Bigfork Valley Hospital is proud of the high-quality health care it provides patients.
“We have a good crew up here,” said Nathan Hough, Bigfork Valley Hospital chief executive officer. “With the reputation we’ve got, there are a number of patients who travel here for health care.”
Bigfork Valley Hospital is a critical access hospital. They are rural hospitals designated as such by the Centers for Medicare and Medicaid Services (CMS). Among other criteria, a critical access hospital must be located either more than 35 miles from the nearest hospital or critical access hospital, according to CMS. They might also be more than 15 miles from the nearest hospital in areas with secondary roads or mountainous terrain, maintain no more than 25 inpatient beds that can be used for either inpatient or swing-bed services and maintain an average annual length of stay of 96 hours or less per patient for acute inpatient care .
Bigfork Valley Hospital, a 20-bed hospital with a 40-bed nursing home, has proven its mettle. The hospital is also a National Rural Health Association Top 20 Critical Access Hospital.
“We have a long history of that,” said Hough of the recognition. “We’ve been one of the top 20 in the nation for a quite a while.”
The city of Bigfork in northeastern Minnesota, about an hour northwest of Hibbing, has a small population. But the hospital that employs 242 serves a large rural area, said Hough.
“Even though we have a town of 400, we have a big service area,” he said. “One of the things that makes us unique is our service area is bigger than people realize. It’s an hour in any direction to get to another hospital.” That’s where critical access hospitals come in.
The rural hospitals provide preventative care, education, primary care, surgeries, treatments, emergency services and more, to residents and visitors in far-flung rural areas. Like other rural hospitals, the Bigfork facility has doctors from larger health care facilities rotate in and out of the hospital.
“A lot of the things people are looking for, we have here,” Hough said. “When I got here, they had a couple of orthopedic surgeons and general surgeons. Now, we have podiatry and we’re going to start women’s health … and wound care. We’re also expanding cardiology. It’s very important for our patients to have something 15 minutes away rather than an hour.”
Bigfork Valley Hospital also has a pharmacy. In fact, it’s the only pharmacy in town.
“It doesn’t make any money. But we do it because we are providing a community service,” he said.
Yet the hospital is facing many of the same challenges that other rural hospitals face. For example, reimbursement rates, notably for Medicare-managed care (advantage plan) patients, doesn’t cover the cost of treatment.
“Thirty-eight percent of what we do is old fashioned Medicare,” said Hough. “But 31% is managed care, which pays us about 20% of what Medicare does.”
Meantime, rural hospitals also need to invest in the latest medical equipment.
“Another big obstacle for Critical Access Hospitals is electronic records,” said Hough. “They’re ridiculously expensive. Our estimated start-up costs are about $2.5 million, and then we would pay about $100,000 to maintain it.”
Meanwhile, the Ely-Bloomenson Community Hospital recently avoided a potential financial crisis. In December, CMS sent a letter to the hospital saying it no longer qualified for critical access designation. The hospital for more than two decades had been a critical access hospital. Receiving the CMS letter puzzled hospital leadership.
But after communicating with CMS and having letters of support written by state and federal elected officials, the critical access designation was restored.
“We had gained this status 25 years ago, and we basically had to cut through red tape,” Patti Banks, Ely-Bloomenson Community Hospital CEO, said. “When I reached out to the legislators in frustration, I think it made them (CMS) look at things more closely and they realized nothing had changed.”
The 21-bed hospital serves a city of about 3,200. But the surrounding rural area has a population of about 6,000, said Banks. In addition, about 125,000 people each year visit the Boundary Waters Canoe Area Wilderness, to which Ely is a gateway.
The hospital is served by doctors who rotate to Ely from all parts of the state, said Banks. Doctors come from Essentia Health, Aspirus St. Luke’s, Fairview or the University of Minnesota systems.
Ely-Bloomenson Community Hospital is the top employer in Ely with a staff of 135 employees, including physicians, said Banks.
Financial stability and sustainability are two of the major issues facing the hospital, said Banks. About 60% of the hospital’s patients are on Medicare, she added.
“To put it simply, if you have 60% of patients on Medicare, that equates to 60% of our costs being reimbursed,” said Banks. “Health care is very complicated. The professionals that work with us here all need to maintain competency and license in their area. To get people to work with your organization and provide quality health care is very important.”
Beyond patient care, Ely-Bloomenson Community Hospital said hospital employees do much more within the community, said Jodi Martin, community benefit and public relations coordinator.
“Being a community access hospital, you’re expected to take care of the community to help them stay healthy so they don’t need our services,” said Martin. “The work we do outside the four walls of the hospital has been beneficial to the community and to our work.”
Among the hospital’s community outreach events are vaccination clinics, healthcare career exploration and job shadowing with high school and college students, distribution of healthy food coupons, mental health, dietary and blood pressure clinics, said Martin. The hospital also provides life jackets for use at four area lakes, a bicycle helmet giveaway, support for firearms training, and brings in professional speakers on a variety of healthcare topics.
“We’re just trying to think outside the box and meet people where they’re at in the community,” said Martin.
Essentia Health operates critical access hospitals in small towns such as Aurora, Deer River, Moose Lake, Sandstone, Ada, Fosston, Graceville and Superior, said Dr. David Herman, chief executive officer and president of Essentia Health.
Critical access hospitals were established in 1997 by Congress as part of a budget balancing act as more than 400 rural hospitals across the nation closed in the 1980s and 1990s, said Herman. Critical access hospitals allow people to not to have to travel too far to get care, he added.
Like other rural hospitals, Essentia Health’s critical access hospitals face staffing and reimbursement challenges.
“The challenges that our hospitals are facing are not unique to Essentia Health. They’re the same challenges that every critical access hospital in the country has right now. Staffing is a challenge. These are generally the largest employers within their community. To get that staff of skilled compassionate people, whether they’re nurses or they’re environmental services workers or people that provide food service, finding that staff in a smaller community can be very, very challenging.”
However, Essentia Health’s critical access hospitals benefit from being part of a larger healthcare system, he said. “We have a common medical record, we have a common materials management program and administratively, they all sit on the same administrative foundation. That’s one of those things that makes it easier for any hospital to be part of a system, is that you can benefit from that larger administrative structure, otherwise you’d have to invent that or buy that all yourselves. This isn’t a feeder system. What this is we want to provide as much care as we can close to home.”
As an example, Essentia Health has oncologists who travel to Deer River to provide cancer care unless more advanced care is needed, said Herman.
Telehealth also allows patients to consult with Essentia Health specialists, said Herman.
Back in Bigfork, Hough said the rural hospital’s reputation is well known and growing.
“We had a nice compliment from someone from the Twin Cities who had care here and came back,” said Hough. “They’re comment was, ‘I’m more than just a number here.’”
