♪ ♪ >>> WELCOME TO "AT ISSUE."

I'M H.W.

WILSON.

-- H. WAYNE WILSON.

THANK YOU FOR JOINING US FOR A HALF-HOUR DISCUSSION, THIS TIME ON RURAL MEDICAL CARE.

RURAL HOSPITALS PROVIDE KEY ACCESS TO MEDICAL CARE FOR ABOUT 20% OF AMERICANS.

YET IN A PAST -- IN THE PAST DECADE, MORE THAN 120 RURAL HOSPITALS HAVE CLOSED, JUST IN THE PAST 10 YEARS.

WE'RE GOING TO TALK TO THE ADMINISTRATORS AT TWO RURAL HOSPITALS ON THE STRUGGLES, THE CHALLENGES, AND THE SUCCESSES FOR PROVIDING CARE TO RURAL AMERICANS.

LET ME INTRODUCE YOU TO DOUG KOSIER.

THE CHIEF EXECUTIVE OFFICER AT MASON DISTRICT HOSPITAL.

THANK YOU FOR BEING HERE.

>> VERY FOR -- THANK YOU FOR HAVING ME.

>> AND EMILY IS HERE.

THANK YOU FOR JOINING US.

>> THANK YOU.

WE HAVE A LOT TO DISCUSS IN TERMS OF DIFFERENT CHALLENGES THAT EXIST AND SOME SOLUTIONS.

BUT FIRST, I WANT TO HAVE BOTH OF YOU JUST OFF THE TOP, WHAT'S THE BIGGEST CHALLENGE FACING RURAL HOSPITALS TODAY, EMILY, IF YOU COULD START IT OFF?

>> I THINK IT'S BEING ABLE TO SURVIVE IN AN ENVIRONMENT THAT'S CHANGING RAPIDLY, WHICH WE'VE OBVIOUSLY SEEN WITH COVID, BUT OUTSIDE OF THAT THERE ARE SO MANY OTHER THINGS GOING ON, WHETHER IT'S FEDERAL MANDATES THAT WE HAVE TO ADHERE TO WITH ERH, INTER OPERATABILITY, JUST ATTESTING TO DIFFERENT QUALITY MEASURE THAT IS THE GOVERNMENT WANTS TO SEE ON TOP OF THAT.

WE'RE COMPETING TO RECRUIT STAFF, WHETHER IT'S MEDICAL STAFF OR, YOU KNOW, YOUR CLINICAL STAFF AND REALLY ANY LEVEL, YOU KNOW, NONCLINICAL STAFF AS WELL, TO COME AND FORK AT YOUR FACILITY.

SO I THINK IT'S SETTING YOURSELF APART FROM OTHER FACILITIES, MAKING SURE YOUR CARE IS EXCELLENT, AND MAKING SURE YOU KNOW, THERE'S A A UNIQUE QUALITY THAT MAKES THE PATIENTS WANT TO COME BACK AND MAKE STAFF WANT TO WORK THERE AND HAVE OWNERSHIP IN THE MISSION THAT YOU HAVE.

>> SHE COVERED A LOT OF TERRITORY.

WE'RE GOING TO DISCUSSES SOME OF THOSE.

BUT FROM YOUR PERSPECTIVE, WHAT IS THE BIGGEST SINGLE CHALLENGE?

>> I HAVE TO AGREE.

I THINK IT'S TRYING TO KEEP THE APPROPRIATE STAFF.

IT'S REALLY HARD TO KEEP RECRUITING AND RECRUITING PEOPLE THAT ARE, YOU KNOW, ABLE TO COME AND DO THE JOB THAT YOU NEED NEM TO DO, FROM MEDICAL DOCTORS TO ALL THE WAY DOWN TO JANITORS, TO -- EVERYONE.

IT'S A TOUGH THING TO KEEP PEOPLE RECRUITED.

>> YOU HAVE A PARTICULAR ADVANTAGE IN THAT YOU HAVE A GRANT PROGRAM TO HELP POTENTIAL EMPLOYEES GO THROUGH SCHOOL.

>> CORRECT.

IT'S CALLED THE McFARLAND SCHOLARSHIP FUND.

>> TELL ME HOW THAT WORKS.

>> YEARS AGO, MR. McFARLAND HAD A WISE IDEA TO PUT MONEY BACK TO COMMUNITY AND TO THE HOSPITAL TO GIVE TO PEOPLE THAT WANTED TO GO BACK TO THE HOSPITAL, SO WE HAVE PHYSICIANS THAT CAN GET A SCHOLARSHIP AND IT PUTS THEM THROUGH SCHOOL.

NURSING STAFF, RADIOLOGY STAFF, ANYBODY THAT QUANTITIES TO GO TO SCHOOL -- WANT TO GO TO SCHOOL, McFARLAND WILL PAY FOR THAT EDUCATION.

AND THE PERSON HAS TO COME BACK AND WORK FOR US FOR A CERTAIN AMOUNT OF TIME TO THEE ARE PAY THE LOAN.

>> AND DO YOU HAVE ANYTHING -- TO REPAY THE LOAN.

