Rural Healthcare Is 'Personal' Says Departing Margaret Mary Health CEO

Tim Putnam, DHA, MBA, shares details about his career experiences, working on the Biden-Harris Administration COVID-19 Health Equity Task Force, and his thoughts on rural healthcare and lessons learned, as he departs from his current role.

Margaret Mary Health (MMH), a nonprofit, rural critical access hospital in Batesville, Indiana, is saying goodbye to its CEO, Tim Putnam, DHA, MBA, at the end of August. The rural healthcare champion announced his resignation in July, and has served 38 years in hospital operations and over 12 years as CEO for MMH.

"Stepping down from my current role will afford me the chance to explore new career opportunities while finishing out my work with President Biden’s COVID-19 Health Equity Task Force," Putnam said in a press release.

Liz Leising, who has served as chief nursing officer and vice president of patient services at MMH since 2016, has been named interim CEO.

HealthLeaders spoke with Putnam prior to his departure about his healthcare career, his experience working on the Biden-Harris Administration COVID-19 Health Equity Task Force, and his thoughts on rural healthcare.

This transcript has been edited for clarity and brevity.

HealthLeaders: What has your healthcare career journey looked like?

Tim Putnam: I started in non-healthcare; my original degree was in lasers and optics. Back in the 80s, when lasers had only been around for not even a decade and a half, I fell under a lucky star working at the Laser Treatment Center of the Jewish Hospital in Cincinnati on research and development projects with the Father of Laser Medicine, Leon Goldman.

I am a purely technical guy with no healthcare background at all, but I became enthralled in the ability to have an impact on patients. I worked research and development for years and then that led to work with minimally invasive surgery. That led to a master's in business administration into more leadership responsibility outside of surgery.

And that led to a rural CEO position at a great community hospital in Illinois. I have a rural background, grew up in a small town. When I started working in the small towns and realized the decisions that I made, and the people I worked with, made a difference for people that I live next to, it started to hit home. That's where I found my passion. You fight the challenges together, you succeed together, all the patients that are cured of cancer because of your team's work, the babies that are delivered—everything is different in rural healthcare because it's so much more personal.

The hospital in Illinois led me to a position back here in my home state of Indiana, so I've been able to work almost 13 years not too far from where I grew up.

HL: What are some of your favorite accomplishments you reached during your tenure as CEO at MMH?

Putnam: MMH has grown quite a bit and I think we have stayed true to our mission.

We were in the lead on the transition from volume to value, and one of the first rural hospitals in the country to have an accountable care organization. We had to partner with other hospitals across the nation to have enough covered lives.

It led us to some other things like our addictions and behavioral health program. Very few rural hospitals are aggressive when it comes to preventing behavioral health issues, treating those, [and] working with addictions. Because of our work with a transition from volume to value, we realized that unless we treated the behavioral health issues or addictions issues, we weren't going to be able to have an impact on the physical issues.

HL: After your departure, do you plan on continuing to serve on the Indiana Graduate Medical Education Board and the Biden-Harris Administration COVID-19 Health Equity Task Force?

Putnam: I've been lucky to be part of several rural leadership and healthcare leadership positions.

With regard to the Graduate Medical Education Board in Indiana, that has been a pleasure. The state of Indiana, to keep physicians from leaving the state, formed that several years ago. We've done a phenomenal job of increasing the residencies, encouraging hospitals to expand the residencies. Bright kids that are growing up in Indiana, they're going to medical school in Indiana and don't have to leave the state to be able to complete their residency program. I'll stay with that probably to the end of the year, that's a gubernatorial appointment. I'll work with the hospital association to [find] someone who's actively in healthcare leadership in the state at a hospital [to] replace me, but I'll stay as long as the governor will have me, or until there's another candidate to step up for that.

