OSCEOLA, Mo. -

The chief executive officer of Sac-Osage Hospital says the date that the hospital will be closed is not decided yet.  Chris Smiley says the only thing that the hospital board has decided for sure is that Sac-Osage Hospital will close and it will negotiate an affiliation agreement with Citizens Memorial Hospital of Bolivar.  That agreement could lead to CMH operating a clinic and an ambulance service in Osceola, but not an in-patient hospital or emergency room.

This week, CMH Chief Executive Officer Don Babb issued a news release that announced the affiliation agreement with Sac-Osage.  That news release didn’t say that details of the affiliation have not been finalized. 

“Sac-Osage and CMH have a letter of intent, but have not signed an agreement -- although it is exclusive, it is not binding,” said Tamera Heitz-Peek, a CMH spokeswoman, in an e-mail message on Friday.

Sac-Osage Hospital, which opened in 1969, has been losing hundreds of thousands of dollars for years because it doesn’t have enough paying in-patients – people who stay overnight to be treated for illnesses or injuries.   The hospital often averages only one to three patients each night.   Its clinics in Osceola and Wheatland, plus its ambulance service, have brought in most of the revenue in recent years.  The hospital also started a retail pharmacy and converted some of its unused beds to hospice care in recent months to try to bring in more revenue.

The Sac-Osage board recently hired BKD accounting firm to solicit requests for proposals (RFPs) for management or affiliation agreements with other companies in an effort to save the hospital.   Smiley says BKD received about a dozen inquiries or feelers, but only two RFPs.   The six-member board chose to negotiate with CMH.

Smiley didn’t name the other company that submitted an RFP.   People in Osceola say it came from Noble Health Care International, a company that manages community hospitals to try to make them financially viable.  Tom Carter of Ozark, a vice president and co-owner of Noble Health Care International, declined to confirm whether his company submitted an RFP.

Smiley, who has been CEO for several months, didn’t know why Sac-Osage didn’t receive other RFPs.   She said the hospital’s finances are in such dire straits that many outside companies may have decided it was too late to save it.  She said it might have been a different story if the hospital board had solicited RFPs a couple of years ago.

Babb said in his news release that CMH would operate Sac-Osage’s Tri-County Clinic in Osceola and the ambulance service.   It would not operate an in-patient hospital, the pharmacy or the clinic in Wheatland, where it already provides some physician services at another clinic.  He said CMH might hire some of Sac-Osage’s employees.  He said the Tri-County Clinic building would offer a family medicine practice and a walk-in clinic that is open seven days a week from 9 a.m. – 8 p.m.

The Sac-Osage Hospital board will meet at 5:30 on Monday.   Smiley hopes a firm date for the hospital to close could be set at the meeting.  She says several things have to happen, legally, before Sac-Osage can close.  That includes legal notice to the 56 remaining employees.  Smiley said a State of Missouri Division of Employment Security task force would work with employees who don’t get hired by CMH, to try to help them find jobs.  Smiley said an earlier estimate that the hospital would close by Sept. 1 might be erroneous.

The board invited St. Clair County commissioners to attend the meeting on Monday.   Smiley said the board plans to vote to go into closed session with the commissioners to discuss legal matters.  

Some community members hope the County Commission could stop the hospital closure because the hospital gets property tax funds from its hospital district.  That district covers about two-thirds of St. Clair County.

Presiding Commissioner Robert Salmon said Friday that he thinks the county commission can’t stop the deal with CMH.  He said the hospital board is a legal, independent entity.   He said the only review of the hospital board’s actions would be if the board decides to sell some of its property.  Salmon said, under state law, the county commission would review the sale to make sure the hospital board followed all legal procedures.  No one has said whether CMH would buy Sac-Osage's property, lease it, or receive a management fee to run the clinic and ambulances service.

Salmon says he opposes the hospital closure because he thinks it will devastate Osceola, both from the loss of jobs and the loss of pride that the town feels from having a hospital.   He said he feels powerless, as other citizens of the county do, to stop the closure.  He feels patients who need emergency room services will suffer because they'll have to travel 30 - 40 minutes by vehicle to CMH in Bolivar or Golden Valley Memorial Hospital in Clinton.

Even with the hospital's closure, Salmon said, the Sac-Osage board would remain in place and is responsible for providing health care services in the hospital district, and deciding how to spend the property taxes, which will be collected until 2019, unless voters in the district decide to renew the property tax that funds the district.  Voters approved the tax district in 1999.

Smiley said Friday that about 45 percent of Sac-Osage’s in-patients are covered by Medicare and Medicaid.  She said 10 – 15 percent are uninsured “self-pay” customers and the hospital often ends up not collecting most or all of the fees that it charges them.  She said the hospital tries to work with those patients on payment plans but still doesn’t collect most of what it’s owed.  St. Clair County is one of the poorest counties in the state.

Smiley said it’s that 10 to 15 percent of uncollected "payments due" that causes the hospital to operate in the red.  She didn’t know how much the hospital might have benefited if the Legislature had expanded the state’s Medicaid program to cover more uninsured, low-income people, as Gov. Jay Nixon and other Democrats, as well as some Republicans, have advocated for the last couple of years.  Conservative Republicans who control the Legislature have blocked that Medicaid expansion, which would be mostly funded by the federal government.

Another problem mentioned earlier in the week by Sac-Osage’s director of nursing, Vicky Hash, is the loss of doctors in the community who refer patients to the hospital.   Dr. Wayne Morton, who’s practiced at the hospital for 38 years, still has an independent clinic near the hospital, but other doctors have moved away, retired or died.  Morton said Wednesday that he thinks the hospital could run profitably if it changed the way it operates.

Smiley said it isn’t certain that the Sac-Osage building will be razed.  She said that could be part of the negotiations with CMH.   She said the 45-year-old building has a lot of structural problems.  She said a new roof is among its needs. 

Smiley said the hospital site is a good place for medical services, given that it has easy access to Missouri 13 and Missouri 82, two highways that cross the county, so she could see CMH wanting the cleared land for a new clinic building.

CMH and Sac-Osage will host a public meeting about the planned affiliation agreement on Tuesday, July 29, at 5:30 at First Baptist Church in Osceola.  The church is at 505 Walnut St.