Rural communities receiving quality healthcare

Tammy Miller (left) John Mengenhausen (right)

Some might think that living in a small town in rural South Dakota might mean a person or family would not get the type of quality healthcare received in a larger metropolis. But for those who handle healthcare needs for people in Kingsbury, Lake, McCook and Miner counties, they will tell you that is just not true.
John Mengenhausen, who is the CEO of Horizon Healthcare based in Howard, thinks the quality of healthcare is as high or as good as you can receive anywhere. “The providers we have here have the ability of being a healthcare home for the individual,” he said. “That is extremely important. Granted, we don’t have all of the specialties that are available, but basic primary care is seen as a gatekeeper so you are not accessing specialty care when you don’t need to. You watch a family grow up. You become their healthcare family.”
Barb Sample, who is the acting business administrator at Interlakes Medical Center in Madison, believes the residents of Lake County are very lucky to have the physicians they have. “It is very difficult being a physician in a rural area,” she said. “It does take a special person to leave that security (of a big city) and venture forth into a rural area.”
In the four-county area there are a number of healthcare providers, including dentists, optometrists, chiropractors and physicians, who all work together to create the excellent healthcare, according to Tammy Miller, who is the CEO of the Madison Community Hospital. Madison Community Hospital provides services for residents of Lake, Miner, Kingsbury, as well as communities in those counties and other counties in the region.
“Our county is fortunate to have the amount of healthcare that we do,” she said. “It helps with the economic viability and development of our county because of the broad spectrum of services that are available and are not available in a lot of counties. Most are independent providers and have to work together for the continuum of care and the best care for the patient. That takes a lot of communication and working together so that we are knowledgeable about the patient.”
One way rural healthcare providers continue to provide quality service is through a continuing quality improvement program.
For example, at the Madison Community Hospital, each department participates in an ongoing quality improvement process. “Not only do we participate in-house and with Medicare, we also participate on a statewide level to improve the quality of care,” Miller said.
In DeSmet, CEO/Administrator Janice Schardin said that Avera DeSmet Memorial Hospital monitors what is appropriate to the community based on the national indicators. In addition, now that the hospital is associated with the Avera system, personnel participate in collaborative and quality conferences to deal with different issues.
Networking is a key component in providing quality healthcare in the rural counties. Many healthcare providers work hand-in-hand with others throughout the region.
In Kingsbury County, there are only two physicians and two-midlevel providers left in the community. But, the community is actively pursuing physician recruitment.
Now that the hospital is part of the Avera system, Avera DeSmet Memorial Hospital is seeking more opportunities to add outreach physician services and educational opportunities. Recently, Avera DeSmet Memorial Hospital started a teleconference educational series on parenting which includes topics involving family members from sibling rivalry to positive discipline techniques to everything you wanted to know about potty training.
In addition, the hospital works very closely with the volunteer ambulance service and fire department. Also, hospital personnel have worked with Kingsbury County to develop a pandemic flu plan. There is also collaboration between the hospital and the high school nurse in DeSmet. Recently, the Good Samaritan Center opened a home health service. And since there is no hospice service in DeSmet, the hospital is able to coordinate that hospice service through an agency in Sioux Falls.
For Horizon Healthcare, a community health center and a non-profit organization, a community board of directors is a key segment that helps with decisions for the communities the organization serves.
“Our goal is to ensure that there is healthcare available in a lot of small communities,” Mengenhausen said. “We work extremely well with the Avera Health System and Sanford Health System. They view us as good partners and colleagues because the type of care we deliver is not competitive to them.”
The bulk of the clinics associated with Horizon Healthcare are in a community of 1,000 people.
Networking is not the only component of quality healthcare. It is also important to provide programs and services.
The Madison Community Hospital provides both outpatient and inpatient services for those in Kingsbury, Lake and Miner counties, as well as other counties in the region. Inpatient services include medical and surgical, obstetrical emergency room, ICU/CCU and swing bed. Outpatient services are ambulatory, radiology, nuclear imaging, laboratory, respiratory therapy, cardiac rehabilitation, rehabilitation services, home care, hospice, Eastern Plains Surgical, emergency service, nutritional services and occupational health services.
“We are just one part of healthcare,” Miller said. “There are a lot of parties and providers that work for the betterment of the community and health of Lake County (as well as Kingsbury, Miner and other counties in the area.”
Horizon Healthcare has considered itself a healthcare home for the communities it serves. “You need one place where you can go for consolidation of all of your healthcare needs,” Mengenhausen said. “You need someone that is managing all of your care.”
Partnerships with the two larger systems in the state helps bring in outreach clinics, dental services and telemedicine for the communities. Each of the organizations’ facilities in Kingsbury and Miner County has different services that are provided.
In the Bell Medical Clinic in DeSmet, patients receive services in family medicine, obstetrics/gynecology, Geriatric Medicine, Family Planning, Women’s Health, Preventive Medicine, Podiatry, Cardiac Rehab and Behavioral Health.
DeSmet Dental provides the following services: extractions, examinations, cleaning, fillings, emergency treatment, oral health education and referrals for specialty care.
At the Howard Clinic, patients receive services for family medicine, internal medicine, physical therapy, women’s health, mammography, podiatry, family planning and primary care.
Services provided at Howard Dental include extractions, examinations, cleaning, fillings, emergency treatment, oral health education, root canals and referrals for specialty care.
Avera DeSmet Memorial Hospital has a medical unit, emergency room, swing bed, outpatient treatments, diagnostic imaging, community education, wellness screenings, laboratory, pathology and blood bank services and rehabilitation services.
Schardin said the hospital is always trying to attract more physicians and specialties through outreach or telehealth programs. “We have a well-rounded program that is beneficial to the community,” she said. “We are continually looking at what else we can offer. Demand, need and cost are all things that determine what programs we take on.”
Those challenges and others are always on the minds of those in the healthcare profession. One of those challenges is cost.
“We try to keep them as reasonable as possible,” Miller said. “We have professional and skilled people. Those types of professionals could make a lot more if they went somewhere else. We have to try and compete on their salaries and we do a lot of time. We still have to pay medical supplies, insurance, benefits for employees, education…it is a challenge. We have been fortunate to have enough patients who are loyal to us.”
Recruiting quality healthcare professionals continues to be an issue.
“Physicians are extremely difficult to recruit to a smaller community,” Mengenhausen said. “We’ll do signing bonuses, recruitment and retention packages for staff, and contract recruitment firms.”
Horizon Healthcare also works to grow its own healthcare professionals. “If you can find someone that is used to a rural community, the chances are you going to have better luck in retaining them,” Mengenhausen said. “What attracts a lot of people in our area is those who are interested in outdoor activities.”
Dealing with insurance companies can also be a challenge. “Each insurance company has several policies,” Sample said. “It is really impossible for us to keep track of what kind of a policy that each person walks in this door has. More rules have been created for particular policy. Patients really have to know the fine print in their insurance companies.”
Then there is the challenge of keeping a rural hospital open. Many healthcare professionals are closely watching the healthcare reform bill and what impact it would have on rural facilities.
“I do not think the public realizes or understands what it costs to keep a rural hospital like this running,” Schardin said. “You have overhead, you need to provide the services, but it cost you more than sometimes what you get reimbursed. How do you make up the difference? That is always a challenge.”
But those involved in the healthcare profession will tell you, that despite the challenges, healthcare is an exciting profession to be in. “I really think for a small rural county between the ambulance and clinic here, we provide a great network,” Schardin said.