The Biden COVID-19 Health Equity Task Force has been a great honor to be part of, working with a team of dedicated people to evaluate what has happened during the pandemic from a perspective of equity, and what do we learn from it, and how do we do better. It's been intense [and] it has been enlightening. I bring the rural aspects because I see it every day, and what we found is so many of our issues are the same. It's been exciting to work with that, but that will be wrapping up in October, when the final report will be coming out.

On top of leading a healthcare organization during the pandemic, which you think would immerse someone enough, a task force met on a regular basis virtually, with people across the nation, and [we] heard from subject-matter experts around everything from vaccinations, long COVID issues, the impact of mental health on the country during COVID. So not just the disease itself, what are we seeing with suicides, what are we seeing with behavioral health, addictions, and then looking forward. What I found is the resources of this nation are vast, and there are brilliant people that are committed to making this a better country, and just being able to sit alongside them has been phenomenal.

HL: Margaret Mary Health received a 5-star quality rating from CMS in May, placing in the top 10th percentile nationwide. What strategies and other factors led to this accomplishment?

Putnam: It is the culture in our hospital. This goes to how we take care of patients; we take care of them like friends and family, because there's high probability they are.

We've been lucky, some of our partnerships with other large academic medical centers and large facilities has been phenomenal. We've had a partnership with The Christ Hospital on cardiac services. When you look at door to-balloon time at the average hospital that has a cath lab, you strive for the goal of 90 minutes. Our time is 110 minutes, but our cath lab is 45 miles away in another system. [The] partnership that we've got between the local ambulance service, our team, being on the same page as that team of cardiologists that work there, gets phenomenal outcomes, and our patients know it.

The desire to get the best outcome for your friends and family drives this quality, drives the patient satisfaction, it all links together. We want to be the hospital that these large systems want to work with. We're self-aware, we can't do everything, so we need to have friends and partners.

HL: By mid-May, MMH had administered more than 25,000 COVID vaccine doses. What strategies were in place to ensure the rural community gets vaccinated?

Putnam: We have a great team of people that have been dedicated to vaccines and vaccinations for years. Years ago, we ran a drive-thru flu vaccine program. People would drive up, they fill their paperwork out, the kids would stay in the car seats, get their shots, get the Band-Aid, and rolled on.

That set us up for how we were going to do it as a community. In the middle of winter, we set up a drive-thru COVID vaccine clinic. At first, we were out in the cold with pop-up shelters, then the city converted the city garage, so we had drive-thru processes rolling through there.

We made it easy for our population. We had good partners with the state to be able to do that. We convinced them that we knew what we were doing, and we also had a lot of volunteers from the community that came out. There's no doubt our team was in the lead on this, but our community came together to do it.

HL: What changes are needed for rural health systems and rural hospitals to be more successful?

Putnam: One thing I've learned is that there are some great people who work in rural healthcare, and rural healthcare leadership is hard. Half the rural hospitals in the nation are losing money. Before this year, there was one that closed every two and a half weeks in the country. It's not for lack of effort, it's not for lack of desire to serve your community, but it's a challenge out there.

I hope that in the near future, the value of being able to have everyone, no matter whether you live in a rural community or not, have access to quality healthcare, [and it] is seen as a higher priority. We're a stronger nation if we do.

We have to realize that rural is not small-urban, there are things that are inherently different about it. [Rural hospitals] need partnerships with [larger] hospitals that can do things that they can't do. They need a payment model that fits to what they do. So much of it is about the cost of readiness and how do you stay ready in your ER 24/7 when your volumes swing so heavily? How do you have an active and effective OB program, when the rules are written for OB programs in a large city?

Looking at some of the regulations and standards through a rural lens is important. I often ask people who write the rules and regulations that affect us negatively, 'what did the rural people in the room say when you proposed this?' To which, there's no answer because there were no [rural-minded] people in the room.

Related: No Regrets: Report Findings Say Merged Providers Would Do It All Over Again

Related: 6 Steps for Rural Hospitals to Rise to the Coronavirus Challenge