DULUTH – National Rural Health Day was Nov. 16 and Essentia Health and St. Luke’s Lake View Hospital took the opportunity to raise awareness about these services and the industry-wide struggles these systems face statewide.
Government-funded health care is inadequate
Rural areas are largely made up of older populations, who more often than not receive publicly funded health care such as Medicare and Medicaid, according to Dr. Bill Heegaard, president of Essentia East, which covers Hayward, Wisconsin and Minnesota West. to Brainerd, north to International Falls and south to Sandstone.
“Generally speaking, government payers pay less than the cost of health care, so that becomes a challenge when you’re trying to deliver care in a large area. That’s why most places really struggle with trying to provide health care in rural areas,” Heegaard said .
Greg Ruberg, vice president of Duluth-based St. Luke’s and president/CEO of Lake View Hospital in Two Harbors, echoed this sentiment, adding that this will require making up the difference from other sources, such as commercial insurance.
“We are increasingly experiencing problems with insurance payers denying our providers’ recommended patient care plans and obtaining prior authorization for specific services from commercial payers,” Ruberg said. “This equation simply will not be sustainable as we deal with the challenges ahead.”
Making care accessible
In populations considered rural, there may only be access to one or two health care systems. Rural communities make up 84% of Essentia Health’s geographic service area. Eight of Essentia’s fourteen hospital systems are defined as critical access hospitals.
“These are hospitals where there’s probably no other care in the area, probably 25 miles away. Often it’s much more than that,” Heegaard said.
Older demographic groups also experience greater medical problems and chronic diseases that impact their health, Heegaard noted. To better manage chronic diseases in rural populations, Essentia is focused on providing easier access to its clinics, such as Cloquet, Moose Lake and Deerwood, which have been added to the hospital’s network. The Staples and Hinckley locations will open next year.
The community paramedicine program, telehealth and other at-home patient care are some examples of how Essentia is making health care more accessible in the rural areas it serves, Heegaard said.
“We’re trying to use telehealth to diagnose and connect people with the care they need,” Heegaard said. “It is not an absolute replacement for all of healthcare. It is not a replacement for individual interactions. It is in addition to or in support of the care we provide through better access to specialists. If you get that right, we will have a healthier population .”
Community paramedics make home visits and communicate a patient’s problems to the team, which in some cases can prevent readmission to hospital. These services are available through Essentia in the Duluth and Fargo, North Dakota regional areas.
“The same applies to home care. We are trying to expand those services. This allows people to receive care at home and only have to come to the hospital when necessary. We have invested heavily in that and we will continue to do so.” invest further as time passes,” Heegaard said.
More surgeons and specialists have also been hired for Essentia’s systems. In addition, services such as ambulance care, obstetrics, neurology and pulmonary diseases have been expanded in rural areas.
“We are investing in rural health care closer to home to be able to support those communities and support ongoing care,” Heegaard said.
Similarly, Lake View has integrated a mental health nurse into its primary care model.
“We also partner with the Human Development Center on site at Lake View to provide comprehensive medical and mental/behavioral health care services on our campus,” Ruberg said. “These innovative approaches treat the whole patient compared to the more isolated models of the past.”
Breaking silos to build partnerships
For St. Luke’s Lake View Hospital, strong community partnerships are critical to making services feasible in the rural environment. It recently partnered with Lake County Public Health to complete a joint community health needs assessment to best serve all of Lake County.
“This innovative approach and continued collaboration will allow us to share resources, address jointly identified health issues and concerns, and integrate medical and public health care delivery in our rural communities,” Ruberg said.
Lake View is also taking a creative approach by working with its public health partners on various community initiatives to ensure the future success of each organization, Ruberg added.
Financial challenges are significantly impacting hospitals and healthcare systems across the state. According to a recent report from the Minnesota Hospital Association, 67% of hospitals and healthcare systems are experiencing negative operating margins in the first half of 2023. Average operating margins have fallen from negative 0.5% in 2022 to negative 2.7% in the first half of 2023. 2023.
“Lake View continues to analyze and carefully evaluate every financial decision to ensure our organization remains financially viable during these challenging times in healthcare,” Ruberg said. “We try to find innovative ways to provide our services more efficiently, while always striving for an excellent patient experience. The cost of delivering medical care continues to rise in the United States, and this is unsustainable. We are doing our best to address this in a positive way.” influence on this.”
Between 2010 and 2021, the American Hospital Association reports that 136 rural hospitals closed nationwide. Another 600 hospitals in rural areas are at risk of closure.
“That really has a cascade effect, because then we are talking about people who have to drive for hours to receive care,” says Heegaard. “In such a situation you will have more emergency visits because access is denied.”
The closure of hospitals in rural areas puts additional pressure on ambulance services, Heegaard added.
Rural hospitals are often the largest employers in the small communities they live in, and the loss of jobs due to closure is a significant blow with a trickle-down effect, Heegaard explains.
Critical access hospitals in the region have invested in rural health care by implementing innovative solutions to unique challenges that are often greater in small communities, such as workforce development.
“In the state of Minnesota, our best estimate is that we have approximately 45,000 vacancies in the health care sector. We know that this is even worse in rural health care,” Heegaard said.
Ruberg added that many employees at hospitals and clinics choose to work part-time.
“This requires us to attempt to hire more employees to serve our patients in our 24/7 operation, but this is an ongoing challenge with the workforce challenges facing healthcare and other industries,” Ruberg said.
Essentia’s greatest employment need, according to Heegaard, is in nursing, followed by demand for nursing assistants, surgical and operating room assistants, surgical technicians, circulators, as well as respiratory, occupational and physical therapists.
“As we look at the demands on health care, and we look at the population, we know that those demands on services are going to increase significantly,” Heegaard said. “People are living longer and demanding to be more mobile, and the numbers are rising at a time when our graduating classes in the United States are declining. We have that conflict – we will have high demand and we know those resources are very precious.”
Heegaard highlighted how Essentia collaborates with educational organizations, both at secondary schools and at university level. This is done by participating in career fairs and offering job shadowing opportunities, configuring new training methods and more – all to spark the interest of younger generations in entering in-demand positions within the growing healthcare industry.
“We recently made a commitment to partner with the College of St. Scholastica to help reimagine new ways we can train and provide pathways to success and careers,” Heegaard said.
Lake View has implemented a number of creative strategies to address workforce challenges as well.
“We have established apprenticeship programs to train new employees in the workplace, while paying for the training and testing of these employees. We also offer tuition reimbursement programs for employees to increase opportunities for individual career growth and development,” said Ruberg.
Lake View also works with employees on specific educational training opportunities to develop the organization’s current and new service offerings, such as the creation of medical weight loss services and the expansion of mammography services, Ruberg said.
“We try to offer special services in smaller towns if necessary,” Heegaard said. “To provide highly specialized care, you always need a center of Excellence. Due to the workforce, this will always remain in the larger cities.”
Both St. Luke’s and Essentia Health have facilities in downtown Duluth in addition to their rural locations.
“We have made the biggest commitment to downtown Duluth that has been made in more than 100 years: keeping a city vibrant,” Heegaard said. “It’s very important that Duluth is successful because the arteries go to the smaller communities.”