Rural health care across the nation is beset by many challenges.

Rural health care across the nation is beset by many challenges. There is a delicate balancing act that health care providers must perform in order to provide affordable, high quality care to patients while still maintaining profitability in order to keep their doors open.


A perfect storm consisting of an aging rural population, access issues, a shortage of doctors, increasing pharmaceutical costs, and an uncertain outlook for the Affordable Care Act is coming together and looming on the not-too-distant horizon.


An aging, rural population’s health care needs are quite different from the health care needs of younger, urban populations. Older people tend to have more medical issues, and it is vitally important for them to have easy access to quality, affordable health care.


Diseases associated with aging such as Alzheimer’s, Parkin­son’s, cancer, and dementia take their toll on patients and their families. People worried about their family members are also worried about  the  costs of caring for loved ones who have a chronic disease, and rightfully so.


Costs associated with caring for the elderly are on the rise, as are medical bankruptcies.


Local health care facilities are committed and determined to provide the best quality care at affordable prices for their patients. They are fighting an uphill battle.


Mark Paulson, CEO of the Chippewa County-Montevideo Hospital, is very concerned about the state of rural healthcare. “The whole system needs to be rethought,” said Paulson.


He cited concerns over the rapidly rising cost of insurance and prescription medicines, as well as the shortage of doctors, as driving factors in the overall increase in health care costs.


“Baby boomer physicians are retiring,” Paulson said, “and there are fewer doctors to take their place.”


The recent departure of two doctors from CCMH is placing a strain on staff. “At this time, we are short on doctors. Ideally, we’d like to have seven or eight physicians on staff,” Paulson said.


Paulson and his staff at CCMH are always recruiting health care professionals. “We offer a lot of incentives to bring professionals here,” he said.


The hospital partners with the University of Minnesota to give medical students the opportunity to experience the challenges and rewards of practicing rural health care.


Medical students come to CCMH to do 30-day internships, after which they return to the U of M to complete their studies. By experiencing first hand what rural health care is about, it is hoped that some may become interested in practicing in rural communities.


“It takes a unique person to come out and practice in rural Minnesota,” said Paulson.


Seeking  creative solutions to keep health care costs down is also part of Paulson’s job. CCMH is partnered with Medi-Sota, a 501c health care association. Medi-Sota represents many  rural medical facilities and negotiates regional vendor contracts to keep costs low for all facilities.


Though he is concerned for rural health care in the near term, Paulson holds out hope that rural health care can weather the storm.


“We believe that, in rural health care, we can take care of our patients just as well as our urban counterparts,” said Paul­son.


Granite Falls Municipal Hos­pital & Manor CEO Tom Kooiman spoke to the challenges he has seen in rural health care. “We have an obligation to care for our community,” he said.


“Part of the challenge is that we need RN’s, Advanced Practice Pro­fessionals (APP) and physicians 24 hours a day, 365 days a year,” Kooiman said. Our CT Scanner has to be available 24 hours a day, 365 days a year.”


Such needs place a strain on medical facilties already struggling to serve their patients. “It’s going to get interesting for everyday operations,” said Kooiman.


Reimbursement from insurance carriers is a big issue. “What we’re starting to see happen is Blue Cross/Blue Shield is struggling. They come to us and say this is what you will get, even though our costs may be more than what they will cover,” Kooiman said.


Kooiman sees investment in technology as a means to rein in the escalating costs of rural health care.


Granite Falls Hospital & Manor participates in eEmergency and TELEHEALTH. eEmergency allows rural physicians to  use computers to directly connect to larger trauma centers that have the medical resources and specialty expertise to handle emergencies.


TELEHEALTH Serv­ices  provides healthcare television and interactive patient education and engagement solutions to the health care industry.


Granite Falls Hospital &  Manor also partners with Medi-Sota.


Kooiman believes that rural health care will have to move towards a more technology based system of care. For example, a cardiologist from a larger facility can be consulted by a rural physician online about a heart attack patient.


“You’ll start to see more rural hospitals partnering with larger entities to improve the quality of care for rural patients,” he said. “We’ve also moved towards a nurse practitioner and Advanced Practice Professional system of operation, to help keep costs down,” Kooiman said.


“Our main focus is on keeping our patients healthy and keeping our emergency departments open,” said Kooiman.


For the time being, rural residents still have access to quality health care, but affordability remains elusive as health care providers struggle to find solutions to control costs.


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