Chad Ross, president and CEO of Mary Rutan Health, offered a candid look at the pressures facing rural hospitals — and what it takes to remain independent — during a Wednesday, Feb. 11 Business Impact meeting hosted by the Logan County Chamber of Commerce.
Ross walked attendees through how Mary Rutan Health operates as a private, nonprofit, independent hospital, addressing workforce pressures, insurance reimbursement challenges, community investment and upcoming facility improvements, while emphasizing the role local governance plays in keeping health care accessible in Logan County.
Founded in 1918, Mary Rutan Health is now 107 years old and has operated as a private, nonprofit, independent hospital since the late 1970s. Ross said hospitals with that level of longevity and continued local governance have become increasingly uncommon as consolidation reshapes the health care industry.
Over the years, MRH has grown and now stands as the county’s sixth largest employer with about 750 employees at present, Ross said.
“We’re not the new kid on the block,” he said.
Leadership and governance
Ross said Mary Rutan Health’s independence is supported by a locally governed leadership structure that includes a volunteer board of directors and an executive leadership team.
In addition to Ross, the hospital’s 2025–26 officers include Rick Gildow, board chair, and Scott Abraham, vice chair.
The executive team includes Tom Denbow, treasurer and chief financial officer; Sarah Leichty, secretary; Christy Myers, chief operating officer; Dr. Gregg Fulmer, chief medical officer; and vice presidents Mary Sebring, patient services; Sally Armstrong, human resources; David Kelly, ambulatory clinics and revenue cycle; Laura Miller, marketing and communications; and Tammy Gump, community relations.
The 2025–26 board of directors includes Scott Abraham, Doug Chamberlain, Paige Duff, Rick Gildow, Rick Hatcher, Joan Haushalter, Jeff Holycross, Kelly Kauffman, Joenee Purcell, Scott Shellhaas, Tom Simon, Dr. Grant Varian, Ben Vollrath and David Willoby.
Ross said the board is intentionally curated to reflect a mix of professional backgrounds while also representing all areas of Logan County, providing balanced local perspectives in decision-making.
Community investment
Despite the financial pressures, Ross said Mary Rutan Health continues to reinvest heavily in the community, with total annual community investment exceeding $23.7 million.
According to figures shared during the presentation, that investment includes:
-
$21.8 million in charity care and Medicaid and Medicare reimbursement shortfalls
-
$1,198,863 for community health improvement services and community benefit operations
-
$357,569 in financial and in-kind contributions
-
$247,303 supporting health professions education
-
$62,781 invested in community building initiatives
Ross said the largest portion of that total reflects uncompensated care — services provided to patients without full reimbursement as part of the hospital’s charitable mission.
Rising operating costs and workforce strain
A central focus of Ross’ presentation was the growing cost of operating a hospital, with labor identified as the single largest expense. He said health care faced a “double whammy” during and after the COVID-19 pandemic.
According to Ross, the long-anticipated retirement of baby boomers from the workforce accelerated during the pandemic, as many experienced nurses, technicians and support staff left health care entirely, even as demand for care remained high.
“You can’t just plug people in,” Ross said.
Ross explained that hospitals cannot quickly replace workers due to licensing, certification and training requirements. Even experienced clinicians often require months of specialized training before working independently in a new department.
In addition to labor costs, Ross said hospitals have faced sharp increases in the cost of medical supplies, pharmaceuticals, equipment, utilities and technology, while reimbursement rates have not kept pace.
How hospital finances work
Ross said hospital billing figures are often misunderstood, explaining that gross charges reflect only the starting point of the reimbursement process and do not represent what the hospital actually collects.
He said it costs the hospital roughly 41 cents to provide one dollar of care, while Medicare reimburses about 21 centsand Medicaid approximately 16 cents. Commercial insurance pays more than government programs but still does not fully cover costs.
Ross said that imbalance forces hospitals to rely on commercial insurance revenue to offset losses from Medicare and Medicaid. He noted that more than 72 percent of rural hospitals in Ohio are operating with negative margins.
Insurance denials and administrative burden
Ross also addressed the administrative complexity of insurance billing. Statewide data show that roughly 17 to 18 percent of hospital claims are initially denied, even though only about 1 percent ultimately remain unpaid.
“There’s more Monday morning quarterbacking in health care billing than there ever is in football,” Ross said.
Ross said denied claims require extensive documentation and appeals, adding cost without improving patient care and often leaving patients caught between providers and insurers.