>> AND DO YOU HAVE ANYTHING IN PARTICULAR OR IS IT A STRUGGLE TO GET QUALIFIED STAFF?

IT'S A FAMILY-STARTED HOSPITAL.

>> RIGHT.

>> SO YOU MIGHT HAVE A BENEFIT THERE.

>> WE HAVE THAT.

, BUT AS FAR AS RECRUITMENT GOING AND/OR, YOU KNOW, THE RECE WE DON'T HAVE THE GRANT FUND, PUT KEY CLINICAL STAFF -- BUT KEY CLINICAL STAFF, THE NURSING STAFF, N -- CNAs, IF YOU'RE TRYING TO GET A CNA WHO WANTS TO BE A FURS.

YOU PAY FOR THEIR A CERTIFICATE, HAVE THEM WORK THROUGH THE SYSTEM, AND THAT'S THE GUESS WAY WE SEE IS PEOPLE THAT ARE KIND OF HOME GROWN, LIKE THEY START OFF -- I GUESS I'M AN EXAMPLE.

YOU START OFF DOING SOMETHING ELSE AND WHEN THE TALENT IS RECOGNIZED OR THE STAFF WANTS TO DEVELOP A CERTAIN WAY, WHEN WE CAN NURTURE THAT AND WE HAVE THE FUNDS TO PAY FOR THAT, WE DEFINITELY, YOU KNOW, ALLOW THOSE SCHOLARSHIPS TO BE HAD THAT THEY HAVE TO WORK FOR A CERTAIN AMOUNT OF TIME TO PAY THEM BACK.

WE GIVE SCHOLARSHIPS THAT ARE STAFF THAT ARE WANTING TO GO INTO OTHER KEY CLINICAL AREAS.

>> WHILE IT TAKES AN EFFORT TO ATTRACT PEOPLE, AND IT TAKES MONEY TO ATTRACT QUALIFIED PHYSICIANS, NURSES, ET CETERA, YOU ALSO HAVE TO ANTICIPATE THE PHYSICAL STRUCTURE NEEDS, THE INFRASTRUCTURE, THE PET SCANS, THE P MRIs, ET CETERA.

IS THERE -- HOW DOES A RURAL HOSPITAL WHO MAY NOT HAVE THE 100% DEMAND FOR AN MRI, HOW DO YOU GO ABOUT OFFERING THAT SERVICE TO YOUR POTENTIAL PATIENTS?

>> FOR US, WE CONTRACT WITH A COMPANY THAT COMES OUT.

WE STARTED WITH ONE DAY A WEEK, AND IT GOT TOO HIGH SO WE HAVE THEM COMING OUT TWICE A WEEK.

SO WE PROVIDE THAT SERVICE ON TUESDAYS AND WEDNESDAYS.

SO WE BUNCH ALL THE PATIENTS ON THOSE DAYS.

LEAVE ROOM FOR ADD-ONS, WHETHER IT'S INPATIENT OR SOMETHING MORE ACUTE, AND WE HAVE A TECH THAT COMES WITH THAT TRUCK AND HE'S WILLING TO STAY AFTER IF WE NEED TO DO EXTRA EXAMS, THINGS LIKE THAT.

SO WE FILL THAT AND IT'S DEFINITELY -- EVEN WITH THE MONEY THAT WE PAID FOR THE TRUCK TO COME AND PER EXAM, WE TURN REVENUE OFF THOSE EXAMS FAIRLY EASILY.

>> SO MOBILE SERVICES ARE IMPORTANT?

>> CORRECT.

>> DO YOU -- I MEAN, THEY'RE ONLY THERE ON CERTAIN DAYS.

BUT THAT REDUCES YOUR INFRASTRUCTURE COSTS.

>> TRUE.

>> SO DO YOU HAVE ANY STRUGGLE WITH PEOPLE, PATIENTS, SAYING, WELL, YOU DON'T HAVE A CERTAIN OFFERING, EVEN THOUGH IT MAY COME ONCE A WEEK.

IS THERE AN IMAGE PROBLEM THAT YOU HAVE TO OVERCOME?

>> SURE.

I MEAN, I THINK IF YOU PROMOTE IT THE RIGHT WAY, THOUGH, THAT -- LIKE YOU KNOW, EMILY SAID, IF YOU HAVE IT TWO DAYS A WEEK, WHICH IS WHAT WE DO ALSO, YOU CAN STRUCTURE THAT QUESTION TO THEM THAT YOU CAN GET IT DONE THE NEXT DAY.

OR THE LONGEST THEY USUALLY WAIT IS TWO OR THREE DAYS.

SO I THINK IT'S A WAY OF MARKETING IT TO THE PATIENT WHEN THEY WANT IT DONE.

>> I WANT TO CONTINUE THE CONVERSATION ABOUT INFRASTRUCTURE.

AND FOR INSTANCE, IN HAVANA, YOU HAVE HOW MANY BEDS?

>> WE'RE LICENSED FOR 25.

WE HAVE 20.

>> AND HOW FULL IS THE HOSPITAL IN TERMS OF BED COUNT?

