WARREN, Ohio – The parking lot is empty and the building is quiet, but Insight Hospital & Medical Center Trumbull’s emergency room could see patients again in the coming weeks.
A timeline for Insight Rehabilitation Hospital Hillside in Howland to reopen, though, remains murky.
Dr. Jawad Shah, Insight Health Systems CEO, said the Warren hospital’s emergency room could open soon, provided required certifications are secured. He met Tuesday with Trumbull County commissioners, Mayor Doug Franklin, U.S. Rep. David Joyce and other officials.
Shah described how plans went awry when Insight took over the hospital three days after being told it was available. Much of that stemmed from the hospital’s previous owner, Steward Health Care System. The hospital closed March 26. The CEO asked for the support of elected officials, medical professionals and the local community as Insight prepares to resume operations.
“There’s a few things you have to do to responsibly open up,” he said. “Infectious control, certain things have to be verified, etc. So we’re actively now pushing towards that, getting approvals wherever we need to and then go ahead and open it responsibly.”
Shah said he believes reopening the emergency room is most important for the community. Other services, including the operating room, catheter lab and inpatient services, will follow.
Most of the medical equipment remains at the hospital, and Shah said Insight has continued to invest in maintaining the facilities. Reopening costs will include bringing back staff.
What Happened
Shah said leaving Steward in charge of billing when that company didn’t have any interest in the hospital and local community was an unforeseen error. He said Steward’s billing agency, put in place through the U.S. Bankruptcy Court’s transitional service agreement, was not taking the hospital’s billing seriously and left Insight without recourse to address it.
“At the end, it’s our institution,” Shah said following the meeting. “Every single dollar would matter to us. We would not write things off. We would not adjust them off. We would negotiate. We would continue to work until we collected what we were owed.”
When Insight took over the hospitals, even while patient volumes and specialty services expanded, the revenue through billing dropped. Shah said while Insight officials were expecting between $8 million and $9 million in accumulated billing, collections were $7 million, $2 million and $6 million, respectively, in the final three months, with a smaller percentage collected than in the hospital’s history.
“We’re collecting around 11%, but they should have been collecting around 22%,” Shah said, adding when Insight got a chance to look at the numbers, revenue should have been double.
Not only did Steward’s billing company stop billing Medicaid for the hospital’s services, but Shah said the company would not allow Insight to bill for it either. He said Insight was informed in March that Steward’s billing company would not send Insight any additional money unless it agreed not to dispute the revenue discrepancies, a move Shah called “extortion.”
“These are the types of things that absolutely accumulated and crushed our ability to bring in the revenue needed to run the hospital,” Shah said. “I really want the community to understand that we were left in a very difficult situation where we had zero control over our own accounts.”
Shah said Steward had reached out to Insight in September 2024 to say the two Trumbull County hospitals would be available, and he mistakenly believed that meant Steward wanted the hospitals to survive. Yet one of the first things Steward did was remove billers with which Insight had a relationship, he said. He added that those entities would have analyzed the accounts and caught the flaws.
Shah said Steward is no longer involved with the hospitals in any way, and he credited Ohio Attorney General Dave Yost for pointing out that Medicare and Medicaid money was involved. That forced out Steward’s billing company.
“We have nothing to do with Steward at this point,” Shah said. “All the software is ours. The team is ours. The staff is ours. There’s no back-end support that we need from them.”
Joyce, who represents Trumbull County, questioned how to recoup the “stolen” money. Shah said that will prove difficult as the bills were sent under Steward’s tax ID. If those bills are paid now, he said, they will go into Steward’s accounts, and Insight has no way to determine if they have been paid.
Medical Properties Trust
Shah said the hospital’s landlord, Medical Properties Trust, remains in place. Concerns remain over the amount of rent Insight must pay MPT and how that will affect Insight going forward.
However, Shah said MPT put in a $20 million initial investment when Insight took over operations. Additionally, Shah said MPT has been helping with the physical property, even as the hospital has been closed, and the company continues to meet with Insight about the hospital’s future.
“MPT’s been very gracious,” Shah said. “They understand that their business model is to own hospitals and properties, but they’ve created a pathway for us to own the hospital [eventually]. That’s what we’re working towards.”
Moving Forward
Representatives from three local nursing unions attended the meeting and expressed concerns and skepticism, but also a willingness to work with Shah and Insight moving forward.
Tom Connelly, a registered nurse and president of AFSCME Local 2026, pointed out that the way Shah closed the hospital with little notice, without paychecks on the day it closed and with accrued vacation time still unpaid, left a bad taste in the nurses’ mouths.
“Dr. Shah, respectfully, and I underline the word respectfully, we have been a severely traumatized workforce,” Connelly said, adding AFSCME nurses backed the initial transition.
Getting them back on board will take work, he said.
“We need transparency,” Connelly said. “We need to know what your intentions are, what goals you want to achieve, so that we can match them up with ours and negotiate effectively and efficiently and so I can get my people back. Right now, I have no idea how many nurses are coming back.”
Dr. James LaPolla Jr., a Howland Township trustee and a physician, said a few physicians have left to go to Sharon Regional Health System, but many others are dedicated to the Trumbull hospital. LaPolla suggested convening a meeting to discuss which physicians will be available.
Some questions remain unanswered, including when the hospital will reopen and what departments will be first.
Howland Hospital
In Howland, Insight Rehabilitation Hospital Hillside’s future remains undetermined. Shah said Insight has not been able to gain full control of Hillside with a tax ID number for billing, but it is in the works.
Ann Mueller, speaking on behalf of the Ohio Nurses Association, which represents the registered nurses at Hillside, said the union has been reaching out for three months, offering their help to reopen Hillside, but have not gotten any response. She said nurses will need more than a week’s notice to return because many were forced to take jobs elsewhere, and she asked Shah to work with them.
As far as opening Trumbull, the tax ID is in place, but Shah said certification is still needed from both the Ohio Department of Health and the Joint Commission, a nonprofit that accredits hospitals.
Commissioner Denny Malloy talked about how when Steward filed bankruptcy in May 2024, the community came together and rallied to save the hospitals. Malloy said Insight and Shah appeared to be the answer and stepped up. Then the hospitals closed anyway because of Steward’s continued involvement.
“So we’re thankful that you stuck with our community as we’ve stuck with you this year, coming back based on the track record we had with you,” Malloy said to Shah. “You could have cut and run and took your losses. You didn’t have to lose $30 million. You could have said this didn’t work – let’s write it off as a bad experiment or a bad investment.”
Malloy said he hopes the community once again gets behind Shah and Insight to bring back the jobs and provide medical care to the community. He urged Shah to continue to be transparent about his intentions if he wants to regain the community’s trust.
“I personally, as a commissioner, I’m going to trust you again,” Malloy said.
After the meeting, Shah said when he first met many of the elected officials and staff in September, he could feel the energy and how much the community supported the hospitals.
But he said he was very concerned coming into the meeting about how the community would react to the explanation of what happened. Even when the reaction was negative, he said he believes it came from a “very good heart” and a desire for the hospitals to succeed.
“They’re not coming from a bad place,” Shah said. “So I’m leaving here thinking, these are wonderful people. They want this to succeed. I have a responsibility to coordinate, to be the maestro in the middle of all that, but at the same time, these people, I believe, want to help. So that’s really a wonderful feeling.”
Pictured at top: Dr. Jawad Shah, Insight Health Systems CEO.