Hospital CEO responds to reported risk of closure

A recent report has spotlighted Eureka Springs Hospital as one of nine rural hospitals in the state in serious jeopardy of closing their doors.

Not so fast, hospital CEO Tiffany Means says.

“Closure has not been part of our discussions at Eureka Springs Hospital,” Means said. “Our conversations are about sustainability and how we strengthen ESH so that we can continue fulfilling our mission and serving this community.”

The Center for Healthcare Quality and Payment Reform recently released a report that shows 32 rural hospitals in the state are at risk of closure, with nine — including ESH and Mercy in Berryville — facing an “immediate risk.”

“The hospitals at greatest risk of closing have more debts than assets, or they do not have adequate net assets (ie., assets other than buildings and equipment, minus debt) to offset their losses on patient services for more than a few years,” the CHQPR report states. “Rural hospitals are at risk of closing in almost every state. In the majority of states, over 25 percent of rural hospitals are at risk of closing, and in 11 states, 50 percent or more at risk.”

The report goes on to mention the losses on patient services, pointing out that it costs more to deliver healthcare in small, rural communities than in urban areas, and many health insurance plans do not pay enough to cover those costs.

“Many hospitals have managed to remain open despite losses on patient services because they receive local tax revenues or government grants,” the report states. “However, there is no guarantee that these funds will continue to be available in the future or that they will be sufficient to cover higher costs. The special federal assistance many hospitals received during the pandemic has now ended. As a result, almost one-third of rural hospitals lost money overall in 2024-2025.”

While a timeframe wasn’t specified, ESH was listed in the CHQPR report as having total expenses for 2025 of $8,575,250, a two-year average total margin of negative 21 percent, and a two-year patient service margin of negative 44.6 percent.

Those numbers can’t be argued, Means acknowledged. She said her focus since assuming the CEO’s role a little more than a year ago has been on current trends.

“The Center for Healthcare Quality and Payment Reform is not a government agency. It is an independent national healthcare policy center focused on healthcare delivery and payment reform,” Means said. “The organization analyzes hospital financial data and has developed a methodology to identify rural hospitals it believes are experiencing significant financial risk.

“The phrase ‘immediate risk of closing’ is terminology from CHQPR’s financial-risk methodology; it is not terminology coming from Eureka Springs Hospital. Closure has not been part of our discussions at ESH. Our discussions are about sustainability, growth and how we continue strengthening this hospital and serving our community.”

Various factors go into developing the list of hospitals at risk for closure, Means said.

“As I understand the report, CHQPR looks at several financial factors, including losses on patient services, whether a hospital has other revenue sufficient to offset those losses, and the financial resources available to absorb continued losses,” she said. “The report also highlights a fundamental challenge for small rural hospitals: maintaining essential services such as a 24/7 emergency department carries significant fixed costs even though rural hospitals serve smaller patient populations.”

ESH’s poor historical numbers, and how they factored into the report, are what they are, Means said.

“For Eureka Springs Hospital, the [recent] media coverage cites a two-year average total margin of negative-21.0 percent and a two-year patient service margin of negative-44.6 percent,” she said. “Those are serious historical financial indicators, and I do not want to minimize them. We are reviewing the underlying data and reporting periods with our financial leadership to ensure we fully understand and validate the figures being reported.

“What is particularly important, however, is that these are historical measures. They do not tell the entire story of the work occurring at ESH in 2026.”

PAST IS REAL, BUT EYES ON PRESENT, FUTURE

The hospital’s focus is on what’s happening now and what lies ahead, Means said.

“Since January, we have been very focused on both sides of the financial equation: reducing expenses responsibly and improving the reimbursement we receive for the care we provide,” Means said. “From January through July, our banking analysis shows that monthly expenditures decreased by more than $95,000 per month, approximately a 12 percent reduction. We continue to evaluate additional responsible reductions while protecting patient care, safety, regulatory compliance and essential hospital services.

“At the same time, we know we cannot simply cut our way to sustainability. We have significant work underway related to contractual reimbursement, payer relationships, denials, accounts receivable, claims processing and timely collections.”

A dedicated “Revenue Cycle Director” position began in early August to focus on accountability in those areas, Means added.

“… That work is already underway,” she said. “We have also been working to rethink how rural healthcare is delivered, not simply how it is financed.”

That led to the creation of the state’s first hybrid ER/urgent care model, which has already received positive reviews at various city council and city commission meetings.

“On July 14, ESH opened our new hybrid emergency department/urgent care model, designed to help patients receive the right level of care in the right setting while maintaining the 24/7 emergency capability our community depends upon,” Means said. “The reason for developing this model was straightforward: not every patient who comes through an emergency department requires emergency-level care. When clinically appropriate, qualifying patients can receive urgent-care-level services through the hybrid model. This can create a more appropriate and efficient care pathway for the patient while allowing our emergency resources to remain focused on patients who truly require emergency-level services.”

The results have already proved the system to be effective, Means said. From July 19-31 the hospital saw 119 patients who qualified for the urgent care option under the new model.

“For a small rural hospital, initiatives like this are important because sustainability cannot be achieved through expense reduction alone,” Means said. “We have to continuously look for better ways to deliver care, improve access, use our resources appropriately, strengthen reimbursement and respond to what our community actually needs.”

Overall numbers at ESH have improved in 2026, staff has reported. Through June, ER visits increased by approximately 36.5 percent, from 971 in 2025 to 1,325 during the same period in 2026, hospital commission members have been told. Additionally, EMS arrivals have increased from 197 through the first six months of 2025 to 404 during the same time this year.

“Those numbers reinforce something very important to us: Our community is using and relying on this hospital,” Means said.

That community, and the way ESH is set up and operates, makes it unique compared to many other facilities across the state and country that have faced similar obstacles, the CEO added.

“There is also important context when comparing ESH with other hospitals listed in the [the report],” she said. “These hospitals are not all organizationally identical. Several operate within much larger health systems. Eureka Springs Hospital is a small, city-owned hospital governed locally through the Eureka Springs Hospital Commission, rather than operating as part of a large health system. That does not excuse our historical financial performance, but it is relevant context when comparing organizations of very different size, structure and resources.”

In the end, however, Means said she acknowledges the hospital’s major struggles of the past. In fact, sifting through numbers — both good and bad — and making the needed changes have been such a task that specific financial reports have been kept internal until their legitimacy can be completely verified, hospital commissioners have been told each month.

“I want to be equally clear that I am not declaring that our financial challenges have been solved,” Means said. “They have not. Sustainable improvement has to be demonstrated over time through actual financial results.

“What I can tell you is that we understand the challenges, we are addressing them directly, and we are taking measurable action.

“My position as CEO is straightforward: We are not going to argue with historical numbers. We are going to learn from them and act on them. We are reducing unnecessary expenses, improving reimbursement, strengthening revenue cycle, redesigning how we deliver care where appropriate, and increasing accountability throughout the organization.”

This is directing ESH in the right direction, Means said.

“I believe we are taking the right actions,” she said. “I believe strongly in our team, and I am incredibly proud of the resilience and commitment our employees have demonstrated through a period of tremendous change.

“Our focus at Eureka Springs Hospital is sustainability and service. We are here to serve this community, and we are doing the hard work necessary to build a stronger ESH.”