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Viable solution is developed

Finding a viable solution to the financial difficulties at Dickinson's St. Joseph's Hospital and Health Care Center may be one step closer to reality.

Finding a viable solution to the financial difficulties at Dickinson's St. Joseph's Hospital and Health Care Center may be one step closer to reality.

North Dakota's congressional delegation brought Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services (CMS), to Dickinson Monday morning to outline a possible strategy for a better financial picture at St. Joe's. The facility is seeking ways to recover from $13.2 million in operational losses from fiscal 2002 to the end of the past fiscal year this past June 30.

Sen. Kent Conrad, D-N.D., Sen. Byron Dorgan, D-N.D., and Rep. Earl Pomeroy, D-N.D., and Weems visited with hospital officials and community leaders at St. Joe's Monday.

"This is a serious situation, but I think the solution is in the hands of the community," Weems said in a group interview following the morning gathering. "We're proud to be here with the congressional delegation to be part of that solution."

Interim plan

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Conrad said during the group interview the morning conversation focused on a plan that involves various stakeholders to help achieve a Critical Access Hospital designation for St. Joe's. The critical access designation brings more revenue to the facility as a rural health care provider. Estimates have an additional $3 million to $4 million coming to St. Joe's if it were to have the critical access designation.

Federal laws currently prevent St. Joe's from getting the critical access designation, however, because it is too close to another facility that already has this designation - the Richardton Memorial Hospital and Health Center Inc.

Conrad said the plan that's to be pursued provides a chance for Richardton to switch from its current hospital services to providing skilled nursing services as a long-term care facility.

This switch would require a waiver from the state regarding its existing moratorium on new long-term care beds, which CMS believes the governor can provide.

The other key to the interim plan is providing St. Joe's the opportunity to apply for a CMS demonstration project that would provide $1.3 million a year in additional funds for the next two years, Conrad said.

"So those are the basic elements of an interim plan, and obviously that requires a real partnership," he said. "It requires the hospital to take certain steps, it requires Richardton to be a full partner, it requires the state government to be involved, it requires CMS to help, it requires in addition the continuation of the (Medicare) 508 status which Sen. Dorgan and I have gotten an agreement from Sen. Baucus (D-Mont.) to be included in the Medicare package, of course, which Congressman Pomeroy played a key role in getting in the first place by getting the House to go along."

Dorgan said during the group interview the interim plan can put St. Joe's back on sound footing.

"It's going to require work on everybody's part, but I think it's doable, achievable," said Dorgan, who was born at St. Joe's. "I think it's achievable within the next 12 months. This was a real breakthrough, this meeting."

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Pomeroy said during the group interview a key to the strategy is finding a win-win outcome for Richardton.

"I want to commend the leaders in Richardton for understanding the problem of St. Joe's in the context of health care delivery throughout southwestern North Dakota," Pomeroy said. "They're viewing their own role in solving this crisis as being an important component of health care delivery in southwestern North Dakota and not just the proprietary city limits of Richardton."

Converting the Richardton hospital to skilled nursing home beds meets a very significant need in this area, Pomeroy added.

"We think we have the outline of a win-win strategy for Richardton, a survival strategy for Dickinson hospital and if the components come together, this will work," he said.

Richardton conversion?

Considering a conversion of part or all of its current hospital beds to long-term care beds is something the Richardton facility administration and board have been looking at or considering for some time, said Administrator Jim Opdahl.

"It's an option to consider, to continue as we're doing right now, to convert some of the hospital beds to long-term care, to convert all to long-term care, to look at our medical clinic and what we do with that, there's just a lot of options out there," Opdahl said.

The issue is what the impact would be on Richardton's financial picture, he said.

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"Essentially, the way the long-term care payment system works, we could probably have 20 beds, the state may allow us 20 beds," Opdahl said. "The issue there is if we would be under the reimbursement limits for long-term care based upon the North Dakota payment system, and that is the big question; that we would probably be over the limits in some of the areas, and therefore you lose reimbursement."

Opdahl said there are two ways to get long-term care beds, with the first being to purchase beds from a state facility that is downsizing its number of licensed beds.

"So we would have to purchase those at the time they were available. The last group of beds I think went for $17,000 a bed," he said. "So there's two issues there. We would have to have the financial resources and the other one is the beds would have to become available at the right time, and then there has to be the right number of beds to at least give us an opportunity to pursue that as an option."

