Marcia O'Connor remembers when her hospital was in survival mode.
Choctaw Memorial Hospital had just severed ties with Quorum Health Resources, and O'Connor, who has worked at the hospital for 27 years, entered the position of chief executive officer.
O'Connor is contractually bound not to discuss the details of why Quorum no longer manages the hospital.
“I will tell you that, when I took over the office, we went from $1.5 million in the hole, and we're about at a break-even point now at a three-year period,” she said.
Choctaw Memorial Hospital is a rural hospital in Hugo, a southeast Oklahoma town of about 5,300 people near the state's border with Texas. The hospital serves Choctaw County, population 15,250, and the surrounding area.
The facility is part of a shrinking number of Oklahoma's rural hospitals that's managed locally. As health care grows more complicated and expensive, more and more of Oklahoma's rural hospitals are joining large health systems, which some say offer stability and resources to suffering institutions.
In early 2012, Integris Health entered into a joint venture with Florida-based Health Management Associates to operate five of its regional hospitals in Blackwell, Clinton, Madill, Pryor and Seminole.
SSM Health Care of Oklahoma, which operates St. Anthony Hospital, has a variety of business relationships with 19 hospitals in Oklahoma. Its affiliate hospitals include Newman Memorial Hospital in Shattuck, Purcell Municipal Hospital, Holdenville General Hospital and Share Medical Center in Alva.
Quorum Health Resources, Solara Healthcare and Capella Healthcare also own or manage hospitals throughout the state.
Over the past three years, Mercy, the eighth-largest Catholic health care system in the U.S., has seen its rural presence in Oklahoma grow from two rural hospitals to eight, with varying levels of partnership.
This past week, Mercy hosted a community round table in Watonga to discuss Mercy Hospital Watonga, a hospital it was managing and is now leasing.
For Fred Lucas, Mercy's presence is welcome news. Lucas remembers a time when Watonga had five doctors. Today, the town of 5,111 in northwest Oklahoma has two primary care doctors.
About 33 percent of Oklahoma's primary care physicians practice in rural Oklahoma, even though about 45.7 percent live in rural areas, according to OSU's Office of Rural Health.
Lucas moved to Watonga in 1965 to open his dentist office. Lucas came to rural Oklahoma because he knew the potential a rural community held for a new dentist.
Over the years, Watonga's hospital has struggled. In 2004, Watonga Hospital Trust Authority filed for Chapter 9 bankruptcy after facing several financial crises. About seven years ago, the hospital owed Medicare about $1.3 million for overpayments and reached an agreement to pay $250,000 to settle the matter, according to The Oklahoman archives.
Lucas is comforted by the stability Mercy offers his community, which has seen its population fluctuate over time.
“If there's not a hospital, why would you want to live here?” Lucas said. “Would you want to raise a family here and take the risk of not having doctors? No.”
Role of critical access
Watonga is one of about 32 critical-access hospitals in Oklahoma. A critical-access hospital has 25 or fewer beds and an average length of stay of four days or less.
The classification was created in 1997 after the nation saw a wave of hospital closures.
Between 1983 and 1991, 360 rural hospitals nationwide closed, said Brock Slabach, senior vice president for member services at the National Rural Health Association.