One of the most unique projects of my architectural career was a replacement facility for Weems Memorial Hospital, a hospital near the mouth of the Apalachicola River at the tip of Florida’s Big Bend. Six years after our initial concept sketches, the project is still nothing more than a drawing on a wall, but Mike Cooper, Weems’ new CEO, is confident construction will begin next year.

“Before I came here, we started with a replacement facility, then developed a conversion and addition scheme, then a smaller addition. All were over budget. The Board of Commissioners set a $10.2 million budget, thinking we would not be able to meet that and they wouldn’t bear the blame. But our latest iteration, which includes renovation and some addition, comes under budget and achieves critical operational changes we need to stay in business.”

Mike’s review of the process requires clarification. A hospital is point of pride, and safety, and jobs, for any community. Weems is the only hospital in Florida’s Franklin County. In 1997 Congress passed legislation establishing ‘Critical Access’ designation to rural hospitals that are at least 35 miles from another facility, run a 24/7 emergency department, and have 25 beds or less. Critical Access designation provides some financial cushion for small hospitals, but it does not guarantee they will stay in business.

Mike explained the unpleasant reality of Weem’s business model. “Forty percent of our business is indigents or Medicaid. We get fifty cents on the dollar for Medicaid patients, zero for indigent care. When I spend a dollar on direct care, I’m only taking in sixty cents.” What keeps Weems in business is a one percent county sales tax designated for healthcare. The County Board of Commissioners controls that purse; they have established Mike’s $10.2 million capital budget. “There’s enough money to make the project happen; this area has rebounded from the recession pretty well.”

Mike has worked in rural healthcare in Kentucky, Indiana and Idaho prior to coming to Florida. He appreciates rural life, though doesn’t consider it as unique as local folk imagine. “People say their part of Americana is special, and it is, but all of these places are essentially the same good place.”

From Mike’s perspective, Weems needs this facelift in order to stay alive. The current facility, which hasn’t been updated in over fifty years, requires multiple staff at ED and inpatient areas. The new layout will streamline staffing. “With a patient census in the two to three per day range, and variable ED traffic, we need to have all clinical activities controlled from one point.”

However, Weems’ largest challenge is probably not the location of its nurse station. Twenty-three miles to the west, the Sacred Heart System recently opened a new hospital in Port St. Joe, close enough to lure patients seeking a new facility even though it is in another county.

It is very costly to maintain a full service hospital in a community as small and remote as Apalachicola. If the county wants to keep Weems afloat, and improve the healthcare Weems can provide, it will require subsidies as far as anyone can see.

How will we live tomorrow?

“I think we are going to be very much defined by technology. Look at education. In Florida and Kentucky you can get a high school diploma and never step foot in a classroom. It is only going to increase as the Millenials have children. Traditional schools will go away and be replaced by a YMCA or Boys’ and Girls’ Club for focused activities.

“From a healthcare perspective, technology will be the order of the day. Small hospitals will go away as we do more with remote procedures and diagnoses. The technology already exists. Right now hospitals would jump on it, but there are no reimbursements for it.

“We’re going to see the demise of the family practitioner. You want a relationship with a doctor, you’ll have a relationship with a mid-level – a nurse practitioner or a PA – who will refer you to specialists. You’re going to see a change in credentialing for nurse practitioners. They’re going to need a doctorate degree. Pharmacists now need a doctorate; physical therapists need a doctorate. Right now, nurse practitioners are the only ones at that level that don’t need a doctorate, and they can prescribe medication.”