Critical Conditions

ORIGINALLY WRITTEN BY DON RATZLAFF
The way things keep changing these days, looking 10 years ahead is a challenge in almost any field, but it must be doubly hard to do so in the field of health-care, isn?t it?

I wish somebody would give me a crystal ball that is clear and wasn?t foggy.

So what do you see down the road for Hillsboro Community Medical Center?

The collaboration we?re trying to do with St. Luke Hospital in Marion is absolutely essential. If we don?t do that in some way, neither hospital may exist. We just have to find ways and means to do what we do better, more efficiently.

Craig (Hanson, St. Luke administrator) and I are working at that, but everybody has to buy into the objective: What?s the big picture and how do we get there?

What?s your early sense of how people are buying into it?

A passive interest, would be my description at the moment. There?s a small core that have a greater interest, but the general population can?t grasp the complexity of it, the sensitivity of it.

And maybe that?s our fault. We keep trying to say it. We talk about the Balanced Budget Act and people say, ?What?s the Balanced Budget Act?? But it knocks our socks off.

Do you think the Balanced Budget Act was an intentional strategy by the federal government to reduce the number of hospitals in our country?

I can?t speak for the people in the Beltway. What the legislation intended to happen in a number of years?to balance the federal budget?happened in very short order. What we?re dealing with now are what we call ?the unintended consequences? of the Balanced Budget Act of 1997.

I?ve been in this business since 1958, and I?m probably not the sharpest knife in the drawer. But I don?t know where it?s going. I?m not sure Washington knows where it?s going.

I don?t think Washington really understands the devastation it has caused. It?s not only rural hospitals. The big systems, like Via Christi, are getting hit big time, too.

Have the corrective efforts of Jerry Moran and other members of Congress softened the impact of the BBA?

Yes, it?s better than what it was, but it?s not enough. There?s going to be another effort this year.

We?re not asking for anything we don?t deserve. We?re not going back to the trough to get rich. We?re going back to the trough so we can make the Hillsboros and the Marions and the other communities in this state be vibrant and serve.

A couple of months ago you cut around $200,000 in your budget to offset the shortfall resulting from BBA-related cuts. How?s that going?

We cut out some small things, like the annual employee Christmas party?that?s more emotional than anything. It might save us $3,000 to $4,000. We also reduced the number of pages in our Healthbeat (newsletter) by half.

These kinds of expenses are miniscule compared to staffing. I?ve got staffing productivity standards from two groups. We can tweak one area a little bit yet, but otherwise we?re right on target. We?re down to where we should be.

But I?m watching overtime like a hawk. That?s where the key savings will come.

If people are working fewer hours, how are you assuring that the standard of care remains high?

They?re not working fewer hours. That was one of the first complaints we heard??Man, you cut our hours.? So I took a couple of labor reports to them and showed them they were working as many hours as they were before.

It?s the overtime hours that hurt us. We were at one time up to 350 hours overtime every two weeks. We?ve got it down to around an average of 220.

Some overtime you never eliminate?lab, x-ray, nursing all have to be called back when they?re needed. But we can sure monitor it so it?s not being abused.

Some things aren?t always palatable to everyone, but, hey, the big picture is that HCMC has to stay here.

How important is a hospital to a rural community like ours?

If we didn?t have this hospital, this community would lose a payroll of about $2.5 million dollars. That?s a lot of buying power.

When industry assesses a community where they might want to go, they ask about education, they ask about health care. If you don?t have health care, the chances of getting an industry are slim to none.

You?d have empty housing, too.

We?ve got a long-term care unit. Right now, those 52 residents have access to almost instantaneous care if something happens to them. If we didn?t have the hospital per se, those residents would be without that service. And families wouldn?t allow their aging parents to be in that circumstance.

Even beyond those things, you?d lose accessibility. If I?m having a heart attack?do I want to go all the way to Newton when I can come here within five minutes, be stabilized and then transferred?

If this hospital were to close, a lot of people in this community would say, ?What do we do now? Where have we been? Why didn?t you tell us?? Well, we have been telling you!

What are HCMC?s strengths as a health-care provider?

I?m prejudiced, but I don?t know of anything we don?t do well. Some may take issue with that, but we do a patient survey and the results we get back rarely contain a criticism. Patients are well satisfied.

Any specific programs or services that you offer that are particularly necessary here?

Everything we do here is necessary. I don?t know of any fluff.

