Bitter pill to swallow: while regional medical centers grow stronger, rural hospitals seek remedies for their financial ills.

• Author: Payton, Kathy
• Position: Includes related articles

Past the mauve-colored hallway on Forsyth Memorial Hospital's third floor, baby Jelisa lay curled on her stomach inside a clear plastic incubator. Born 13 weeks early, she weighed 2 pounds, 2 ounces. Her tiny body was tethered to a maze of tubes and cords, and teams of five to eight people per shift worked around the clock to keep her alive.

Thirty years ago, Jelisa would have died. Twenty years ago, she would have been sent to Duke Medical Center, North Carolina Baptist Hospital or North Carolina Memorial Hospital in Chapel Hill -- which then had the three largest neonatal intensive-care units in the state. Now, 12 hospitals have them, all but four of them regional hospitals.

Jelisa's parents took her home May 7, the beneficiaries of a boom in regional hospitals, which, in turn, has sparked an explosion in medical employment. From 1980, when 3.5% of the state's workers held health-care jobs, to 1990, when the percentage increased to 4.8, 65,000 new jobs were added.

In the Winston-Salem area alone, nearly 16,000 jobs (one of every 10) are in medical-related fields. Annual revenue from health care represented more than $1 billion for Forsyth County in the 1990-91 fiscal year -- despite the recession, a 22.5% increase over the previous year.

In fact, Bowman Gray/Baptist Hospital Medical Center, the teaching center for Wake Forest University's Bowman Gray School of Medicine, is expected to overtake R.J. Reynolds Tobacco Co. next year as the county's largest employer.

But the jobs and wealth didn't get spread evenly. Hospitals in the urban areas like Winston-Salem got bigger by taking patients from hospitals in smaller towns. Though rural hospitals haven't shrunk, many are struggling financially as they evolve from being the source of medical care for local residents to a place they now consider going for basic care or because it's convenient.

What is happening in cities like Winston-Salem, Charlotte, Asheville, Fayetteville, Greenville, Wilmington and Greensboro is TABULAR DATA OMITTED the proliferation of an ever-changing medical technology that carries an escalating price tag -- a trend that makes it increasingly difficult for rural hospitals to compete. The bigger regionals that can woo specialists and pay for high-tech equipment will likely continue to take patients from their smaller counterparts, eventually forcing them to change their role, form alliances or close their doors. "It's just getting harder and harder to survive," says Sandra D. Priddy, administrator of Danbury's Stokes-Reynolds Memorial Hospital.

Though regional hospitals say they are interested in keeping their rural neighbors viable, they clearly don't want them competing on the same level, especially for patients needing the high-tech gadgetry their specialists crave. Says Jim Bernstein, director of the state's Office of Rural Health and Resource Development, "We have a technology war going on, and the people who can play are limited."

Fayetteville's Cape Fear Valley Medical Center has become a major player of late. "We've been growing as a regional referral center with a trend toward getting patients from surrounding counties," Clinton Weaver, the hospital's public-relations director, says. The center draws patients from 43 counties in North Carolina, South Carolina and Virginia.

Gross revenue has more than quadrupled, from $51.8 million a decade ago to $219.5 million in the 1991-92 fiscal year. During that time, employment, measured by hospitals in full-time equivalents or FTEs, rose from 1,499 in 1982 to a budgeted 1,960 for the 1992 fiscal year. The hospital is gaining on the city's largest employer, Kelly Springfield Tire Co., which has approximately 3,000 employees.

With 500 beds, the hospital has launched a $37 million four-floor patient-services tower that will make the hospital one-third larger when it's finished next spring. Included in the expansion will be eight new operating rooms, three 10-bed intensive-care units and 15 labor/delivery/recovery rooms. Already equipped with a coronary-care unit and a cardiac-catheterization lab, the medical complex expects to begin performing open-heart surgery by the fall.

Much of the increased demand came in outpatient services, a trend almost all hospitals are experiencing. This year's budget projects 124,850 outpatient visits.

Cape Fear Valley's latest...