>> UM, WE USUALLY AVERAGE AROUND 4 PATIENTS A DAY.

DURING COVID IT'S BEEN A LITTLE DIFFERENT.

>> SO THE HOSPITAL OF COURSE BUILT THOSE ROOMS WHEN THERE WAS MORE INPATIENT CARE INSTEAD OF OUTPATIENT.

>> YES.

>> HOW DO YOU ANTICIPATE FUTURE NEEDS?

AND I KNOW WE TALKED ABOUT MOBILE WITH MRI, ET CETERA.

BUT YOU'RE SITTING WITH EMPTY BEDS.

AND THAT'S NOT MAKING MONEY.

>> YES AND NO.

CRITICAL ACCESSES HOSPITALS ARE A LITTLE DIFFERENT, BUT YES.

YOU CAN MAKE MORE MONEY WITH THEM FULL.

>> SO THAT LEADS TO THE CONVERSATION ABOUT HOW DO YOU GO ABOUT ANTICIPATING THE NEEDS OF MEDICAL CARE FOR PATIENTS DOWN THE LINE?

>> I THINK IT'S MORE GONNA BE -- MORE OUTPATIENT THAN IT IS INPATIENT.

I THINK THAT'S THE WAY WE'RE KIND OF MOVING TOWARDS, IS LOOKING AT MORE OUTPATIENT SERVICES THAN INPATIENT.

IT JUST DOESN'T SEEM TO BE THAT WAY FROM THE PAST FEW YEARS AT ALL.

AND I DON'T SEE IT MOVING TO THAT ANY DIFFERENT.

WE UTILIZE SWING BED.

I'M SURE THAT HOPEDALE DOES ALSO.

AND THAT'S ANOTHER PROGRAM YOU CAN USE TO -- >> SWING BED?

>> SWING BED PROGRAM.

IT'S WHERE PEOPLE GO AND HAVE A SURGERY AT OSF OR WHEREVER, A BIG HOSPITAL, AND THEN THEY NEED PHYSICAL THERAPY OR ANOTHER CARE, AND THEY CAN COME BACK TO OUR HOSPITALS TO GET THAT CARE.

>> AND WITH REGARD TO THE SAME QUESTION, EMILY, EMPTY BEDS AT HOPEDALE?

>> YEAH, WE AVERAGE CENSUS ABOUT SEVEN ON TO EIGHT.

WE HAVE THE LICENSED 25 BEDS FOR CRITICAL ACCESSES HOSPITAL.

I THINK SAME THING.

THERE'S BEEN -- I'VE SEEN DECREASE IN OUR AVERAGE CENSUS.

WE DIDN'T HAVE A LOT OF COVID PATIENTS, WHICH WAS GOOD FOR US.

BUT I THINK THERE IS THAT DRIVE TOWARDS THE OUTPATIENT.

FOR US THE BIG DRIVE IS SURGERY.

AND IT'S A LOT OF OUTPATIENT SURGERY.

YOU HAVE A A COLONOSCOPIES, KNEE SCOPES, YOU KNOW, CARPAL TUNNEL, THINGS LIKE THAT.

AND YOU HAVE A CERTAIN PERCENTAGE OF THE INPATIENT SURGERIES.

BUT THE BIG DRIVER FROM A REVENUE STANDPOINT FOR US IS THE OPERATING ROOM, BECAUSE THAT'S -- THAT'S JUST WHERE YOU GET THE BIGGER DOLLARS COMING THROUGH.

SO THAT AND OUR OUTPATIENT SERVICES.

SO YOU'RE TALKING ABOUT YOUR LAB, RADIOLOGY, OR VASCULAR LAB, CARDIOPULMONARY, THOSE SERVICES ON THE YOWSH PAIRN SIDE, PT, THAT ARE GOING TO DRIVE THE REVENUE THAT'S GOING TO A BULK OF WHAT WE'RE TAKING IN.

>> IS THAT WHAT'S KEEPING THE HOSPITAL AFLOAT, SO TO SPEAK IS -- >> I GUESS YOU WOULD TERM IT THAT WAY, YEAH.

AND I THINK WHEN YOU'RE TALKING ABOUT LOOKING AHEAD, ANTICIPATORY NEEDS AND DEVELOPMENTS, THOSE ARE -- THAT'S A DIRECTION THAT YOU KNOW, LIKE WE WOULD BE GOING, LIKE RIGHT NOW WE'RE LOOKING AT RELOCATING OUR OPERATING ROOM TO EXPAND IT BECAUSE WE NEED MORE ROOM.

WE HAVE MORE SURGEONS COMING IN.

WE HAVE MORE SPECIALTY SURGEONS COMING IN BECAUSE WE'RE ANTICIPATING AND KIND OF TEMPING THE WATER ON THE NEEDS FOR WHAT YOU KNOW, THE PUBLIC NEEDS RIGHT NOW.

AND SO THERE'S MORE WITH ORTHOPEDICS, MORE WITH SPINAL SURGERY, WITH PAIN MANAGEMENT.

SO WE'RE ALREADY STARTING TO GO DOWN THAT ROAD AND EXPANDING THOSE O.R.

