and we just started hearing some stories about how much they loved the place. Somebody told me it was the only place they'd ever worked. They started after high school and they'd been here ever since. Met someone who'd been here 27 years. Just some incredible stories.

And they were talking about how it was like family here and how they were so disappointed to hear what was going on. And, of course, in this period of time right before Thanksgiving, there was some Christmas decorations that were up, and on the wall as soon as you walked out from the elevator, there was a sign that said, "Dear Santa, all we want for Christmas is to keep our hospital." So we left that night, got back in the car, and I said, "Man, if everyone that works there are like those folks we just met, it really is worth trying to keep this place open." And that's when we really were kind of inspired to say, "Let's just really dig in and look at this."

And they didn't disappoint. I mean, through the end of December and all the way through January no one complained. Worked double shifts. Worked five, six days in a row. Did everything that they could. I said, "Look, we're not going to do anything to endanger a patient, but we can't shut down services. If we're in a shutdown mode, it's going to create a shutdown because you can't bring it back once you've turned it off." So everyone just stuck in there.

And, amazingly, if you want to talk about a community effort, we went to the local hospitals in the neighboring towns that were offering these people jobs and we said, "Hey, look, you know what the situation is. We're really trying hard to keep this hospital open. If you make a job offer to them, would you just hold it for 30 days and give us a chance so the employee is not going to risk losing that job? That we can hold onto them for 30 days, if they're willing to work with us for that 30 day period. And amazingly, everyone said, "Yes," they would do that.

Host: Wow.

Bappa: And they could have been looking at it as an opportunity. "Hey, I'm going to get more business if that hospital shuts down." But instead, they said, "No, we'll work with you on that," for really no gain at all. And we're not talking about one or two. We're talking every neighboring hospital. And every neighboring system said, "Yes, we will do that for you."

Again, we're talking about what it takes. It takes a great community pulling together in order to make this happen. And that's what was going on right here. Again, it was inspiring. It was really rewarding to be part of it. And at the end of the day, that one-month extension turned into a three-month extension to keep the hospital open. The city did do what they wanted to do. They did pass the taxes and created the Health Care Authority and used the taxes to fund the Health Care Authority. We helped them negotiate the acquisition of this Lakeland Community Hospital.

And then they asked us to come in and manage it for them, which really wasn't part of our plan. Had a day job already. They said, "Look, it was your plan. We believe in this plan. Come in here and help us run it." And so we did. Created a company to help manage the hospital and have been here really managing it since January 1st of 2018. And we're almost on the one-year anniversary now of the announcement that the hospital was going to close.

Host: Health IT on the Record is brought to you by MEDHOST. With over 30 years of experience partnering with providers, nationwide MEDHOST is helping evolve better solutions for health care management through innovative workflows and technologies. For more information, visit www.medhost.com. Let's jump back in.

Host: I love how you've been able to rewind us back and to really take us to this place and theme of a shared belief and a shared pride in this place and how through all these different partnerships and the community, I've heard it called the Christmas miracle, was able to work out. It's really neat.

So we're going to come back in just a moment. We're going to talk about some of the specifics of the plan that you were just talking about, and we're going to talk through some other challenges that you were facing. I know you shared one challenge of staffing and hiring. There were some other challenges that you and your team, your leadership team, had to face.

And so I think it's going to be really helpful insight for other rural health care communities to learn from. So before we get to that, one insight, the government came together, all these different people came together so quickly. Have you ever seen something like that happen?

Bappa: I personally have not. I think we brought our first hospital in 2002, so we've been involved in health care and it's always been rural health care for a long time. And in this particular case, and I was talking to my business partner who also happened to be a state representative, not for this district, but a state representative.

And I said that to him when we were driving one day, I said, "I am just absolutely amazed at how at every level of government everyone has come together and supported us." Whether it was a state agency, whether it was a federal part of the government. Anything local, county. Everybody pulled together and everybody tried to help us. And what he said was, "Governments still work at a local level. It's just as you get bigger that they really start becoming more complex and more difficult to work with." And obviously, he's in state government and I'm sure he believes that. I don't know if I believe that, but I certainly saw it happen here, where there was just a strong consensus.

Now, I will say that there was also strong leadership in this community that said, "We're not going to want this hospital to close." I know you're going to talk with the mayor a little bit later today, and he really was a fantastic, strong, dominant leadership force to make this happen, and he kind of corralled everybody around it and said, "This is what we need to do." And we were fortunate to be the person that they called to help them. So yeah, it really did come together.