Lately, we have tried to reach out to the community more with educational services, such as in the area of diabetes. Is that important? Sure, it?s important. At the county fair, we uncovered three people who were diabetic and didn?t know it. And it was done with a simple, inexpensive test that we conducted.

We also could go out to the schools and check children for diabetes and asthma.

Those are the kinds of things we want to develop. We?re going to have to do some nontraditional things.

You mentioned cooperation with St. Luke as being a critical piece of the future. How?s that going? What direction are you heading?

We haven?t made any definite decisions. We?re sort of in a search mode. But we?re going to be doing health care better than we?re doing it now.

Yes, there?s been talk about building a new hospital midway between our two cities. People say, ?You won?t be able to service the debt.? I disagree. It?s going to take more study and it may take a little bit of tax money.

But here?s why I say we can service the debt. The two hospitals combined have a $5 million payroll at this time. Let?s say you cut that by three-fourths. I think that would go a long way toward servicing the debt.

How much money would be needed to build a new facility?

Ten million dollars. That?s just a guess.

People won?t believe this, but we went through a pretty comprehensive market assessment. Both facilities have outlived their useful lives.

People say, ?That?s impossible.? But let?s compare the hospital with a business downtown that runs eight hours a day, five days a week and is not subjected to the stringent codes and plethora of regulations we have.

We sit out here and operate 24 hours a day, 365 days a year. This building takes a lot of abuse as compared to somebody downtown.

Our building was built in 1956. That?s 44 years ago.

What other options are you considering?

The other thought we?ve had is to keep two facilities and develop a ?super board? to operate them under one umbrella. And you could have one CEO manage both hospitals.

All we have to do is use our imagination. Marion doesn?t want its hospital closed. Hillsboro doesn?t want its hospital closed.

The option of having two facilities with a super board has some sales appeal as opposed to ?Let?s do away with this one or that one.?

But you see a new hospital as the best option?

I say the ultimate would be a new facility midway between our two towns. That?s a big step. People will have to give a little bit?take the politics and the turf issues out of it.

If you had one facility and a combined staff, it would also be the home base for your ambulance service and public health.

If everything is integrated at one location, and you have state-of-the-art equipment?we do now, but even more so?you might have the distinct advantage of being able to recruit more physicians. You would certainly gain efficiency.

What?s the timeline by which something significant needs to happen in regard to cooperation with Marion?

Some have said 10 years. I think that?s generous. I?d say 2004, maybe 2005.

If we decided today that one hospital is the way to go, I think by the time you put all the nuts and bolts together, it would be three to four years before it?s up and going.

Carl Long (president of the HCMC board) states it as well as it can be stated: Our objective should be to devise a system to provide health care to Marion County?not just Hillsboro, not just Marion.

There?s a lot of diversity in this county. Goessel probably wouldn?t warm up to that too much because they go to Newton now already.

But it?s been said that if this hospital closes, St. Luke?s not going to gain anything. If St. Luke closes, we?re not going to gain anything. People will go to Newton or El Dorado.

What?s the biggest obstacle that could keep cooperation from moving forward as quickly as it needs to?

I think it?s the current mindset in the general public that takes our hospitals for granted. That ?ostrich syndrome? is not going to work. Somebody?s got to get proactive. If I go out and do it, it looks self-serving.

So where should the initiative come from?

The two boards are a starting point, but I think the two city councils need to sit down and talk, maybe in concert with the county commissioners. Bring in somebody neutral from the outside who can be a facilitator.

That?s the kind of thing that needs to be done. We?ve got some leadership in this county. There are people who can join hands and say, ?Hey, this is what we need to do.?

As long as I?m here, my concern is to keep this place perking along so that the people in this community and the surrounding area have access to health care. If that wasn?t my objective, I should have been walking on down the road some time ago.

What can the ?average citizen? do to help ensure that adequate health care will remain in Marion County?

Using our facilities for their health needs is a start. But with most people, their everyday thoughts are not on health care. The younger person wonders, ?How am I going to make that next car payment?? They don?t think about health care until they need it. Then it becomes a priority.

Do the challenges facing HCMC discourage you?

I think there are a lot of positive aspects about this scenario. It?s just a matter of getting everybody on the same page. That?s not easy. There are some naysayers out there.

But as far as our working relationship with St. Luke, I think it?s getting along quite well. We?ve made no giant strides. Craig and I have breakfast at least once a week just to talk about things. We?re not the decision-makers, but I think we have to be the catalysts.

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