SERVICES.

>> SO WHEN YOU TALK ABOUT THE DIFFERENT SERVICES, DO YOU BRING STAFF ON FULL TIME OR DO YOU HAVE PHYSICIANS WHO ARE ASSOCIATED ON A PART-TIME BASIS?

>> YEAH, RIGHT NOW THEY'RE ASSOCIATED ON A PART-TIME BASIS.

OUR ORTHOPEDIC SURGEONS.

WE HAVE TWO.

THEY COME OUT OF BLOOMINGTON.

OUR SPINE SURGEON OUT OF KINGA KEY -- KANKAKEE.

AND THEN PAIN, OUR PAIN MANAGEMENT, IF COMES DOWN FROM KANKAKEE ABOUT THREE TIMES A MONTH.

AND AGAIN, IT'S KIND OF THE SAME CONCEPT AS THE MRI.

YOU CAN WHEN HE'S COMING.

THE PHYSICIAN IS COMING.

SO YOU'RE STACKING THE PATIENTS ON.

SAME THING, YOU KNOW EXACTLY WHEN TO SCHEDULE SURGERIES, SO THEY HAVE THEIR BLOCK TIMED IN THE O.R.

>> THIS COLLABORATIVE RELATIONSHIP WITH OTHER FACILITIES, TRUE AT MESA DISTRICT?

>> YES.

>> SOME EXAMPLES?

>> WE HAVE ORTHOPEDIC SUFFRAGEON THAT COMES FROM -- SURGEON THAT COMES FROM CARTHAGE AND AN ORDER PEDIC COMES FROM GRAHAM HOSPITAL IN CANTON.

WOUND CARE THAT COMES FROM GRAHAM.

WE HAVE DOCTORS THAT COME FROM SPRINGFIELD CLINIC.

>> SO WHAT I'M HEARING IS THAT YOU CAN CITY ABREAST OF THE LATEST SERVICES BY USING THESE -- MOBILE TRUCKS OR THE ASSOCIATED PHYSICIANS.

AND THAT ALLOWS YOU TO STAY CURRENT WITH SERVICES WITHOUT HAVING TO INVEST IN EXTRA INFRASTRUCTURE OR FULL-TIME COSTS FOR A PHYSICIAN?

>> RIGHT.

AND I THINK ALSO IT GIVES THAT DELIVERY OF CARE AND THE DELIVERY OF SERVICE AT YOUR FACILITY, BECAUSE THAT'S WHAT THE PATIENTS WANT.

AND AS FAR AS -- AND IF YOU EVEN TAKE IT A STEP FURTHER, FROM THE START, LIKE THE HUB OBVIOUSLY FOR EVERYTHING THAT WE DO AND ALL THE REVENUE DRIVERS IS OUR CLINICS.

SO THE PHYSICIANS IN OUR CLINICS, THEY'RE DIRECTING THE PATIENTS WHERE THEY NEED TO GO AND THEY WANT TO DIRECT THE PATIENTS TO STAY HERE BECAUSE THEY WANT TO BE INVOLVED WITH THEIR CARE, YOU KNOW, KNOWING EXACTLY WHAT'S GOING ON, BECAUSE WHEN -- TYPICALLY IF THEY GO OUT TO LARGER FACILITY, WE LOSE SOME CONTINUITY.

SO THE MORE WE CAN KEEP THEM ON CAMPUS AND DELIVER THOSE SERVICES ON CAMPUS, AT HOPEDALE PROPER, I THINK THE BETTER OUTCOMES WE GET AND THE BETTER CARE WE HAVE WITH THOSE, BECAUSE IF YOU HAE -- LIKE IF WE HAVE A SURGEON COMING FROM OUTSIDE, THEY DO SURGERY AND IF SOMEBODY HAS TO STAY OBSERVATION OVERNIGHT, THAT SURGEON IS GOING HOME TYPICALLY AFTER THE CASE.

SO THEIR PRIMARY CARE WHO'S ONE OF OUR PHYSICIANS FROM THE CLINIC, THEY'RE GOING TO ROUND ON THEM IN THE HOSPITAL, SIMILAR TO A HOSPITAL, BUT NOT REALLY.

THAT'S WHAT OUR PHYSICIANS DO.

SO OUR PRIMARY CARE IS GOES TO DIG CHARGE THEM, GO ROUND ON THEM, WOUND LOOKS GOOD, AND ALL THAT STUFF.

AND THEY MIGHT COMMUNICATE WITH THE SPECIALTY SURGEON.

BUT THEY'RE GOING TO BE STILL DOING THAT CARE FOR THE PATIENT.

>> AND YOU'VE BEEN SHAKING YOUR HEAD "YES."

>> YES.

>> SO YOU'RE IN AGREEMENT?

>> THAT'S HOW IT'S DONE.

WE HAVE HOSPITALLISTS WHO COME IN AND TAKE CARE OF OUR PATIENTS.

SO WE'RE PRIMARY CARE.

SOME OF THEM DO AND SOME OF THEM DON'T.

