Medical services in Powder River County have been a hot topic of late, with the expansion of Powder River Health, the COVID-19 pandemic putting an emphasis on the Public Health Program, the expansion of the Physical Therapy Department, changing control of the local ambulance service, and, as always, the topic of the Manor.
While looking for ways to gauge the community’s feelings on its healthcare needs, the Powder River County Commissioners, along with the Health Advisory Board, worked to develop a comprehensive community health assessment. The advisory board worked with Loveland Consulting, LLC, to send out an electronic healthcare assessment survey to the community in December of 2020. Community leaders took part in the survey, with 44 participants returning the survey. The reason cited for targeting community leaders as opposed to the population as a whole was cost associated with surveying every county resident.
The assessment, which is available via a link on the Examiner Facebook page, asked a number of questions about current healthcare options in the county, as well as what services should be prioritized for development in the future.
The survey includes population level data for Powder River County including how our population compares with Montana as a whole on such demographics as age, employment, income, chronic disease prevalence, childhood education, and others.
The demographic data shows that Powder River County is an aging community, where medical issues in the elderly community are expected to increase as the population ages. Powder River County is also in the top 1% of counties in the nation when it comes to rurality, which is a rather nebulous term but is quite obvious when looking at our lack of population (1607) and wealth of land (3,298 square miles). This translates to around 0.48 people per square mile.
Returning to the survey results, 68% of those responding to the survey indicated a desire for expansion of a primary care facility, and over half of respondents indicated they would like to see an emergency department and expanded medical lab in the county. With those results in mind, the commissioners and the Health Advisory Board have been looking at options for potential expansion of health care options in the county.
Next Steps
One such option which has been used effectively in many small towns around Montana and across the West is the Critical Access Hospital.
Critical Access Hospitals (or CAH) came about through congressional legislation in the mid-1990s in response to a large number of rural hospitals closures during the 1980s and early ‘90s. The designation of a CAH is meant to improve access to healthcare for patients in rural areas, while reducing financial costs for those in the area, through a cost based reimbursement model. Essentially what this means is that the hospital makes more money per patient than our current separate clinic and nursing home model, while also providing additional levels of care, such as a Physician’s Assistant or Doctor if available. If set up correctly, the model also minimizes the burden on the local tax payer through the additional federal funding generated through cost based reimbursement.
The requirements for CAH include being located in a rural area, as well as more than a 35 mile drive from another hospital.
Karl Rude, President of Health Management Services, LLC, spoke to the commissioners at a recent meeting where he detailed the positives of the Critical Access Hospital model. Rude heads the Billings based company, which has built medical facilities around the region and is currently working on a facility in Saratoga, Wyoming.
Rude pointed out that a Critical Access Hospital has a 24 hour emergency department, a fully certified lab, imaging such as xray machines, a CT scanner, and ultrasound, as well as a senior care facility.
He described the reasoning behind the move to the CAH model was in large part from the US Department of Agriculture. In order to help ensure a secure food supply, farmers and ranchers needed to be out on the land, growing their families and staying in those rural communities. As populations in rural areas were aging and fewer folks were staying on the land, in part because of a lack of medical facilities, the CAH model was brought about to keep more rural folks in their communities and working to ensure a safe and constant food supply to power America’s nutritional needs.
If PR County were to transfer to the Critical Access model, it would involve combining the clinic, manor, and other county health care facilities, as well as the ambulance service. According to Rude, the ambulance staff would be able to work in the emergency room, furthering their skillset as well as providing paid positions for those jobs.
Communities such as Jordan, Circle, and Ekalaka currently use the Critical Access Hospital Model for their health care needs.
The CAH model is limited to 25 acute care inpatient beds. This would also include swing beds, which offer an alternative to nursing facilities like the Manor. PR County Medical Director Sean Hill was present at the meeting, where he indicated that the PR Manor has generally been below that 25 bed capacity for years. All of these beds would be covered under the cost based reimbursement model, helping to cover costs associated with the CAH.
If PR County were to go to the CAH model, the potential would still exist to transfer the current Manor facility to an assisted living facility, providing extra capacity for those patients who might not need skilled nursing but aren’t well enough to live at home.
The costs of building the facility would be paid for in large part by a federally insured loan featuring 30 year fixed rates, which would cover 80% of the cost. Another 10% could come from other banks, and 10% would come from the county, which could potentially be offset by grants and other sources.
Rude pointed out the employees currently working at the county facilities would generally still have a similar position in the CAH model. An MD, nurse practioner, or PA would either need to be onsite, on call, or available within an hour drive – telehealth options also exist for some of these needs. An RN would need to be available 24/7, which is currently the case at the Manor.
Karl said that in his experience, the timeframe from the community making the decision through completion and opening of the doors on the CAH was around five years; this process could be expedited as necessary.
The commissioners and the advisory board are now looking at the next step as to whether or not a CAH makes sense for our community – a feasibility study. This analysis would take into account the relevant factors as to what a CAH would look like and cost.
Rude pointed out that a major plus to the CAH model is the reduction of “the golden hour” – that first 60 minutes when a trauma patient is in urgent need of definitive next level medical care. Currently, once an ambulance is on scene a patient will either need to be transported to a hospital by ambulance or by calling in a life flight. With the CAH model, a number of patients would be able to be treated right here in Broadus. “A CAH hospital in Broadus would save lives,” Rude said.
Ultimately, the factor deciding whether or not a CAH is right for our community will be the community itself – what do we want for future healthcare options?
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