Rural hospitals focus on services, quality care

By George C. Ford, The Gazette

Mike Riege can give a firsthand account of the emergency medical care provided by Eastern Iowa's rural hospitals.

Riege, administrator of Virginia Gay Hospital & Clinics, Home Health, Nursing and Rehab in Vinton, was working to restore electrical service to his home in the aftermath of the July 11 storm when a tree limb knocked his ladder out from under him.

Riege sustained a broken right arm in the fall and received treatment in the Virginia Gay emergency room.

“I guess you could say I was able to do a little QA (quality assurance) in our emergency room,” Riege recalled.

Rural hospitals such as Virginia Gay, Jones Regional Medical Center in Anamosa, Marengo Memorial in Marengo, Regional Medical Center in Manchester and Washington County Hospital & Clinics in Washington focus on customer service and quality medical care to attract and retain patients.

“This may sound corny, but it really comes down to taking care of one patient at a time,” Riege said. “In a small-town hospital, it's really all about providing small-town service. You try to relate with patients more on a personal level.

“We don't have a huge marketing budget where you can go out and influence people to use your hospital. There are seven hospitals within 35 miles of Virginia Gay, so our success really depends on word-of-mouth.”

At Marengo Memorial, Chief Executive Officer Barry Goettsch believes rural hospitals need to reach out to the community and develop awareness of the services they provide to become the first choice for medical care.

“The day is long gone when we could just sit and wait for patients to come to us as ‘the hospital' or ‘the clinic,'?” Goettsch said. “We have to be at the county fair doing free blood sugar tests. We have to be the resource that the Lions Club in Williamsburg calls when it wants a presentation on kidney dialysis.

“We need to take the hospital outside of our walls.”

Goettsch said hospitals need to earn the trust and patronage of their communities.

“The local hospital has a responsibility to the community it serves to make sure it provides everything it can and maintain excellence that helps people stay in the town,” he said.

“It kills me to think that someone in Marengo has to drive to Cedar Rapids for an oncologist because we don't have one here. We are pursuing having an oncologist in this community.”

Lon Butikofer, chief executive officer of Regional Medical Center in Manchester, said immediate access to critical care at a local hospital soon after the onset of a stroke or heart attack can make a significant difference in the outcome.

“In both cases, we're able to give medication very quickly to help prevent further damage and stabilize a patient,” Butikofer said. “We know what we need to do in a timely manner to get the best outcome for a patient.

“We also know our limitations and we transfer many patients to larger hospitals for further treatment.”

All the rural hospitals in Eastern Iowa are critical-access hospitals, defined by the federal government as those with no more than 25 inpatient beds and offering 24-hour emergency care services. Regional Medical Center and Washington County Hospitals and Clinics are public hospitals receiving property tax funding.

Washington County Hospital received about $813,000 of property tax revenue in fiscal 2010. That funding - along with foundation and community contributions and investment income - helped turn an $882,000 operating loss into a $384,000 net profit.

Regional Medical Center received about $884,000 in property tax revenue in fiscal 2010. Butikofer said the tax revenue represents a small but important component of the hospital's annual revenue stream.

“As a public hospital, we have to allow anyone to come into our health service arena,” Butikofer said. “A lot of that care is free or based on a sliding-fee scale.

“The tax support we receive is less than 4 percent of our annual revenue of $52 million. It supports things like public health, ambulance service, emergency service and some behavioral services that are largely not funded.”

At Virginia Gay, Riege said the hospital's annual revenue stream comes from traditional and non-traditional sources.

“We would not be here were it not for the generosity of the community down through the years,” Riege said. “We have operating revenue, and we also have gifts as well as income from the farms that have been left to us over the years. We cash rent our property, which is good for us and good for the farmer.

“Although we are not tax supported, we have a very strong financial base with our foundation. We had a very successful fundraising campaign last year that supported our most recent construction project - we raised $2.25 million that the community gave us.

“We have a tremendous amount of buy-in from our employees and the community.”

Despite having to write off bad debt each year and worry about Medicare and Medicaid reimbursement, Iowa's rural hospitals have continued to modernize or replace facilities as well as add medical clinics and additional medical specialties.

Regional Medical Center will hold a public open house Aug. 7 for its recently completed $5.9 million Regional Family Health medical office building. Jones Regional Medical Center moved into a new $12.8 million hospital in October 2009, and Washington County Hospital completed construction of a $22 million replacement hospital in May 2008.

But the history of Marengo Memorial probably ranks among the greatest comeback stories of any rural Iowa hospital.

The Iowa County hospital came within days of shutting down in August 1998 when it needed $200,000 to stay open. Within a week, the public contributed more than $193,000 to the cause and the hospital was able to begin paying off about 150 creditors.

A month later the hospital board went to the public, asking it to pass a plan to transfer hospital control from the city to the county. Voters rejected the plan by 1,300-vote margin.

But another $100,000 in contributions had been raised by then to keep the hospital operating, and the board began looking at alternatives. By July 1999, an affiliation with University of Iowa Hospitals and Clinics had been sealed.

With strong support from the community and a healthy dose of fiscal responsibility, Marengo Memorial was able to recover financially to the point where it severed its affiliation with UI Hospitals and Clinics, formed its own network of primary care physicians and ultimately embarked on a major expansion and remodeling project.

Barry Goettsch, who joined Marengo Memorial last month as CEO, sees even brighter days ahead for the hospital in terms of expansion opportunities.

“We have Williamsburg in our county and we really haven't taken advantage of that, North English or Blairstown,” he said. “If we're going to survive and be a presence in the community, we need to start pushing out with our services.