Rural hospitals seek Rx for survival
POMEROY, Wash. – It is autumn in this small town along Pataha Creek, tucked into the rolling hills south of the Snake River. The downtown is populated with a handful of shoppers, pickups and minivans. It boasts nine churches and two bars. This wheat farming town also has the distinction of being the seat of Garfield County – with 2,400 people, the state’s least populous. These aren’t heady times for Pomeroy. The price of wheat is down, big-box stores in larger towns lure away local dollars, and the recession has delivered a wallop. Yet there’s a bit of rejoicing about the arrival of the town’s newest resident. After two years of searching, Pomeroy has a local doctor again.
Embraced by residents
Although people in Pomeroy like to brag that the town is “about 30 miles from anywhere,” it sits squarely at the crossroads of what works and what doesn’t in the realm of rural health care.
On the plus side, “If something is wrong I can walk right in here and see my doctor,” said Harold Waldher, who moved back to his hometown after retiring in the Seattle area. “That’s not something a lot of people in cities can say.”
But while many in the town laud their local care, Garfield County Memorial Hospital has been on life support for years.
Although Garfield Memorial is debt-free, there is no reserve fund for the hospital, which is supported by patient revenues and a taxing district. Taxpayers are asked each year to help with the most basic needs. This year, it’s $70,000 to fix the roof and paint the building, said Andrew Craigie, administrator of the hospital district. Last year it was $198,000 for a new phone system, emergency generator, fire alarm and nurse call system.
The struggles are similar at many of Washington’s small-town hospitals. Most of the state’s 43 hospitals operated by taxing districts need an annual infusion of property tax dollars to meet maintenance costs.
But is that sustainable?
Jeff Mero, executive director of the Washington Association of Public Hospital Districts, is not sure.
“In many other states you have small hospitals that just throw in the towel,” he said. “Honestly, that could happen in Pomeroy at any time. That it has not is a real testament to the district and people of Garfield County who continue to voice support with their taxes.”
Eyeing new business models
A long-term answer is needed.
Administrators at several small hospitals across the state, from Pomeroy to Forks and from Sunnyside to Republic, are looking at policies and business models that could usher in new cash flows based on population or other measures that are more dependable than how many people get sick each year. Mero said there’s also interest among small hospital operators in setting up demonstration projects to test new funding models based on fostering a community’s wellness rather than attempting to achieve a profit margin on the seriously ill.
“It’s a hard message to deliver,” Mero said, “because it reverses a way hospitals have been funded.”
Yet something has to be done, said Pat Richardson, a retired nurse and chairwoman of the Pomeroy hospital’s board. She worries federal health reforms focusing on new restrictions to rein in soaring Medicare spending will ensnare rural hospitals that are providing efficient, good care.
“If Medicare pays us less for treating people, we’ll be down the tubes,” she said matter-of-factly.
And that would be devastating to the people and economy of Pomeroy, just as it would for other small towns served by rural hospitals.
Fewer choosing family medicine
Garfield Memorial is managed in conjunction with an adjoining nursing home, which includes a dementia care unit, and a medical clinic several blocks away where Dr. Glenn Houser is based.
The clinic will have about 5,000 appointments this year. About 800 patients will go to the hospital’s emergency room.
Before Houser arrived, Pomeroy had been served for years by Dr. Sayed Zafar, who retired and moved away.
Two other physicians served interim roles to bridge the two years it took to attract Houser, 55, from Eureka, Mont.
Houser, who has worked in rural Washington, including a time at Deer Park Hospital before it was closed by Providence Health Care, said there aren’t many doctors who go into medicine with aspirations to tend the everyday maladies of small-town residents. “It has to fit,” he said. “For me, I wasn’t worried about all the money and I didn’t want to be in the rat race of a big-city practice.
“Out here,” he said, “I have what so many others work so hard to find: good people, fishing, hunting, plenty of space. A person can do whatever they want,” he said, smiling and shrugging his shoulders. “What I didn’t do is get rich … and I still drive junky cars.”
Mero said it’s his belief that the state and nation don’t have a doctor shortage so much as a “doctor distribution problem.”
There’s been a sharp decline in the number of medical school graduates who choose family-medicine residencies, according to the American Academy of Family Physicians. At the University of Washington School of Medicine, for example, just 10 percent of graduates went into the field of family medicine in 2006 compared with 23 percent in 1997.
It’s hard to blame doctors for choosing from among the wide range of specialties, such as oncology or surgery, instead of family medicine, agree Houser and Craigie.
The intellectual rigor of specialization is attractive. And so is the money. Doctors graduate with large medical school debts. The typical graduate from UW’s med school this coming year will owe $129,000.
The quickest way to repay loans and achieve an upper-class lifestyle and prestige is by joining a specialty practice.
Such reasons are real and understandable, Mero said.
Additionally, family-practice doctors are in high demand in cities, too, where jobs offer the inducements of hospitals brimming with technology and the expertise, camaraderie and safety net of a large group of colleagues. So how does Pomeroy attract a physician?
“It takes the right person,” said Craigie, likening the search to “finding a needle in a haystack.”
“You need someone who wants the small-town lifestyle for their family.”
‘We’re lucky to have them’
Organizations such as Spokane-based Inland Northwest Health Services also help.
The nonprofit collaboration of Spokane’s large hospitals runs a sophisticated electronic medical records system and tele-health network that can tap the expertise of specialists if a doctor working in a rural clinic or hospital needs assistance.
INHS sometimes gives tours of its network to prospective rural doctors, along with showing off its MedStar fleet of helicopters, airplanes and ambulances that can be dispatched quickly to rural communities for patient transfer. The tours are meant to assure candidates that even though they may be operating solo in small towns, they aren’t alone, according to INHS executives.
Major medical episodes are rare in Pomeroy. One that is often recalled happened 25 years ago when a van carrying the University of Oregon wrestling team crashed near Pomeroy en route to Pullman for a match against Washington State University. All of the passengers were ejected from the van. Two died, including Jed Kesey, the son of the late author and 1960s counterculture hero Ken Kesey. The injured were treated in Pomeroy, and some were later transferred to major hospitals, said Susan Morrow, the district’s chief nursing director.
More typical medical emergencies are cases like that of Gary Wisenfels, a Pomeroy schoolteacher who suffered chest pain one day at school and was urged to seek help.
He climbed into his pickup, drove several blocks to the hospital and within minutes was diagnosed as having a heart attack.
Within two hours of the hospital staff summoning help, he was under the care of cardiologists at Deaconess Medical Center.
It takes a MedStar helicopter about 45 minutes to fly from Spokane to Pomeroy.
But it all started at the local hospital, recalled Wisenfels’ wife, Lee Wisenfels. “We’re lucky to have them,” she said of Garfield Memorial.
“This hospital helps make our community complete.”