Rural hospitals are struggling to stay open as the communities around them shrink. Some have an average census of one or two patients a day. But one small hospital in southwest Kansas is drawing patients from a 90-mile radius. Heartland Health Monitor’s Bryan Thompson sat down with the administrator of that hospital to find out how his operation is growing at a time when one in three rural hospitals is at risk of closing.
Primary care can be hard to find in southwest Kansas. Benjamin Anderson knows that fact well.
“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 says.
Anderson is the administrator at Kearny County Hospital, in Lakin. He says people who couldn’t get appointments at the clinic were showing up at the emergency room for things that weren’t really emergencies. From 2005 to 2015, emergency department visits were up more than double the rate of clinic visits, while inpatient hospital days grew six times as fast as clinic visits. That caused Anderson to wonder whether the hospital was really helping people to stay healthy.
“We don’t mind growth and taking care of a larger population. We just want to take care of them well," he says. "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.”
So Anderson’s first step was to recruit two new 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 are often mission-minded.
“We offer 10 weeks, actually, of paid time off to all of our physicians to be used however they would choose. 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," he says.
Anderson says that overseas experience helps the doctors understand and connect with their Kansas patients who may be immigrants from other countries. With a medical staff of 13, clinic appointments are now much easier to get. And when patients need to be hospitalized, they tend to go where their doctor is located.
The Kearny County Hospital and its two rural health clinics in Lakin and Deerfield have added more than a thousand new patients in the last six months—most of them from other counties. The hospital’s daily census is 12. That’s high for a small, rural hospital.
“We can’t have another 126 percent increase in hospital days, or we’ll run out of our 25 beds," Anderson says. "And 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.”
Anderson is creating a team of social workers and nurse case managers whose role will include making house calls. Their goal will be to focus on the overall well-being of the patient, not just any symptoms they might be experiencing.
“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?’" he says. "The answers to those questions have profound implications on our readmission rates, and on our emergency department utilization.”
Reducing hospital readmissions and preventable emergency department visits can save money—but Anderson says 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. We’re paid to admit people into hospital beds and monitor them there," he says. "But we’re not paid very well by payers to manage care from home."
But that’s starting to change. Anderson says Blue Cross Blue Shield of Kansas is paying his rural health clinics a monthly fee for keeping patients healthy as part of a pilot project. And the private companies that administer KanCare, the Kansas Medicaid program, have also expressed interest.
“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," Anderson says. "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 says that holistic approach is good for patients and his hospital. It’s one of the ways he’s managing to keep it off the endangered list.
