WARREN, Ohio – The founder and CEO of Insight Health Systems, Dr. Jawad Shah, would have preferred ownership of two Trumbull County hospitals to change over a year instead of three days.
But the former Trumbull Regional Medical Center and Hillside Rehabilitation Hospital didn’t have that luxury. And it’s an ongoing process.
“Overall, I would say it’s messy,” Shah says. “There are some things that we predicted would be difficult and some things we didn’t. And we’re just continuing to try to fight through that. Every day we’re a little bit better. So, we’re excited about the trajectory we’re taking.”
In September, the future looked bleak for both hospitals – casualties of the Steward Health Care bankruptcy. A closure notice had been issued that left the community only days to ponder life in Trumbull County with fewer healthcare options and medical professionals to question their next career moves.
Then Insight Health Systems stepped in as interim operators and eventual purchasers of the two hospitals, bringing new life and possibilities to them.
Shah would have liked to have had more time to transition gradually, which he says should have included a planning committee and a staggered process for changes involving accreditations, revenue cycle management, software, billing, medical records and payroll. He believes, though, things are heading in the right direction.
Over the next year, Shah would like to focus not only on stabilizing the hospitals but also on expanding services at the newly named Insight Hospital and Medical Center Trumbull and Insight Rehabilitation Hospital Hillside.
While Steward Health Care remains involved with billing and patient records during the transition, improvements are happening under Insight.
“As I’ve gotten to know [Insight], as a company, I fully trust in their integrity and we are well aligned in our philosophy around what’s important to patient care,” says Cindy Russo, president and CEO of Insight Hospital and Medical Center Trumbull. She started in the CEO role at the former Trumbull Memorial in February 2021, bringing more than 20 years of experience.
“With Insight coming in, from Day One we felt that they care,” says Jamie Gunia, chief administrative officer at Insight Rehabilitation Hospital Hillside. “They want the organization to succeed. They’re concerned about the community and providing access to care. They understand that Trumbull and Hillside are a staple to the community.”
Shah’s Philosophy
The Trumbull hospitals are not the first Shah has helped to resuscitate. In Flint, Mich., when he began practicing in his wife’s hometown, Shah saw the need for an institution where specialists could do research and practice ethical, patient-first medicine. Those goals led to renovating an abandoned 600,000-square-foot General Motors building into a clinic.
“I don’t think medicine is simply prescribing things and doing surgeries and so on,” Shah says, adding he believes in helping communities to overcome the social-economic struggles and other health determinants to becoming healthier.
The physicians who joined him at the Flint clinic also were believers in that vision of redefining health care, according to Shah. Insight began purchasing hospitals, including a bankrupt hospital, surgical centers and nursing homes.
Through experience, he believes several factors cause a hospital or medical facility to struggle financially.
One, he says, is how difficult it has become to get payments for contracted services and insurance reimbursements. Payers are often slow to pay or try to pay less than what is billed.
Russo also has concerns about the increasing costs of the health care industry. When pharmaceuticals and equipment costs increase, a hospital cannot simply charge more because public health insurance only pays so much, she says.
To combat issues with payers while operating on small margins, Shah says hospitals must hire additional quality people – experts in complex bill coding systems – to oversee proper payment.
Payers suffer no repercussions for bad behavior, he adds.
The second concern for Shah is ethics – when hospitals are more concerned with profits than providing critical care.
“That’s the big dilemma or the big question,” Shah says. “When does it become inappropriate and unethical?”
Steward sought to maximize profits by selling all of its real estate to Medical Properties Trust. According to critics. Steward pocketed the sale proceeds instead of investing them into the hospitals – and then MPT leased the properties back to Steward at exorbitant rates.
Not Just the Status Quo
At Insight Hospital and Medical Center Trumbull, a new neuroscience center with telestroke capabilities is already helping those suffering from neurological injuries, hemorrhages, trauma or stroke. Shah points out time is of the essence in many of these cases.
A team of qualified doctors, nurses and other staff in the new department is already making a difference for patients. Russo says the neuroscience center allows the hospital to treat more patients who previously would have been transferred.
Shah is a neurosurgeon specializing in the central nervous system, skull-based surgery, tumors near the brainstem and vascular pathology. He began performing neurosurgery at Trumbull once Insight took over. It had been 15 years since neurosurgery had been performed there.
The medical center is working to complete certification. Once that’s finished, a pain management clinic and retail pharmacy will be added to hospital services.
At Hillside, Gunia says, Insight is installing new technology and therapy equipment into the two gyms. There, each patient works 15 hours per week with his therapist on activities of daily living: walking, lifting, navigating stairs and getting in and out of a vehicle, making dinner, bathing and doing laundry.
More Than Medicine
In Michigan, Insight expanded services for the community beyond health care. The company began an afterschool program to help children from impoverished backgrounds, broken homes or suffering other struggles. In addition to sports, dancing, music and other enrichment activities, the program provided student tutoring. The company is exploring offering similar programs in Trumbull County.
“We had tremendous success with that where our kids are getting scholarships to exceptionally great universities. So we’re very excited about that,” Shah says.
Challenges in Transition
Some of the current challenges at both Trumbull and Hillside include staffing, particularly the nursing staff. Many loyal and dedicated nurses and other hospital staff stayed, even when they received notices of pending layoffs and closures. But more are needed for the hospital to return to full capacity.
“Yeah, things were hard,” says Gunia about the possibility of closure last fall. “But we knew we were going to get through it, and we worked together as a team, pulled together and a lot of us stayed … We had hope and wanted to continue to serve the community whatever it took. So, it came together and we’re looking now on the other side of things and looking forward to the growth.”
Hillside currently is using roughly half of its 69 beds, providing both inpatients and outpatients with collaborative care for the rehabilitation of strokes, spinal cord injuries, traumatic brain injuries and trauma.
Gunia says Hillside has an 80% success rate of sending patients home immediately after their stay, an achievement that takes physical and rehabilitation physicians plus an entire team of rehabilitation nurses; physical, occupational, speech, recreational and respiratory therapists; case managers; dietitians; pharmacists; and psychologists.
Hillside is also seeking nurses and therapists as the hospital tries to regain the numbers it once had so it can serve more patients, Gunia says. Hillside also operates outpatient locations in Cortland and Austintown.
Likewise, Russo says patient levels at Trumbull hospital have not returned to where they were before bankruptcy, but patient levels continue to grow slowly. She says it is important not to outpace the number of nurses and staff.
In early February, 40 new Insight employees attended an orientation for the two hospitals and both are still hiring, especially nurses.
Gunia points out people continue to choose Trumbull and Hillside as their preferred providers. Medical, nursing and physical-therapy students continue to train there. And many employees remain after 20, 30 or even 40 years.
Russo and Gunia each say that feedback through patient advocates or letters shows patients in Trumbull County are happy with the health care they are receiving and that such services remain.
The community saw the need to support Trumbull hospital when things looked bleak, and Russo says she hopes that will continue with Insight as the new owners.
Under Steward’s ownership, the hospital’s mechanical equipment deteriorated, such as the chillers and boilers that the hospital needed to rent because it couldn’t afford major repairs. “Even with Insight here, they’re maintaining the operations, the payroll and all the expenses related to supplies and things like that. But when you have those daunting capital needs, that’s where the challenge really exists,” Russo says.
When Shah arrived Sept. 8, he was impressed with how passionate Trumbull County officials and residents were about keeping their hospital.
“The hospital was slated to be shut down within days, yet nurses, executive staff, and so on, physicians – they didn’t leave,” Shah says.
“It was very surprising that they would continue to work, not knowing what would happen a week later. That sort of passion was very, very telling to me that people really, really care about this hospital.”
Pictured at top: Among employees in Trumbull’s emergency room are Cindy Bakos, nurse manager, 30 years this year; Zach Veras, nearly five years; Vicky Hall, RN, 41 years in June; Brooke Walters, RN, six years; and Matthew Faherty, medical student.