Opdahl is not aware of a process that exists under which an exception or waiver could be given.

"Other than to talk to the governor, and Department of Human Services and the Department of Health and whomever else we need to visit with to see if we can convert some beds without having to buy them" he said.

Opdahl thinks Richardton's facility is as much a part of the Dickinson community as it is its own, as it has a service area of about 2,300 people.

"The majority of those people are accessing health care and retail and all sorts of services in Dickinson. So I think whatever happens on this critical access designation, I think there is a win-win situation for both communities," he said. "I think that is the bottom line, socially and economically, there is a win-win situation, so hopefully things will work out in such a manner that that will happen."

Unprecedented interest

St. Joe's CEO Claudia Eisenmann said given her experience at various hospitals in various states, it is unprecedented to see the existing level of interest, commitment and collaboration of the various constituencies to help find a solution for Dickinson's facility.

"I've never seen this before where people are so extraordinarily focused on regional health care that they are willing to give up their time, give up their energies, to make something happen," she said.

Eisenmann said hospital officials have poised themselves knowing there were possible opportunities that could come their way to help correct St. Joe's financial situation.

"So we have been crafting our operations around those possibilities so we would be in a position to be successful in achieving those things at the point we were able to do so," she said.

She said the interim plan that is before everyone is really the best of all worlds.

"We have interested people at all levels, we have things happening because people are very focused and they are very outcomes oriented, and we have an organization that has poised itself to take advantage of doors as they are opening," Eisenmann said. "And ultimately who wins from this, are the citizens of this region. It is an extraordinary thing for us to all be here today talking about this."

Conrad said this is one of those happy circumstances where there is an opportunity for everybody involved.

"There is an opportunity for Richardton, it really is good for them long term to become a skilled nursing facility; real opportunity for St. Joseph's and there's a partnership," he said.

He also credited Eisenmann for leading the search for a resolution to St. Joe's financial woes.

"Her competence and her drive has pushed the board, pushed the community to recognize this requires action. She has really been constructive and aggressive and that is what this requires," Conrad said. "And we have an administrator at CMS who is not somebody who is reluctant to step forward and take responsibility to help fashion a solution. He is results oriented, which I think all of us applaud. I deeply appreciate his coming and spending an entire day in North Dakota."

After the early morning stop in Dickinson, Weems and the congressional delegation were off to Bismarck for a gathering with health care providers from across the state.

"We'll work to make this work and if the waiver doesn't work, we'll just keep working and find a way that Richardton can switch status," Weems said of the St. Joe's situation.

Moving forward

Eisenmann said Dickinson Mayor Dennis Johnson has offered to bring the request for the moratorium waiver on long-term beds for the Richardton facility to Gov. John Hoeven.

"When it's time for someone from the community to talk with the governor, I am certainly willing to do that," Johnson said in a telephone interview Monday.

He said it was certainly reassuring to have the head of CMS at the hospital and he is grateful the entire state congressional delegation was here Monday.

"They are engaged and they are working on this, and that is a huge plus," Johnson said.

He said it is so obvious that having a hospital is so important to this region, especially when you think of all the development currently going on here and the development that's expected in the future.

"I think we're going to see growth yet from the Bakken (oil) formation. I'm looking forward to the (South Heart) coal gasification plant. That will have both a short-term and long-term impact on this region," Johnson said. "The energy industry in general is going to expect the community they are in to have more than adequate health care services available, as do any of us employers."

Board member perspective

Johnson's wife, Nancy, is president of St. Joe's board of directors. She too is excited about finding a win-win situation for St. Joe's and the Richardton facility.

"I think it is a real positive atmosphere right now," she said. "There is a good sense that we will be able to work something out between the two entities."

She also serves in the state House of Representatives, and said she and her husband in their respective capacities have spoken to Hoeven about the critical needs in Dickinson and the region for hospital services.

"So the governor is aware that we're really working to get the critical access designation, and he's aware because of Richardton being located 26 miles away, that's the sticking point," she said.

Johnson also is very thankful for the efforts of the state congressional delegation to help find a solution.

"They obviously have the contacts with the Center for Medicare and Medicaid Services, that has been invaluable," she said. 'They in essence have been working from their end to see what would work for St. Joseph's and the southwest region. We really appreciate their efforts and their continuing efforts. They are going do what they can to keep the pressure on. It takes all of us working on this."

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