An ambulance prepares to leave the Washington Regional Medical Center in Plymouth, which is currently under renovation and reopened in April under new ownership. Calvin Adkins / Carolina Public Press

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Editor’s note: COVID-19 poses an increased risk for severe illness or death in people over 65 years of age. Carolina Public Press previously identified 20 North Carolina counties that have the highest percentage of their population in the high-risk age range for COVID-19, nearly all of them rural. This is the fifth installment in a six-part series looking at hospitals and health infrastructure in those counties. This article focuses on a cluster of six northeastern coastal counties, including Washington, Beaufort, Perquimans, Chowan, Pamlico and Carteret.

When Frank Avignone decided to buy an ailing critical care hospital in Washington County, he had no idea that a global pandemic would turn the world upside down for owners of hospitals.

Initially hired to manage Washington County Hospital in Plymouth as it sat in bankruptcy, the owner and CEO of Texas-based Affinity Health Partners was ready to purchase the 25-bed facility in January with an eye toward eventually building a completely new hospital in town.

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“We got our first patients back on the floor in July of 2019,” Avignone said of his health care management team.

But as the new coronavirus that causes COVID-19 took root, the purchase date was delayed, and Avignone spent his time renovating parts of the hospital and opening a primary care center across the street.

Finally, on April 23, the Dallas-based entrepreneur completed his purchase and rebranded the hospital as Washington Regional Medical Center, which has now been certified by the state as a nonprofit.

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Avignone said he has big plans for the facility. He envisions it as a hub for coordinated care that both receives and hands off patients within a network of area health providers.

In the process, he also hopes to help his hospital and others achieve greater financial stability.

Avignone has already struck an oral agreement with Vidant Health, the Greenville-based nonprofit that operates eight community hospitals with 1,447 beds serving 29 Eastern North Carolina counties. 

“We send all of our patients to Vidant that we have to helicopter out that are too high acuity for us,” Avignone said, while receiving some patients needing rehabilitation services from Vidant.

“They lose money on a lot of those rehab patients, where we can take focused care of them in a family environment and we can make better revenue for them just because we’re critical access and we get 101% of our costs back plus reimbursement.

“So it’s a much better environment, and they basically can ship off their cost to us, and we make money, and the hospital thrives. So it’s a great relationship.”

Tough times for Vidant hospitals

Although not huge, Washington Regional’s relationship with Vidant comes as the Greenville-based system incurs additional costs brought on by the pandemic, including financial losses due to the recent suspension of nonurgent procedures.

Before the pandemic hit, Vidant Medical Center, the system’s flagship operation, reported net annual income of $107.3 million on Sept. 30, 2019.

But this March, Vidant laid off nearly 200 workers to address an $18 million budget shortfall for the first quarter of fiscal year 2020. Of the nearly 200 affected employees, 23 were located at rural hospitals across northeastern counties outside Greenville.

One month later, Vidant announced that it was enacting furloughs, reducing salaries and cutting employee benefits at its hospitals. Its CEO, Michael Waldrum, faced a 25% cut in “compensation.” Waldrum is paid $1.2 million annually.

Patti Kersey, chair of the Chowan County Board of Commissioners, doesn’t think Vidant’s recent organizational moves will impact the quality of services delivered to patients at Vidant Chowan Hospital.

“I have not seen any detriment in the services, nor have I heard of any,” she said.

Coordination opportunities for region’s hospitals?

Last summer, Vidant closed an inpatient behavioral health unit at its Beaufort County hospital in the town of Washington, citing pending changes in the structure of Medicaid reimbursements.

Washington Regional, located just north of Beaufort County in Plymouth, wants to build on its relationship with Vidant and initiate similar arrangements with other hospitals, Avignone told Carolina Public Press.

He hopes to coordinate patient care with Martin General Hospital, a 49-bed acute care facility in Williamston, about 30 minutes west of Plymouth. Martin General’s lease is held by Quorum Health, a national hospital chain that just emerged from bankruptcy after restructuring its finances.

“I would actually like to acquire Martin General so that I have a higher-acuity hospital in my health system to provide even more services and grow in Eastern North Carolina,” Avignone said.

“They do fairly well from a revenue perspective. I don’t think they’re in danger of closing or anything, but they could do a little better with a lot of focused attention and tied to another hospital where there were mutually beneficial gains for both facilities.”

