From Surviving to Thriving – The Future of Rural Healthcare in America

By Jeni Wright, AIA, LEED AP BD+C Principal

Delivering quality healthcare in rural communities is challenging. An estimated 50% of rural hospitals are losing money, which is leading to more closures each year. Since 2010, 113 rural hospitals have closed, creating a “medical desert” for many rural populations nationwide. The number of closures in states that have not adopted the Medicaid expansion offered by the Affordable Care Act is significantly greater than those in states that have adopted it.1

Kansas is one of the states that has not expanded Medicaid coverage, which continues to contribute to a high level of uninsured or underinsured rural residents. According to a hospital assessment and financial impact analysis conducted by Leavitt Partners in 2015, the population of Harper County, Kansas continues to decline. Harper County hospitals, like many other rural community hospitals, were experiencing an increasing number of county residents traveling long distances to medical centers (in Wichita) to access a broader array of healthcare services and providers than those offered in the county.

Compound these facts with the rural socioeconomic realities that rural populations tend to be older and poorer than urban populations, have a higher incidence of chronic diseases than in urban areas (diabetes, hypertension, cardiopulmonary diseases and cancer2), and experience higher poverty levels (16.5% in Harper County versus 13.7 % in Kansas per the 2015 Community Needs Assessment for Harper County). The situation was daunting to continue to meet primary health care needs for Harper County residents, let alone provide them access to much needed specialty care.

In 2015, two critical access hospitals/clinics situated 10 miles apart in Harper County, Anthony Medical Center, in Anthony, Kansas and Harper Hospital District #5 in Harper, Kansas, were both struggling financially and facing possible closure. In early 2017, Oklahoma State University’s Center for Health Systems Innovation was engaged to provide an operational assessment for a proposed merger of the two hospitals and identify opportunities for optimizing the merger. Both facilities excelled in some areas, such as pharmacy relationships, diagnostic processes, and clinical quality measures. Common to both hospitals were aging and inconvenient facility layouts, as well as outdated information technology leading to inefficient operations and lack of access to specialty care outreach.3

Enter Neal Patterson, co-founder and former Chairman and CEO of Cerner Corporation, which provides health information technology software solutions and services to the healthcare industry. Neal grew up near Anthony on a wheat farm and was well aware of the challenges to obtain quality healthcare close to home. For him it was personal that access to healthcare not only remain but flourish in his childhood home. His vision was to provide high quality care, delivered locally to Harper County residents, which was in sync with the vision of both hospitals to improve the quality of life in the communities they serve. His strategy was to create a new rural healthcare delivery model focused on community engagement and wellness. Mr. Patterson believed that a new rural health center should be rich in state-of-the-art information and medical technologies to support innovation in healthcare delivery, such as a robust electronic medical record, electronic outpatient registration, digital patient tracking, telemedicine capabilities, and automated medication dispensing units.

Western Wisconsin Health

Early in the project planning process, Kahler Slater, medical planners for the new Health Center, invited key leadership to tour their recently completed Western Wisconsin Health (WWH) project in Baldwin, Wisconsin. WWH provided many care delivery features that were incorporated into the Patterson Health Center. In addition to providing a new 15-bed critical access hospital including 2 Labor/Delivery/Recovery/Postpartum (LDRP) beds and 2 antepartum rooms, the WWH facility also provides a large primary and specialty care clinic using an Integrated Care team model to foster team collaboration and communication, while enhancing a private patient experience. Of great interest were the facilities and programs developed at WWH that focused on health and wellness, including a community Fitness Center with hydrotherapeutic pool, community gardens, walking trails, a cafeteria/dining space dedicated to serving nutritious meals from locally grown farms and gardens, and a variety of nutritional programs offered to improve various health conditions.

Like WWH, the new Patterson Health Center (PHC) had similar goals to create a campus focused on promoting wellness for their patients and surrounding communities and to deliver healthcare in their rural area with resilient, flexible, and cost-effective operations. PHC’s 60-acre campus design features a large front lawn for facility-sponsored health fairs, community events such as farmers’ markets or run/walk events, and development areas reserved for a future Wellness Center, a Community Center, community gardens, and walking trails. Located adjacent to the Anthony and Harper communities’ shared high school brings opportunities for both facilities, such as introductory training programs for future healthcare professionals offered at the high school and improving the health of teenagers via wellness programs and sports medicine offered by PHC.

During the medical planning and interior design of the health center, the philosophy of “Get Well, Stay Well, Eat Well” guided the team of Kahler Slater’s Medical Planning Consultants and Architect of Record, Gould Evans in design and operational decision-making. Some of the innovative features of the new Patterson Health Center include the following:

Get Well. Design and operational innovations include a new inpatient care unit with 10 large, private bedrooms where a family member can stay overnight. Three adaptable care rooms were included—designed as three semi-private inpatient rooms which will be licensed as patient beds for peaks in census. They will also be used for multiple procedures, such as outpatient infusion bays and same day surgery prep/recovery beds. These adaptable care rooms minimize underutilized, costly spaces, such as a dedicated prep/recovery, while maximizing the nursing staff already required for the inpatient and Emergency Department (ED). The nurse stations for the inpatient unit and the 4-room ED are interconnected to efficiently operate the two services and allow staff and providers to easily flow between the two services. Two ED rooms dedicated to trauma patient care have cameras and microphones to enable telemedicine consults when needed and the medical equipment for imaging and surgical services is all new, state-of-the art equipment.

Stay Well. A 22-exam room clinic is connected to the critical access hospital and features an Integrated Care Team clinic delivery model for its primary and specialty care providers. Dual access exam rooms are located around two large “off-stage” collaboration areas to allow clinic staff and providers to more easily collaborate and communicate, thereby enhancing care coordination and the patient experience. To offer more services locally, built into the clinic are spaces for delivering both private and group Behavioral Health care. Additionally, a telemedicine robot can move from exam room to exam room to connect distant specialists to local outpatients without leaving the community.

To enhance the focus on wellness, an 18-equipment station outpatient rehabilitation gym with several private treatment rooms and an in-ground hydrotherapy pool provide physical, occupational and cardiopulmonary therapies for outpatients. All equipment and the pool are available for staff to use off-hours to meet their own fitness goals. A smaller fitness center dedicated to staff use 24/7 is also provided.

Eat Well. A new kitchen offering locally-grown produce and more healthy menu options features indoor and outdoor seating options. The dietary service hopes to serve not only patients, staff, and visitors to the health center, but also offers another dining destination to the surrounding communities.

With all the aforementioned design and operational innovations incorporated into the Patterson Health Center, the future seems bright that it will succeed in providing high quality care to its patients. Not only will the health center thrive, but the communities it serves will also flourish.

The Patterson Foundation funded most of the new $41 million Patterson Health Center. A USDA Rural Development loan completed the financing for the project. The Patterson Health Center’s grand opening was July 19, 2019, and it began serving patients on July 22, 2019. “This building saves our rural community from potentially losing a hospital or two. The unique merging of two critical access hospitals into one efficient, well-organized, patient-centered facility could become a national model. It provides resiliency against the constantly shrinking resources we’re seeing nationwide,” said Pat Patton, CEO, Patterson Health Center.


Footnotes:

  1. https://public.tableau.com/profile/stroudwater.associates#!/vizhome/ClosedRuralHospitalsSince2010/ClosedRuralHospitals
  2. American Hospital Association (2011), “The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform”; Retrieved: https://www.aha.org/guidesreports/2011-04-18-trendwatch-opportunities-and-challenges-rural-hospitals
  3. Harper County Hospital Consultation Report, Center for Health Systems Innovation, Oklahoma State University, 2017.