And it was not just government that came together. I mean, it was the staff that came together. It was the community itself showing up at meetings. We had said, "Part of our plan, we'll talk about is that we needed to do more preventative health." Something you can still do in rural communities. And said, "We needed to put together a wellness plan." I said, "We needed 2,000 people to sign up." There are 5,000 Medicare beneficiaries in this county. Said, "I need 2,000 of them to sign up for a wellness plan."

And within two days we put up a website and we had 200 people sign up just in the first two days after we just said, "Hey, we need this to happen." I mean, so this thing kind of took on a life of its own of the whole community coming together to save their local hospital.

Host: Up next, let's talk through some of the challenges. You said something earlier on: operating a rural hospital right now is challenging. So I want to hear about some of the challenges that you've faced and some of the ways that you were able to overcome those.

Bappa: Sure. I mean, everywhere across the country, rural hospitals are struggling, and the reason they're struggling is not because the communities don't need those hospitals, or because there are bad people working in those hospitals or running those hospitals. It's because the way reimbursement has changed over time has put a lot of pressure on rural hospitals.

And what we're really talking about most of these hospitals were built 30, 40 years ago. They're not recent built hospitals. They're older hospitals. So 30 and 40 years ago the emphasis of how reimbursement worked and what hospitals were looked at were inpatient facilities. When you think about a hospital, you probably either think about a hospital room with the nurse walking in to take care of you or you think about the emergency room, and you don't think about outpatient surgery or diagnostics as much. That's not the first thing that popped into your mind when you think about a hospital.

Well, today's world, it really is about diagnostics. It's about preventative care in rural markets because the higher, more acute cases are all going to the bigger cities where they have the additional resources. So what's that created over time is there's a trend if you have a declining amount of inpatients both the number of inpatients and the average length of stay has come down for a number of reasons. Part of it is because we do have better preventative health, but part of it is just because of the way you're reimbursed when doing to a DRG based system and you're penalized if the patients stay too long, so you've got the incentives to try to get them out.

So you've got hospitals that were built around an inpatient model that have to adapt to the fact that that model no longer works financially for those hospitals. Still works in the urban environment, but it's really difficult to make that work in the rural setting. So what these hospitals need to do is adapt their business models to continue to stay relevant for their communities. And when I say relevant, they better offer the services that can be done effectively and profitably in a rural environment in order to make it work. And to me, that is more diagnostic, preventative health as opposed to acute care.

Now, that doesn't mean you're not going to have an emergency room. Doesn't mean you're not going to take care of the lower acuity patients. Obviously, you don't want to risk anybody's life because you want to keep them in the hospital where they don't belong. But for the average patient that has the flu, or pneumonia, or COPD, or something that doesn't have a high acuity, those are the appropriate patients to keep as an inpatient. But really what you have to be looking at is, how do we expand the service offering to be relevant today?

And unfortunately, if your hospital is struggling because you're kind of fighting this reimbursement model that's not working for you, having the investment dollars to be able to expand diagnostics or add surgeries or some other things, very challenging. And it's not that a lot of them don't know what they need to do, it's just they're in an environment that it's almost impossible for them to get the resources to do what they need to do.

And on top of that, access to capital in rural hospitals is difficult. If you owe to local banks who are very vested in wanting to keep their hospitals open, the problem is often you're looking at millions of dollars and some of these smaller banks just don't have the ability legally to lend millions of dollars, and almost invariably they have no experience in healthcare lending and healthcare lending is its own little world. So you've kind of got two strikes for the people who want to help you to be able to help you. And again, it creates a very difficult set of circumstances in order to run a small hospital today.

Host: So how do you, from your vantage point with something that is so complex, so specific, you have to have the right people you're working with, which one or two things have worked for you?

Bappa: Sure. There have been all kinds of programs that have been developed to help smaller hospitals, and the problem is you've got to know about all of them and you've got to use almost all of them. If you've cut yourself off from being able to use them, then, you just don't have all the tools in the toolbox in order to make it work.

And the problem is now you just can't use a hammer or a screwdriver, you've got to use a hammer, a screwdriver, a drill, and everything else in order to make it work because you've been hit on your reimbursements every place else, so if you don't use all of the tools, you're not going to be able to make it work.

So some of the things that you need to do – for example, in this local community, we said, instead of it being privately run, even though it was a non-profit, it was a private non-profit, said it needed to be a public nonprofit because all of a sudden now you're getting some more Medicaid dollars in. And said, "Now this hospital qualified to have a 340B pharmacy," but they weren't running a 340B pharmacy. So that was a program that we needed to look at and start.

They had been recruiting physicians, but they had been recruiting physicians under income guarantees where they really needed to be recruiting these physicians into provider-based rural health clinics because you can get some additional reimbursement there. So we kind of looked at, if we tacked all of these blocks on to the basic structure that the hospital was today, would that be enough to offset the losses?

