In the first of a series of meetings and town halls over the next six weeks to examine health care in Franklin County, county commissioners and members of the Weems Memorial Hospital board heard Tuesday afternoon from a consultant with a plan.

Jim Coleman Jr. chief executive officer for a Louisville, Kentucky based management company specializing in small rural and critical access hospitals, unveiled a term sheet for a five-year management proposal that would make Alliant Management Services responsible for financial, operational and clinical oversight for Weems.

Describing it as an “all-inclusive engagement,” Coleman said the plan was developed in conjunction with Tallahassee Memorial Hospital, whose CEO, Mark O’Bryant, was a colleague of Coleman’s several years back, when the two were chief operating officers at competing hospitals in Chattanooga, Tennessee.

“When he found out I left HCA, and went into rural markets, he reached out to me three years ago,” said Coleman. “He’s very serious about (this). TMH is a huge ICU; he needs healthy facilities around his region. He needs open space at his facility.

“He wants those partners where they know they can discharge a patient back to a local facility and it has to be good quality care,” he said. “That’s a key criteria, before he would go in and put investment in that county itself.”

Alliant’s proposed fee schedule would run about $28,100 monthly in the first year of the contract, and then increase to $28,500 monthly in year two, about $30,000 in year three, $30,400 per month in year four and $31,400 in year five. The salary and benefits for the Weems CEO, who currently makes $10,000 per month, would be included in this monthly fee.

All told, the management agreement would start at $337,000 annually, and gradually increase to $377,000 in year five, for a total of about $1.8 million.

“We’re adding bench strength to the local management, to keep them moving, more as advisors and as a resource and support for the team,” Coleman said.

In his presentation, he talked about a bringing together of resources from the other small hospitals in the Panhandle and southern Georgia and Alabama that Alliant manages, which are typically in communities with populations of between 15,000 and 50,000.

Coleman said the hospitals that Alliant now either oversees or has a partnership with include Medical Center Barbour, in Eufala, Alabama; Mizelle Memorial Hospital, in Opp, Alabama; Northwest Florida Community Hospital, in Chipley; Doctors Memorial Hospital in Bonifay; Jackson Hospital in Marianna; Doctors Memorial Hospital in Perry; Campbellton-Graceville Hospital in Graceville (now shuttered, but in talks to become a behavioral health facility) and Calhoun-Liberty Hospital in Blountstown.

Coleman said a management plan could include sharing a chief financial officer with Calhoun-Liberty, although he stressed that each hospital should have its own locally-based CEO.

“I think it would work between Calhoun Liberty and Weems,” he said. “Let’s put a position together, that rotates and helps all three facilities.”

Commissioner Smokey Parrish said he has talked with Calhoun County commissioners about their situation. “They’re facing a lot of the same challenges we’re facing here,” he said.

Coleman referred to a number of possible changes that could result from a management deal, including the creation of a seasonal clinic on St. George Island, the possible closure of the Weems clinic in Apalachicola and the consolidation of its services with the existing clinic in Carrabelle, the creation of a behavioral health program and the expansion of the swing bed program.

“The goal would be to right-size, where you can rely on the hospital to be totally self-sustainable,” said Coleman.

The meeting opened with a brief appearance by Kevin Begos, the newly elected mayor of Apalachicola, who was invited by Weems board chair Doug Creamer to attend the hospital board meetings.

Allan Feifer, with Concerned Citizens of Franklin County, said it was notable that the proposal was not provided ahead of time. He was not critical of the proposal, but asked for an enumerated list of pass-through and third party costs. “Typically there will be additional costs you don’t have today,” he said.

Coleman cautioned that he could not offer “a silver bullet” and said Alliant’s focus would be on improving operations, and creating an atmosphere of “respectful accountability, finding additional revenue streams, recruiting, and engaging the board in establishing strategic direction.”

He did not detail whether staffing cuts would be made, but did not that he had questions about the financial data he would reviewed.

“I don’t have any confidence in those financials,” he said. “I think there’s a little work to do there and straighten that out.”

Parrish said he was skeptical any growth in revenue could happen without the building of a new facility. “Last time I looked at financials, ain’t neither one of them toting their load,” he said. “These clinics are not going to build revenue for you.

“The only way you’re going to have a revenue stream is build a facility. That’s where your revenue is at,” Parrish said.

Coleman said the key is beefing up the county’s array of primary care physicians. “You don’t have doctors to admit those patients,” he said. “Doctors admit patients and that’s how you make your money at an inpatient facility.”

He said once a deal was signed, Alliant would do a thorough review of the facility within two months, and then schedule a board retreat. “In the worst case scenario it would be nine months where we’re at point where we say where we want to go,” he said.

“We’ll look at new revenue streams and every expense reduction you can have,” he said, noting that he foresees a savings in insurance costs due to the existing divisions of Aliant’s parent company, Blue Management Services LLC.

Coleman said he forecasts a clear strategic direction by Jan. 2021, possibly with the additional of more services. “It’s going to cost you a little bit to add service lines,” he said. “Strategic planning would be fun because it’s never been done before.”

Commissioner Bert Boldt called for a comprehensive approach that brings together all the health care components in the county. “We need to be thinking about a tool kit that allows us to do this at a reasonable cost,” he said. “It’s the management of our entire medical environment in Franklin County.”

Commissioners Rick Jones, Noah Lockley and William Massey all indicated they were encouraged by Coleman’s proposal.

“I know there are a lot of pieces in this puzzle. I am very encouraged we have gotten to a point where we have a substantive conversation about it,” said Jones. “

“I want to see some brick and mortar,” said Lockley.