Onaga’s prescription for fully funded, staffed rural hospital

By Stephen Cameron

ONAGA — Providing quality health care in rural areas has always been a hit-and-miss proposition.

In that context, a large and sparsely populated chunk of northeastern Kansas has scored a notable hit with a new $22 million hospital and wellness campus under construction in the center of Onaga.

A first glance at the everyday affairs of Community HealthCare System — the not-for-profit organization that serves a 10,000 square miles of Pottawatomie, Jackson and Nemaha counties — seems to suggest a business that might collapse under its own weight.

Yet just the opposite is true.

One answer to this puzzle might lie in the type of people who live in towns stretching from Seneca to St. Mary’s, and Frankfort to Hoyt. These are folks who have had to rely on each other for generations.

“They might have huge rivalries and call each other all sorts of names when their high schools play football,” Community HealthCare System CEO Greg Unruh said with a laugh. “But when cooperation and help is needed for anything important, these are people who will stick together for the common good.”

Beyond the regional togetherness of the residents, however, CHCS has found a workable formula to make mhealth care available to the area.

Construction on the new hospital is just more proof that amazing things get done when everyone buys into a concept — especially something born of a shared need.

On April 2, 2013, voters in Community Hospital District No. 1 (Onaga and another few close-in towns) overwhelmingly approved a $17.6 million bond issue — agreeing to raise their own property taxes by 1 mill — as funding for the all-purpose health campus now under construction in Onaga.

(A mill is $1 in tax for every $1,000 in assessed, taxable property value.)

Next came a savvy piece of business, right on top of that commitment.

The U.S. Department of Agriculture’s rural development arm agreed to buy the bonds — leaving CHCS with a low debt service of 3 1/8 percent over 30 years.

Patty Clark, director of USDA Rural Development in Kansas, pointed out that the agency gave or loaned around $415 million to state communities for various projects in fiscal 2013, and the Onaga bonds represent exactly the type of help that the organization wants to provide.

“Basic human needs don’t go away in a town of 200,” Clark said. “There is a great deal of truth in the saying that Rural Development can build a community from the ground up.”

Even with help from a federal agency and agreement among residents willing to pay for high-level care, however, actually getting it done properly is no cinch.

Hospitals in rural areas throughout the United States — and in many other industrialized countries — sometimes turn into regional problems because of staffing issues, and the fact that sheer distance between cities runs up costs for both providers and patients.

“Our focus to mitigate those supposed difficulties is to put an emphasis on relationships with our partners (patients),” Unruh said, “and to make sure our network serves their individual needs — which vary from town to town, sometimes more than you’d imagine.”

To do that, CHCS is aiming to create its flagship in Onaga, while maintaining separate clinics in Frankfort, Centralia, Corning, Holton, St. Marys and Westmoreland.

Doctors and clinicians have specific days and hours at the various locations, allowing patients throughout the vast area a chance to keep up with their health needs without constant trips to Onaga.

“It’s all centered around family practice,” said Marcia Clark, CHCS chief operating officer. “We have 25 members in that practice — physicians (12), a psychiatrist, physicians’ assistants and advance practice registered nurses.

“Those APRNs can write prescriptions and handle a lot of things that would take longer or require a trip if you had to wait on a doctor. It’s all about maximizing resources — and still getting family medicine out to the entire area.”

Historically, rural landscapes have meant constant struggles for funding and finding staff willing to live far from any bright lights.

In northern Scotland, for instance, there is such difficulty finding doctors to live and work in out-of-the-way villages that the government had to subsidize a program to recruit and import physicians — mostly from eastern Europe.

Northeast Kansas hasn’t needed that sort of drastic assistance, but shouldn’t the same problem of holding on to qualified medical personnel be a constant worry?

“That’s an easy assumption to make,” Unruh said, “but in our case it just isn’t a major issue.”

One way CHCS holds onto medical specialists is by hiring people with ties to the area — or those from other rural areas.

“One thing to remember is that most of our staff come from rural backgrounds themselves,” said Susie Kufahl, CHCS director of community service. “A lot of them are actually from this area — but even if not, it’s usually someplace with a culture like this.

“They’re comfortable here, they want to raise their families here, and they feel a connection to the people they’re serving.”

Though the hospital can’t always compete with bigger facilities in the pay department, many people choose to stay.

“It’s not about the money,” Unruh said. “It really isn’t. We have a decent pay structure, I think, but of course it’s not the same as a big city.

“The medical professionals who come here, though, tend to stay here because of relationships — to their towns, to the people. You might think we stress that word “relationships” a lot, but to create a successful medical care culture in a rural area, it comes down to that.

“It really does. When people understand that, it’s easier to see how the bond issue passed with 80 percent approval. Everyone in the area is in this business along with us.”

Certainly it’s hard to argue with the way history has shaped health care in the region, right up to this state-of-the-art hospital being built attached to an assisted living facility – along with all those clinics down various two-lane roads.

It’s working, without question.

“Let me give you one story,” Unruh said. “In 2012, we got a call from a bank president over in Westy. He told us they were losing their only local physician and asked if we could help.

“In less than two months, we had a clinic and practice set up over there.

“That’s how health care in rural areas needs to work if it’s really going to serve residents properly. And that’s our everyday goal.”

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