John Jacobson, the interim CEO at Martin General, was not available for comment.

As for the types of services to be offered at the hospital in Plymouth, Avignone mentions “top-of-the-line” surgical services, orthopedics, ophthalmology, infusion services for cancer patients and dialysis, among others.

Meanwhile, construction workers have continued to blow out walls, redo operating rooms and lay a new roof on the reopened hospital, which was built in stages from 1957 through 1989.

“I would hope we could break ground in the next 18 months on the new facility,” Avignone said.

His strategic plan for Washington Regional Medical Center is one of a number of cross-border business approaches underway to ensure that six of the counties along the coast — Beaufort, Carteret, Chowan, Pamlico, Perquimans and Washington — have the medical infrastructure they need to serve the many older residents who populate the area.

Reliance on bigger regional partners

North of Plymouth in Perquimans County, Frank Heath, the county manager, said Vidant Chowan Hospital in Edenton and Sentara Albemarle Medical Center in Elizabeth City, to the northeast in Pasquotank County, serve his county’s residents.

Vidant Health Greenville and Chesapeake Regional Medical Center across the state line in Virginia are also available for more advanced procedures, Heath said.

An intercounty transportation authority run by Albemarle Regional Health Services, an eight-county regional health department, provides rides to medical appointments for older or disabled individuals who can’t get there on their own.

Telemedicine is also emerging as a growing safety net for older residents who are at a higher risk of falling victim to COVID-19 than the general population.

In June, the Federal Communications Commission announced that Greene County Health Care, a network of community health clinics in Greene, Pitt and Pamlico counties, was awarded nearly $1 million to strengthen the group’s telemedicine capabilities under the agency’s COVID-19 Telehealth Program.

The $948,576 award covers remote monitoring and diagnostic equipment for COVID-19 screenings and follow-up care.

To date, the six rural counties in Eastern North Carolina with largely older populations have been spared the elevated number of positive cases and hospitalizations that have raised supply-and-demand concerns among health care professionals in other parts of the state.

Early last week, the total number of positive COVID-19 cases across the six counties totaled 623, with 10 deaths attributed to the disease.

Testing helps reduce spread

Stephanie Cannon, Carteret County’s health director, said her jurisdiction — located on the south-facing central coast of the state, south of most of the other coastal counties with aging populations — has seen an increase in demand for testing since the beginning of June. 

“Testing in Carteret County is a shared effort between the Health Department, Carteret Health Care, urgent cares, medical providers and CVS,” she said. “It will take all of us to continue meeting the demand for testing.

“The concern right now is the laboratory testing capacity. We are seeing testing turnaround times increasing significantly.” She said this concern has become widespread across the state and delays the contact tracing process.

Contact tracing allows health workers to identify individuals who have come in contact with an infected person so they can get tested for their own safety and minimize community spread of the disease.

Cannon is also continuing COVID-related emergency preparedness efforts with the Port of Morehead City and the U.S. Coast Guard at Field Office Fort Macon.

Noncompliance with masks helps increase spread

One vexing concern for health officials along the coast is the refusal of some young adults to wear masks in public or to engage in social distancing.

North Carolina Health News recently reported that a noncompliant gathering of about 100 individuals in Dare County had triggered 27 positive cases of the disease.

Cannon told Carolina Public Press that her department has received complaints about similar events.

“If we become aware of a large event, we will reach out to the event organizer and educate them on the executive order related to mass gatherings,” she said.

“Any requirements in the governor’s executive orders are enforced solely by local law enforcement, so there is a very limited role for local public health.”

Other articles in this series

Cherokee, Clay, Graham counties: Slow start to pandemic in SW NC counties but future of hospitals uncertain

Brunswick County: Brunswick medical providers coordinate pandemic efforts in retiree haven

Chatham, Moore counties: Central NC health systems battle outbreaks, but confident of preparations

Ashe, Allegany counties: Provider partnerships crucial to NC rural hospitals in NW mountains

Clarification: The article has been revised slightly to clarify the demand for COVID-19 testing in Carteret County, based on new information that became available after the article initially published.

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Neil Cotiaux

Neil Cotiaux is a contributing writer for Carolina Public Press. He is based in Wilmington. Send an email to info@carolinapublicpress.org to contact him.

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