SO THE HOSPITALS WILL TAKE CARE OF THE PATIENTS WHEN THEY'RE IN THE INPATIENT WING.

>> EARLIER, DOUG, EMILY MENTIONED COVID-19 AND WE HAVE TO TALK ABOUT COVID-19.

WHAT KIND OF CHALLENGES DID THAT PRESENT AT YOUR FACILITY AND I'D LIKE TO EXPAND THAT CONVERSATION INTO HOW DO YOU ANTICIPATE THE NEXT UNKNOWN?

>> ONE OF THE BIG THINGS THAT HAPPENED AT MASON DISTRICT HOSPITAL WAS WE COULDN'T TRANSFER PATIENTS OUT.

SO WE WERE -- WE WERE KIND OF STUMBLING TO -- WHERE YOU'RE USED TO TRANSERRING THOSE SICKER PATIENTS OUT, YOU WEREN'T GOING TO BE ABLE TO.

THERE WEREN'T ANY ACCEPTING HOSPITALS.

THEY WERE FULL.

SO WE WERE TAKING PATIENTS THAT WE PROBABLY HADN'T KEPT FOR A YEAR OR TWO YEARS.

AND I DON'T THINK WE WERE READY FOR THAT.

STAFF STEPPED UP.

THEY DID A WONDERFUL JOB.

MINE, WE TOOK CARE OF SICK PATIENTS, WHICH IS WHAT WE WERE THERE FOR.

BUT I THINK IT DID OPEN EVERYBODY'S EYES THAT, YOU KNOW, YOU DON'T HAVE TO TRANSFER EVERYBODY THAT YOU -- THAT WE WERE DOING BEFORE.

SO THAT KIND OF WAS A GOOD AND BAD THING THAT HAPPENED, YOU KNOW.

AS FAR AS FUTURE, WE TALKED ABOUT -- I WISH I HAD A CRYSTAL BALL.

I THINK YOU'RE GONNA MAKE A LOT OF MISTAKES IN THE FUTURE PICKING AND CHOOSING.

I THINK LIKE I SAID BEFORE, OUTPATIENTS, EMILY HIT ON THAT ALSO.

I THINK WE'RE ALL THE TIME TRYING TO ADD TO THE SERVICES TO KEEP THE PEOPLE AT OUR ORGANIZATION.

>> BUT IT GIVES YOU -- BECAUSE OF THE EXPERIENCE WITH COVID-19 AND BECAUSE OF THE MOBILE TRUCKS, ET CETERA, YOU'RE MORE FLEXIBLE THAN EVER BEFORE.

>> YES.

>> COVID-19, CHANGES AT HOPEDALE?

>> I THINK THE BIGGEST THINGS I SAW -- I MEAN, OBVIOUSLY WE HAD A DISRUPTION OF SERVICES.

THE ADAPTATION THAT THE STAFF WAS ABLE TO DO AND ACCOMMODATE STILL BE IN TOUCH WITH THE PATIENTS, ENSURE THAT WE WERE FOLLOWING UP WITH THEM AS TIME WENT ON SO WE COULD GET THEM BACK IN THE DOOR WHEN IT WAS APPROPRIATE, WHEN WE HAD THE SHUTDOWN FOR A LOT OF SERVICES.

I THINK THAT'S THE BIG THING.

AND I THINK THE OTHER THING WAS YOU NOTICED WHEN THOSE PATIENTS START COMING BACK, I MEAN, THEY TRULY MISSED SEEING THEIR PHYSICIAN.

THEY MISSED -- THEY DIDN'T LIKE THE PHONE CALLS.

WE DID NOT DO A LOT OF TELEHEALTH BECAUSE OUR PATIENTS DID NOT LIKE IT.

THEY WANTED TO -- AND WE OBVIOUSLY -- WE HAVE A HIGH MEDICARE POPULATION, SO WE HAVE OLDER PATIENTS AND THAT'S NOT SOMETHING THAT THEY'RE INCLINED TO DO NECESSARILY.

SO THEY WERE ALMOST THRILLED TO BE ABLE TO SEE THEIR PHYSICIAN IN PERSON AGAIN WHEN THEY COULD.

AND SEE THE FAMILIAR FACES, YOU KNOW, AT THE CHECK-IN DESK AND WITH THE NURSING STAFF.

SO FOR US I THINK THE BIGGEST THING WAS BEING ABLE TO ADAPT AND SEEING OURSELVES BE ABLE TO OVERCOME ALL THOSE OBSTACLES, LIKE EVERYONE THAT WOULD COME UP, AT SOME POINT I FELT IT WAS LIKE EVERY MINUTE OR HOUR THERE WAS SOMETHING DIFFERENT WE HAD TO DO OR CHANGE OR WRITE A NEW POLICY ON.

SO I THINK IT WAS THAT COLLABORATIVE TEAMWORK, WHERE EVERYBODY PITCHED IN AND STEPPED UP AND YOU KNOW, DID EVERYTHING THAT THEY NEEDED TO IN ORDER TO DO THE SAME THING THAT WE DO EVERY DAY, WHICH WAS TAKE CARE OF PATIENTS, YOU KNOW, SUPPORT THE PHYSICIAN-DIRECTED CARE, AND PROVIDE EXCELLENT CARE AT THE SAME TIME.

LIKE THERE IS -- WE DIDN'T HAVE ANY EXEMPTIONS TO HOW -- EXCEPTIONS TO HOW WE PROVIDED CARE EVEN WITH COVID BEING THERE.

>> LET'S TALK ABOUT TELEHEALTH.

PLUSES AND MINUSES TO TELEHEALTH?

>> I WAS GOING TO -- KIND OF SURPRISE THAT TELEHEALTH DID NOT TAKE OFF THE WAY I THOUGHT WE THOUGHT IT WOULD, BECAUSE EMILY IS RIGHT.

THE PEOPLE WANTED TO SEE THEIR PHYSICIAN.

AND SO -- PLUSES AND MINUSES -- TELEHEALTH, I THINK IT'S A GREAT SPOT FOR YOUNGER PEOPLE.

I THINK THEY LIKE IT.

I'M NOT SURE THE OLDER POPULATION, WHICH IS WHAT WE HAVE, WANTS THAT.

>> AND MENTIONING THE OLDER POPULATION, YOU PROBABLY HAVE MORE CHRONIC CONDITIONS THAT EXIST -- >> YEAH.

>> SO A LITTLE BIT DIFFERENT APPROACH TO PROVIDIG SERVICES TO AT LEAST A LARGE PORTION OF YOUR POPULATION.

>> YEAH.

TELEHEALTH DOESN'T REALLY PERFORM THE WAY IT SHOULD WITH CHRONIC CONDITIONS.

THEY NEED THAT TOUCH OF THE PHYSICIAN TO BE THERE RATHER THAN JUST A FACE ON A COMPUTER OR -- YOU KNOW, A PHONE.

I JUST THINK -- I THINK THAT'S WHAT IT MISSES.

>> DO YOU SHARE THAT OPINION ABOUT TELEHEALTH?

>> YEAH.

I MEAN, I WOULD AGREE.

LIKE I SAID EARLIER, I THINK IT WAS JUST NOT INDEADLINED OUR POPULATION.

-- NOT INCLINED TO OUR POPULATION AND NECESSARILY INCLINED TO THE MODEL OF CARE THAT WE PROVIDE SO IT MADE IT MORE DIFFICULT TO DO.

IT WAS THE YOUNGER PATIENTS THAT WERE GOING WITH DOING IT, BUT AT SOME LEVEL, WHEN THEY GET TO A CERTAIN POINT, THEY NEED TO COME IN AND SEE THEIR PHYSICIAN.

THEY NEED TO SHOW THEM IF THERE'S SOMETHING GOING ON, YOU KNOW, IF THEY HAVE SOME KIND OF SKIN ISSUE, IT'S SOMETHING THAT THEY WANT TO TALK TO -- OR THEY JUST WANT TO HAVE A CONVERSATION WITH THEIR PHYSICIAN, AND I THINK THAT'S THE BIG THING.

OUR PHYSICIANS SPEND TIME WITH THEIR PATIENTS AND THEY GET THE WHOLE STORY AND I THINK YOU MISS THAT -- THAT PERSONAL CONNECTION.

IT GETS LOST WHEN EAR DOING THE TELEHEALTH AND I THINK THAT'S SOMETHING THAT THOSE SMALLER RURAL HOSPITALS TYPICALLY HAVE.

>> LET'S TURN TO THE QUESTION OF BEHAVIORAL HEALTH MEDICINE.

THERE IS AN OBVIOUS NEED FOR MORE BEHAVIORAL HEALTH SERVICES.

HOW DO YOU GO ABOUT PROVIDING THAT IN A RURAL SETTING?

>> WE'RE LUCKY ENOUGH TO HAVE SOMEBODY RIGHT NOW.

IT'S TOUGH.

I THINK THAT'S ONE -- MAYBE YOU'LL BE ABLE TO USE TELEHEALTH FOR THAT, I GUESS YOU COULD ADD THAT TO IT.

IT'S HARD TO FIND PEOPLE TO DO IT.

I THINK THAT THEY -- SEEING THE POPULATION OF PATIENTS AND EVERYTHING THAT YOU HAVE IN A HOSPITAL SETTING IS DIFFERENT THAN WHAT THEY'RE USED TO.

SO IT'S DIFFICULT TO GET THEM TO TRANSITION INTO HOSPITALS.

>> YOU SAID YOU HAVE A FULL-TIME PERSON THAT PROVIDES -- >> YES, WE DO.

>> THAT SERVICE?

>> UH-HUH.

>> IS THAT PERSON BUSY -- >> VERY BUSY.

>> FULL?

>> YES.

>> BEHAVIORAL HEALTH?

>> WE DO NOT HAVE ANYONE FULL-TIME.

SO MOST OF OUR BEHAVIORAL HEALTH IS GOING TO GET REFERRED OUT.

AND UTILIZING TELEHEALTH IS A LITTLE BIT DIFFICULT WITH THAT, JUST BECAUSE THERE'S SO MUCH MORE CONVERSATIONAL INTERACTION WITH THAT.

SO FOR US, I MEAN, IT'S JUST MAKING SURE WE HAVE A RELATIONSHIP WITH ANOTHER FACILITY THAT WE CAN REFER TO.

>> LET'S TALK ABOUT THE ISSUE OF PAPERWORK, I'LL USE THAT TERM.

HIPAA, ABOUT, WHAT, 10 YEARS AGO, 12 YEARS AGO, ELECTRONIC RECORD KEEPING, ET CETERA.

AND MY DOCTOR, WHO -- HE'S BEEN MY DOCTOR FOR 40 YEARS, HE DIDN'T HAVE ANY OF THOSE ISSUES EARLY ON.

HE WAS AN INDIVIDUAL DOCTOR ON HIS OWN.

HE'S NOW ASSOCIATED WITH OSF.

BECAUSE OF PAPERWORK.

WHAT'S THE CHALLENGE IN A RURAL SETTING FOR MEETING THE HIPAA REQUIREMENTS AND MAKING SURE THAT ELECTRONIC RECORD KEEPING, WHICH IS IN THEORY A GOOD THING, BECAUSE IF YOU'RE AT MASON OR HOPEDALE AND YOU GO TO UNITY POINT, IT'S EASY TO TRANSFER THOSE RECORDS.

YOU JUST -- A COUPLE OF CLICKS AND THERE IT IS.

WHAT'S THE CHALLENGE FOR YOU IN KEEPING UP WITH ALL OF THESE REQUIREMENTS?

>> WE JUST SWITCHED OUR EMR IN THE LAST SIX MONTHS.

IT'S BEEN A BIG CHANGE FOR OUR PHYSICIANS TO LEARN NEW.

IT'S JUST -- THEY WANT TO BE PHYSICIANS.

THEY WANT TO SEE THE PATIENT.

THEY WANT TO GET THOSE PATIENTS THROUGH.

TALK TO THEM, GET THEM IN.

IT'S DIFFICULT I THINK FOR THEM TO DO ALL THE CLICKS, AS THE WORD -- WHAT I HEAR.

YOU KNOW, WE HAVE TO CLICK THESE BUTTONS AND THEN WE AS ADMINISTRATION HAVE TO SAY, YEAH, DO THE CLICKS BECAUSE WE HAVE TO GET PAID FOR IT.

AND IF YOU DON'T DO THE CLICKS, WE DON'T GET PAID.

IT'S DIFFICULT FOR PHYSICIANS TO UNDERSTAND THAT PART, I THINK, OF HOW IT ALL FEEDS DOWN THE LINE OF ALL OF THE BUTTONS THAT HAVE TO BE PUSHED AND -- >> THE PHYSICIANS WENT TO SCHOOL TO PROVIDE MEDICAL CARE.

>> YEP.

>> NOT TO PROVIDE PAPERWORK.

>> THAT'S RIGHT.

>> THE CHALLENGE OF THESE REQUIREMENTS?

>> I THINK PART OF IT IS -- AND THEY'RE SOMEWHAT TEDIOUS AND IF YOU'RE TALKING ABOUT SOME OF THE REPORTING THINGS THAT COME OUT OF THEM, BUT THEN ALSO JUST IN REGARDS TO THE EMR IN GENERAL, AGAIN, I THINK A LOT OF THE PHYSICIANSSH THEY WANT TO DO THE CARE.

THEY DON'T WANT TO HAVE A COMPUTER IN FRONT OF THEM TALKING TO A PATIENT.

THEY DON'T WANT TO -- THAT'S NOT THE MODEL OF CARE THAT THEY WANT TO PROVIDE.

SO A LOT OF IT -- WE HAVE A HYBRID SYSTEM SO WE STILL HAVE SOME PAPER.

AND WE DO HAVE -- AND IT'S DIFFERENT BECAUSE WE HAVE ONE EMR FOR A HOSPITAL AND ONE FOR OUR PHYSICIAN CLINICS, BECAUSE OUR CLINICS ARE TECHNOLOGICALLY -- THEY'RE INNOCENT.

THEY'RE NOT DIRECTLY RELATED TO THE HOSPITAL.

SO WE HAVE A DIFFERENT COUPLE DIFFERENT EMRs GOING ON.

SO THAT MAKES IT MORE INSENSITIVE, BUT IT HELPS THEM BE ABLE -- INTENSIVE, BIT IT HELPS THEM OPERATE HOW THEY WANT TO.

WE SO WE PROVIDE THE ADAPTATIONS TO PROVIDE THE PHYSICIAN-DIRECTED CARE AS WE WANT TO AND WE'RE AS EFFICIENT AS POSSIBLE ON THE BACK END.

A LOT OF IT IS IS JUST KEEPING UP WITH ALL THE CHANGES AND WHAT THE REPORTING REQUIREMENTS ARE AND WHAT YOU HAVE TO PUT IN IN ORDER TO GET PAID AND WHAT YOU GOT TO ATTEST TO AND THINGS LIKE THAT, WITH ALL THE DIFFERENT -- YOU KNOW, THE QUALITY MEASURES AND THINGS LIKE THAT.

>> SEVERAL TIMES WE'VE MENTIONED CLINIC ALONG THE WAY.

AND IT'S CLOSELY ASSOCIATED WITH A MEDICAL FACILITY.

KARL EUREKA HAS A CLINIC RIGHT NEXT DOOR TO THE HOSPITAL.

YOU HAVE A CLINIC?

>> YES.

>> AND YOU HAVE A CLINIC?

>> UH-HUH.

>> HOW IMPORTANT IS IT TO HAVE THAT CLINIC AND THEN THE HOSPITAL?

>> OH, IT'S -- I THINK THE CLINIC DRIVES WHAT WE GET AT THE HOSPITAL.

THE PHYSICIANS IN THAT CLINIC ARE ORDERING THE EXAMS.

IT GETS TO THE HOSPITAL.

SO IT'S VERY IMPORTANT.

>> AND THE RELATIONSHIP IS SIMILAR IN -- >> YEAH, THAT'S YOUR HUB.

LIKE THAT'S YOUR -- MIDDLE AND THEN EVERYTHING ELSE SPOKES OFF FROM THERE, BECAUSE ALL YOUR -- YOU KNOW, I WOULD SAY 95 PLUS% OF ALL OUR REFERRALS IN THE HOSPITAL, PATIENTS THE SAME, MORE THAN THAT FOR THE PATIENTS ON THE FLOOR.

PROBABLY 98, 99%.

IT'S ALL GOING TO BE REFERRED IN FROM OUR CLINIC PHYSICIANS.

WHETHER IT'S THE ANCILLARY PHYSICIANS, WHICH WOULD BE THE ONE THAT HAS COME FROM OUTSIDE, OR THE ONES THERE EVERY DAY.

>> A FINAL THOUGHT, AND I WANT TO GO OUTSIDE.

MEDICAL ASPECT OF -- OUTSIDE OF THE MEDICAL ASPECT OF A HOSPITAL OR MEDICAL COMPLEX.

IN BRIEF, CAN YOU SHARE WITH US THE IMPORTANCE OF HAVING A MEDICAL FACILITY LIKE MASON DISTRICT OR LIKE HOPEDALE IN THAT SMALL COMMUNITY?

THE ECONOMIC IMPORTANCE OF IT, THE EMPLOYMENT, ET CETERA?

HOW IMPORTANT IS ALL THAT?

>> WELL, I THINK IT'S VERY IMPORTANT.

WE'RE THE BIGGEST EMPLOYER IN MASON COUNTY.

AND PROVIDING MEDICAL CARE, SO THE ELDER POPULATION DOESN'T HAVE TO DRIVE BASICALLY 45 MINUTES TO AN HOUR AWAY IS INCREDIBLY IMPORTANT TO THOSE -- THAT COMMUNITY.

AND THE OTHER COMMUNITIES OUTSIDE.

WE HEAR ALL THE TIME ABOUT HOW WE'VE SAVED SO-AND-SO OR CITIES LIFE OR SOMEBODY LIKE THAT BECAUSE THEY HAVE AN E.R.

FIVE MINUTES AWAY AT THE MOST.

IT'S INCREDIBLY IMPORTANT FOR THOSE SMALL COMMUNITIES TO HAVE US.

>> THE MEDICAL ASPECT DOUG HAS POINTED OUT.

WHAT ABOUT THE ROLE IN THE COMMUNITY?

>> YEAH, I MEAN, I THINK EVEN OUTSIDE OF THE MEDICAL ASPECT, I GUESS, WHICH -- WE ALSO HAVE A NURSING HOME.

WE HAVE ASSISTED LIVING, THINGS LIKE THAT, NURSING HOME STILL IN THE MEDICAL SIDE, BUT STILL YOU HAVE THAT -- THAT HOUSING SIDE.

SO I THINK IT'S PROVIDING THOSE OTHER SERVICES, BUT THEN ALSO THE COMMUNITY OUTREACH AND THINGS LIKE THAT, THAT WE DO ARE IMPORTANT TO THE COMMUNITY AS WELL.

>> AND WITH THAT, WE CAN CONTINUE THE CONVERSATION.

BUT WE'LL HAVE TO DO THAT OFF CAMERA AS WE'VE RUP OUT OF TIME.

I'D LIKE TO SAY THANK YOU TO DOUG KOSIER, THE CHIEF EXECUTIVE OFFICER AT MASON DISTRICT HOSPITAL.

THANK YOU FOR BEING WITH US.

AND TO EMILY WHITSON, THE CHIEF OPERATING OFFICER AT HOPEDALE MEDICAL COMPLEX.

PLEASE JOIN US AGAIN FOR ANOTHER CONVERSATION ON "AT ISSUE."

NEXT TIME, JIM ARDIS AFTER 6 DEEP YEARS OF MAYOR, WILL RESPECT -- 16 YEARS OF MAYOR, WILL REFLECT ON WHAT HIS SUCK -- SUCCESSES.

NEXT TIME ON "AT ISSUE."

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