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JAMESTOWN – Health care providers cited workforce issues, regulations and rising costs as three challenges to provide services in rural areas.
Rural health care officials spoke about the challenges Monday, June 27, during a roundtable discussion that included Xochitl Torres Small, U.S. Department of Agriculture’s under secretary for Rural Development; Sen. John Hoeven, R-N.D.; and Erin Oban, North Dakota’s USDA state director of Rural Development.
Tim Eissinger, CEO of the Anne Carlsen Center, said the primary challenge for Anne Carlsen is workforce and the ability to get dedicated people in its direct support professionals group.
“It’s an incredibly competitive environment,” he said. “The other aspect is we had a most recent change in our payment system that went from cost driven to an acuity based system, which is good that it fits the unique needs of the individuals we serve but anytime you have a major economic shakeup like we’ve had most recently relative to the national impact, whether it’s inflation on our new building project, we don’t have a rate system that’s responsive to the unique circumstances relative to the economy. That’s serious for us because in the competitive world and wanting to have the best available training, if we don’t have the mechanisms to respond, it puts us at a unique disadvantage.”
Jamestown Regional Medical Center CEO Mike Delfs said the difference between JRMC and many hospitals is it is located far enough from larger geographic areas to be a hub but not large enough to provide tertiary care. He said JRMC employs lots of surgeons but it is difficult to recruit a surgeon to Jamestown and get all of the support that goes with a surgeon including nurses and equipment.
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He said inflation is also a challenge.
“We just got done doing our budget,” he said. “We budgeted for a 10% increase. That’s going to be shopping around to get the 10%.”
Alan O’Neil, CEO of Unity Medical Center in Grafton, North Dakota, said many rural health care providers have had to deploy travel nurses for the last two years.
“That has really blown our budgets sky high,” he said.
He commended the USDA for creating opportunities for rural health care providers to build new buildings and facilities, which have an impact on the communities. He said the buildings are safer and the culture of the employees and patients change once they go to new facilities.
“It’s helped with recruitment and retention of employees, he said.
Erik Christensen, CEO of Heat of America Medical Center in Rugby, North Dakota, said rural health care providers struggle with increased regulations. He said the regulations appear to be a “one size fits all.”
“We don’t have the backup idea to handle all the regulations to do all that work,” he said.
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Torres Small said one challenge for Rural Development is it does not have a direct impact on the workforce and does not work with regulations for health care providers. She asked the rural health care providers how funding from Rural Development helps address any issues and how it can be better.
Hoeven said Rural Development is vital for rural health care providers. He said a rural health care facility is a major employer in small communities and the funding helps the workforce in rural facilities become more efficient.
“You can’t bring people if you don’t have health care,” he said.
Eissinger said Anne Carlsen Center has had opportunities to move to a more populated city but that has never been a consideration. He said Rural Development supported the initiative to keep the Anne Carlsen Center in Jamestown and is helping with construction on a new facility that will be located directly east of JRMC.
The Anne Carlsen Center received a $27 million low-interest loan through the USDA’s Rural Development Community Facilities Direct Loan and Grant Program in February to construct the facility south of Interstate 94.
Eissinger said Rural Development grants also help fund technology that helps individuals with developmental disabilities and special needs become more independent. O’Neil said about 20% of people get care from a rural provider. He said there are trends for people moving to rural areas because they can work remotely now.
“I think it’s important that we keep the programs and keep looking for ways to improve and expand,” he said. “I don’t think rural is heading where we thought it was years ago.”
Hoeven said telehealth needs to be an area to focus on. Hoeven helped introduce the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, which will further expand coverage of telehealth services through Medicare, make permanent certain telehealth flexibilities that were put in place during the COVID-19 pandemic and allow patients to more easily connect with their doctors. by:
