Rural hospitals are struggling to stay open as the communities around them shrink and average patient counts drop as well. A study released earlier this year said one in three rural U.S. hospitals is at risk of closing.
But one small hospital in southwest Kansas — Kearny County Hospital — is drawing patients from as far as 90 miles away and expanding its services.
Benjamin Anderson, the hospital’s administrator, last year analyzed statistics dating back to 2005 for the hospital in Lakin.
Emergency department visits were up 45 percent. Inpatient hospital days had climbed a whopping 126 percent. At the same time, visits to the hospital’s two rural health clinics had grown by only 21 percent.
So Anderson conducted a survey of all patients who came to the emergency department for minor illnesses like sore throats that weren’t really emergencies.
To his surprise, Anderson discovered that the main reason they came to the emergency department was because they couldn’t get a clinic appointment.
“We had been so short on primary care in our region that we were turning away 50 new patients per week in our clinic for over two years,” he said.
That led Anderson to wonder whether the hospital was really helping people stay healthy.
“We don’t mind growth and taking care of a larger population. We just want to take care of them well,” he said. “We want them to stay out of the hospital if possible. We want them to stay out of the emergency room if possible. We want them to remain well and not need those services.”
Mission-minded medicine
Anderson’s first step was to recruit two doctors and four physician assistants last fall. It’s hard to attract and keep providers in frontier counties. But Anderson recognizes that medicine is a calling and its practitioners often are mission-minded.
“We offer 10 weeks, actually, of paid time off to all of our physicians to be used however they would choose,” he said. “And as it turns out, all of our family physicians choose to use some of that time to serve in developing countries overseas — sometimes in the very places that our diverse patients in southwest Kansas are from.”
According to Anderson, that overseas experience helps the doctors understand and connect with their Kansas patients who may be immigrants.
Those staff additions have made it easier for patients to book clinic appointments. And when patients need to be hospitalized, they tend to go where their doctor is based.
The Kearny County Hospital and its rural health clinics in Lakin and Deerfield have added about 1,500 new patients in the last six months — most of them from other counties. The hospital’s daily census is 12, which is high for a county with a population below 4,000.
“We can’t have another 126 percent increase in hospital days, or we’ll run out of our 25 beds,” Anderson said. “So we’ve got to focus on growing the right way, and that means not even seeing everybody in a traditional clinic visit, but seeing people in their homes or building initiatives that would keep people so healthy they wouldn’t even need to come into the primary care clinic as often as they are.”
A holistic approach
Anderson is using a three-year, $300,000 Rural Health System Improvement Pilot Project grant from the United Methodist Health Ministry Fund, based in Hutchinson, to create what he calls the Pioneer Care Advocacy Team.
It’s a team of social workers and nurse case managers whose role will include making house calls. Their mission will be to focus on a patient’s overall well-being, not just symptoms the patient might be experiencing.
Anderson said when hospitals and health systems evaluate their own performance, they often conduct patient surveys. The questions typically focus on the performance of the staff: Were the doctors and nurses friendly and punctual? Were the meals good? Were the linens fresh?
Anderson believes those surveys are missing the most important issues.
“What we ought to be asking is: ‘How are you? Does your arm still hurt? Are you still tired all the time? Did the heat get turned on in your house, so that you don’t get pneumonia again? Are you still depressed? Did the pastor come by and see you as you requested?’
“The answers to those questions have profound implications on our readmission rates, and on our emergency department utilization,” he said.
Reducing hospital readmissions and preventable emergency department visits can save money. But Anderson said there has to be a way to pay for this big-picture approach to health care.
“Right now, our payment systems really don’t incentivize us to do that,” he said. “We’re paid to admit people into hospital beds and monitor them there. But we’re not paid very well … to manage care from home.”
However, that’s starting to change. Anderson said Blue Cross and Blue Shield of Kansas is paying his rural health clinics a monthly fee for keeping patients healthy and meeting certain benchmarks. It’s part of the company’s new primary care medical home project.
He said the three insurance companies that administer KanCare, the state’s privatized Medicaid program, also have shown an interest in some sort of value-based payment system.
Caring for the whole person is going to become the cornerstone of the health care system in Kearny County, Anderson said.
“It’s about everyone who works here saying, ‘I love you, and I’m going to find a way to communicate that to you in a way that you’ll understand it. I’m going to learn your language, I’m going to learn your culture. I’m going to touch you in a way that breaks down walls, so that eventually you can believe that you’re loved, and that love can lead to healing.’”
Anderson said that holistic approach is good for patients and his hospital. It’s one of the ways he’s managing to keep the Kearny County Hospital off the endangered list.
Bryan Thompson is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.