So when we kind of put those blocks and kind of worked them and said, "Now, realistically do the assumptions make sense or is there enough volume to support this?" We found out, yes, this could work. This community could work.

And I'm not going to tell you that in every town in this country we need a hospital. There are towns that are not big enough. There are towns that are shrinking in size. Just people move away from them. But that's not Haleyville. Now, Haleyville is geographically rather isolated, but it's a vibrant community. It's got low unemployment. They're attracting people to good jobs. This was not a town that didn't need to have a hospital.

So again when you put all those building blocks together and said, "Can you make all this work?" Our answer was, "It's not going to be easy, it's not going to be fast, but it is certainly possible."

Host: As we're slowly starting to wrap up, this has been such a treat to get to talk with you, and it has been such an amazing story, but challenges. So staffing and hiring we've talked about keeping up with a relevant service offering. Is there another challenge that comes to mind that really had to be overcome for this all to work?

Bappa: Yeah, absolutely. One other thing that this hospital was struggling, and one of the things that happens is, well, when you're struggling, you get a little bit behind with your vendors or you get a lot behind with your vendors. And so, we were having to deal with the fact that you had a lot of people threatening to potentially cut off services. A lot of people that were owed a lot of money.

And a lot of people that, if they stopped providing services to the hospital, again, the hospital cannot function. If we don't have drugs, if we don't have supplies, if we don't have electronic medical records, if we don't have some of the basic building blocks of running a hospital, we don't have a hospital again.

So some of the things that we had to do was reach out to a number of the critical vendors and ask them if they were going to be willing to work with us, and if they were going to be willing for an extended period of time because it wasn't an overnight fix, but are they willing to work with us and to allow us to have that opportunity to continue.

It would be great to get everything put together and all of a sudden the drug company says, "I'm sorry. We're no longer going to provide you pharmaceuticals." Doesn't really matter if we have the staff. It doesn't really matter if we have the equipment. Doesn't matter if we have the financing if, at the end of the day ,if someone says, "We can't do this."

So we did reach out to a number of the key vendors. MEDHOST comes to mind because they were first and foremost the electronic medical record, and if we don't have an electronic medical record, we don't have really anything. And they were amazingly willing to work with us in order to restructure what they were owed, and on top of that, to take on additional services because right now we didn't have the business office here. It was centralized with the previous management company. As we were breaking away from the previous management company, we needed to have a way to run a business office.

And with all the moving parts of trying to put this together in an incredibly short period of time another challenge of, "Hey, if we mess this one up, especially since it's our dollars and cents, if we mess this up in any way that again it's going to create a risk that was unacceptable." And so were fortunate to be able to negotiate with them, again, on short order to not only renegotiate the way that we were going to pay them, but that they would pick up additional services for us and manage that for us.

And that was tremendously beneficial to us and really don't know if we could have made this work without MEDHOST and a number of other vendors looking at it and saying, "Yeah, this is worthwhile. We are willing to work with you to help you through that process."

Host: I love the whole story. I hear you loud and clear. MEDHOST was definitely a part of it. There's a lot of people who had to come together to make this happen and cheers to you and your team. I'm really excited to see the future here. Any final things on your mind or on your heart that you want to leave us with?

Bappa: Well, first of all, I mean, this wasn't going to happen without some tremendous leadership, and that came from the mayor, it came from the city council and the county commissioners. It came from the tremendous efforts of the people that work in this facility. We have a lady that has worked in this facility since the day the hospital was open for over 40 years, and it's amazing that group of people and I'm glad we could keep that group of people together.

Since the time that we've taken it over, we've created jobs here. We've hired significant numbers of more people. We've added services here. We have now brought in an interventional radiologist. We've brought in a cardiologist. We have brought in an orthopedic surgeon. So now we are bringing services that Haleyville has never had before, ever, to this hospital, and that's part of the plan of increasing these relevant services.

Now, we're not going to start doing total joint replacements tomorrow, but over time, if it becomes necessary and something that we can do, we're certainly going to start doing simple orthopedic surgeries and hernia repairs and gall bladders and things like that immediately. With an interventional radiologist we've brought services again that never have been done in this town before, but now are being performed here. And that's really part of what we're trying to do is just bring the right mix of services here, marry it with the right group of people, and so far so good.

Host: Thanks again. I look forward to continuing the conversation in the future.

Bappa: Thank you very much.

Host: Thanks for listening to Health IT on the Record presented by MEDHOST. For more stories and content like this, be sure to visit medhost.com/resources. Thanks.