In January 2002, a study was released, detailing the pros and cons of reopening River Valley Hospital. The study was conducted by Quorum Health Resources, LLC, which has offices in Plano, Texas, and Brentwood, Tenn.

Among the study's findings:

&t;"Lawrence County does have a sufficient population base to support a small acute care hospital. However, Ironton's relatively small and declining population - River Valley's core market - is a source of concern regarding long-term viability of a local inpatient facility."

&t;According to the report, the scope and availability of services offered by a hospital has a major impact on market share. "There will be 100 percent patient outmigration for any service not offered (e.g. obstetrics). Prior to its closing most service volumes at RVHS had been steadily declining for years. Successful hospitals in small communities are typically experiencing stable volumes of inpatient services including surgical procedures and ancillary services and strong increases in most outpatient services, imaging and physical therapy, for instance." Therefore, the report suggested that if RVHS reopened as an inpatient facility, the scope of services should be comparable to those offered at the time it closed, such as inpatient medical and surgical, emergency services, outpatient services and appropriate diagnostic and ancillary services.

The report suggested that obstetrics should not be added right away (OB unit closed in 2000) but would be a potential addition in two or three years."

&t;"A reopened hospital should be private or nonpolitically driven. It won't work to have the same 'old boy' network."

&t;"There are several primary care physicians who continue to practice in the Ironton community and who have likely retained their patient base even in the absence of a local hospital. These physicians are key to directing patients to a facility."

&t;Unemployment continues to plague the area, resulting in limited prospects for new permanent jobs.

&t;"River Valley has been closed for one year. All local physicians and health care consumers have established new utilization patterns at competing hospitals, primarily King's Daughters and Bellefonte. … New relationships have been formed among physicians for coverage of their patients. The longer the hospital remains closed, the harder it is to change or redirect these new patterns and relationships."

&t;"River Valley did not enjoy a positive image … prior to its closing." The report stated that the image was most often characterized as "political" or appearance-related rather than "clinical."

&t;"Market stakeholders believe that some physician referrals could be recaptured if the hospital were reopened. This opinion could not be verified with many of the active physicians in the market due to their lack of availability or interest in participating in interviews. Redirecting self-referral patients who have chosen other providers is even more challenging, given that the hospital's image had apparently been somewhat negative in the community for many years."

&t;"Recruitment of professional/technical employees could present a challenge to reopening the hospital."

&t;"Threats to the successful reopening if a full-service acute care facility in Ironton are numerous. Among these are the continued competitive pressure demonstrated by Our Lady of Bellefonte Hospital, King's daughters and the Huntington (W.Va.) hospitals."

4Only one in five Lawrence County residents requiring a hospital stay sought care at RVHS in 1999. The statistics declined further in 2000.

&t;If RVHS reopens, the hospital should expect that its competitors would "aggressively" seek to retain county patients.

&t;"In general, there seems to be a sense that community members have been left hanging with more questions than answers about why the hospital closed and those issues remain unresolved to this date." The report stated that if the hospital reopens there will need to be assurances to the community that systems for sound management … have been put in place.

&t;The hospital had a high percentage of Medicaid patients as well as a high percentage of self-pay consumers. If the hospital reopened it was suggested that new ways be found to attract more people with health insurance. Also, new ways had to be found to break even on care of government-insured patients.

&t;River Valley was not a participating provider for Anthem and other health insurance plans at the time it closed.