Urban/rural hospital partnerships such as the one between St. Luke’s Hospital and Cook County North Shore Hospital & Care Center are becoming a trend. This was one of the things Head Nurse Bridget Sobieck reported to the hospital board on July 18, 2013 after attending a rural health care conference in Duluth in June.
In the next few years, Sobieck said, rural hospitals will face competition from other hospitals and challenges maintaining employees, meeting information technology requirements, and securing funding.
Critical access hospital expert Eric Shell, a speaker at the conference, predicted that 20 percent of small rural hospitals would be closing by 2015. Being affiliated with larger hospitals will help in getting doctors to work at rural hospitals and in getting referrals for services that can be done locally, Sobieck said.
North Shore Hospital is the most remote hospital in the state, St. Luke’s President John Strange said. North Shore Hospital Administrator Kimber Wraalstad said that it and a hospital in Idaho are the two most remote hospitals in the country. Board member Howard Abrahamson pointed out that patients in Grand Portage and up the Gunflint Trail live up to 160 miles away from the Duluth hospitals.
In the future, patients are going to weigh the quality of their services against the cost in making decisions about their health care providers, Sobieck said. Up to this point, hospitals have made more money for more volume. The new model for success will be providing better care and better service at lower cost.
Another issue Sobieck reported on was pain medication. The number of prescriptions written out for pain-relieving narcotics has “skyrocketed,” she said. Some doctors have been told that “the sixth vital sign is pain” and that pain should be controlled. More people are dying of prescription medication overdoses than of car accidents, however, Sobieck said. A national database tracking prescriptions is in the works, she said.
Synthetic drug problems
Board member Kay Olson reported that at a recent health care meeting she attended, she learned that violence by patients on synthetic drugs has become a problem, and workers are getting injured. One facility needed eight people to subdue a patient, and mental health facilities don’t always take these patients. She said some people are proposing a law that would make hurting a health care worker in a health care facility a felony.
John Strange said people out of control on synthetic drugs are being transferred to facilities all over the state. St. Luke’s needs to use their security guards about 100 times a month, he said, and they have one stationed in their ambulance garage.
Nurse Sobieck said that in the previous month, North Shore Hospital had three mental health and drug use-related incidents that involved violence or safety threats to staff. “It occurs more and more,” she said.
Within the last several days at St. Luke’s, three people had been on ventilators because of synthetic drugs, Strange said. In the last three months, 17 employees had been hurt by patients. One incident involved a 5’2” female who beat up the staff, he said.
Professional attire
Board member Sharon Bloomquist took issue with the way some care center employees dress for work, saying she would like to seem them dress more professionally.
The trend is for employees in care centers to dress casually in order to help residents feel more at home, Administrator Wraalstad said.
This issue is a struggle in other places as well, John Strange said.
Wraalstad said she is working on the dress code policy.
Facility remodeling
The hospital board continues to work toward the possibility of remodeling the hospital and care center to better meet current and future needs. They will discuss financing options at their next meeting on August 22.
The board adopted a set of guiding principals that will be used in planning the upgrade. They include statements about providing a comfortable environment, ensuring confidentiality, utilizing technology, being cost-effective, and being adaptable to future needs.
Financials
“Our volume in June left a lot to be desired,” Administrator Wraalstad reported. Fewer hospital, swing bed, care center, emergency room, and home health services were provided than the amount budgeted.
The year-to-date loss was $236,276 at the end of June. Last year at that time, the hospital had a gain of $542,218.
The board voted to join the American Hospital Association at a cost of $3,381 for the first year, half of what North Shore Hospital’s regular membership would be. Board member Tom Spence said he felt being a member might help the hospital “be heard.” Sharon Bloomquist concurred, saying it would be “good to get our name and our faces out there.”
Clinic
Help is on the way for people wondering what they will need to know about federal Affordable Care Act enrollment that will begin October 1. Cook County Public Health & Human Services and Sawtooth Mountain Clinic will both have employees ready to help people learn about how the legislation will affect them, what their options are, and how to navigate the system. Clinic Director Rita Plourde said she hopes the information they have to offer will reach everyone in Cook County.
County Commissioner Heidi Doo-Kirk said that the Public Health & Human Services Department had several vacancies, and because of this, having people on hand to help community members with enrollment will be challenging.
Hospital board member Tom Spence said he hopes the website will be as easy to nagivate as the Medicare site, where people can answer a series of questions and then be shown what options are possible.
Hospital Administrator Kimber Wraalstad said tax penalties will be meted out to people who fail to enroll in anything.
Sawtooth Mountain Clinic Director Rita Plourde reported that the clinic is working on a “Patient Portal” software program that will allow patients to confidentially access basic information from their records on the clinic website. Dr. Milan Schmidt said the feature will likely include diagnoses, medications, and vital sign readings.
Plourde said she was feeling positive about recent governmental reviews of the clinic. Some are unannounced, such as one from the Internal Revenue Service, in which the reviewers did not even say hello. She said the staff told her, “We couldn’t get them to laugh.”
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