Patient billing and legal action
During the question-and-answer portion of the meeting, Ross addressed questions about unpaid medical bills and the hospital’s use of legal action to collect past-due accounts.
Ross said about 1.5 percent of patient accounts at Mary Rutan Health ultimately reach the point of legal action, a rate he said aligns with 13 comparable regional health systems, which typically pursue legal collection on roughly 0.5 percent to 2.5 percent of accounts.
He emphasized that legal action is a last resort, used only after repeated outreach, payment-plan options and charity-care screening.
Hospital-provided data show that over the past five years, Mary Rutan Health managed more than 236,000 patient accounts that resulted in a balance, with 3,664 accounts referred for some form of legal action, which may include attorney correspondence or court filings.
Hospital officials said a recent increase in filings reflects post-pandemic factors rather than a policy change. Collection efforts slowed during and after COVID-19, creating a backlog of older accounts once courts reopened. Changes in Ohio law also shortened the statute of limitations for collecting medical debt from eight years to six, and changes to liability rules now require some claims to be filed separately for spouses, increasing the number of filings without increasing total debt.
MRH stopped reporting medical debt to credit bureaus in 2024, ahead of possible state-level changes now under consideration by the Ohio General Assembly.
According to the hospital, more than 7,000 accounts are enrolled in active, interest-free payment plans — some extending up to five years with minimum monthly payments as low as $25 — representing more than $12.6 million being paid down through agreed arrangements. Charity care is available to patients earning up to 400 percent of the federal poverty level.
Hospital officials said accounts move toward legal action only when repeated outreach receives no response.
For hospital billing help, visit: https://www.maryrutan.org/patient-resources/billing/
Community investment
Despite the financial pressures, Ross said Mary Rutan Health continues to reinvest heavily in the community, with total annual community benefit exceeding $23.7 million in 2024.
That total includes charity care, unreimbursed Medicare and Medicaid costs, and community investments such as financial and in-kind contributions, community health programs, workforce education and scholarships. Hospital officials said an average of more than $750,000 in charity care has been written off annually over the past four years.
Facility improvements and cardiac care
Ross highlighted recent expansions, including growth at the Indian Lake campus and the addition of services such as Inspire therapy for sleep apnea patients who cannot tolerate CPAP machines.
He also confirmed that Mary Rutan Health is preparing for a multi-million-dollar improvement project at its main campus, expected to begin this summer. While specifics were limited, Ross said the work will focus on improving patient flow, modernizing outpatient areas and enhancing emergency and cardiac care.
One planned improvement involves relocating the cardiac catheterization lab closer to the emergency department.
“The national benchmark is about 50 minutes door-to-balloon time,” Ross said. “We’re already beating that.”
Property transactions and Northpointe development
Ross briefly touched on questions that have circulated publicly regarding property transactions involving Mary Rutan Health and the Northpointe Development near the intersection of U.S. Route 68 and State Route 33.
He did not address the issue in detail during the meeting. The hospital previously issued a Dec. 22 media release responding to social media claims alleging wrongdoing in those transactions.
According to the hospital, the questions stem from misunderstandings about its transition from city ownership in 1978, subsequent long-term lease arrangements, and a 2017 agreement in which the hospital paid the city $1 million to terminate the lease and simplify operations. City officials later used those funds to establish an economic development fund.
The hospital also stated that the Northpointe hotel project is separate from the main campus and involved a private land purchase in 2015, followed by an equity investment approved by the hospital’s board. The hotel is owned by Bellefontaine Hospitality LLC, made up primarily of local investors, and is not operated by Mary Rutan Health.
Hospital officials said any returns from the investment are subject to standard business taxes and directed toward supporting the hospital’s mission.
A question-and-answer session followed Ross’ presentation.
During the discussion, Ross addressed topics including cybersecurity, electronic medical records and the hospital’s regional affiliations. He said cybersecurity remains one of the hospital’s top operational concerns and outlined ongoing investments in outside monitoring, staff training and system testing.
Ross also explained that Mary Rutan Health operates on a cloud-based electronic medical records system with built-in redundancies designed to limit disruption during system outages.
In response to questions about partnerships, Ross emphasized that the hospital remains fully independent while collaborating with multiple regional health systems. He said participation in the Ohio State Health Network allows the hospital to share purchasing power and access specialized clinical resources while keeping patient care local whenever possible.
Ross emphasized that Mary Rutan Health’s mission remains unchanged despite the increasing complexity of the health care environment.
He said maintaining independence requires constant financial discipline, workforce investment and long-term planning, but remains essential to keeping health care accessible in Logan County.
