Delivering State-of-the-Art Care to Rural America

Ryan Tjeerdsma, Surgery Manager, Murray County Medical Center

In rural healthcare facilities, demonstrating your worth and capabilities to the surrounding community is often one of the most important steps you can take to attract patients and keep revenue flowing. As the Surgery Manager for the Murray County Medical Center in Slayton, Minn., I have a firsthand perspective of the variety and quality of care that can be delivered in a rural area. Our clinic is a multi-specialty facility staffed by two family practice physicians, two physician assistants, and two family nurse practitioners. It is equipped with two surgery suites, and currently offers surgical services in general surgery, orthopedics, endoscopy, ophthalmology, ENT, podiatry and urology. In addition to surgical services, we offer specialty outreach services in areas including cardiac rehabilitation, diabetic education, behavioral health, and numerous diagnostic testing procedures. The clinic is equipped with MRI and CT scanners, and also provides screening services for breast cancer, bone density and audiology.

Slayton has a population of approximately 1,800 people, and our clinic is proud to offer such a wide variety of services. To achieve this, outreach doctors visit us on a rotating schedule, with general surgeons and orthopedic specialists visiting twice a month, and doctors performing ophthalmology, ENT, podiatry and urology procedures one day a month. Endoscopy is our most frequently scheduled service, which we offer five to six times a month.

Despite having this variety of offerings, our facility faces a challenge that is likely shared by many other rural clinics—educating area patients on the services we provide, and convincing them that the level of care they will receive in our facility is equal to that provided by a big city facility. Having worked in large hospitals prior to my experience here, I can personally attest to the level of care that is provided in our clinic, and I work to convey that message in our marketing and community outreach. We work hard to let our community know that even in the“middle of nowhere,” the quality of the services we provide is up to the same standards of a “big city” hospital.

The growing need for rural care

The need for healthcare in rural communities underscores the importance of making it accessible. Naturally, the aging population has a significant impact on the growing demand for care. People over the age of 60 are expected to represent close to 25 percent of the population by the year 2030, and the proportion will likely continue to grow higher in rural areas. Currently, people over the age of 65 make up approximately 15 percent of the rural population, versus 12 percent of the country as a whole. A recent report from the USDA’s Economic Research Service states that older Americans living in rural areas generally have a higher need for medical, social and financial assistance. The report also notes that delivery of service is more difficult in rural areas, and that attracting healthcare providers to these areas can often be a challenge.

For older patients who do not have accessible healthcare services nearby, their ability to find safe and reliable transportation to a city facility provides an additional hurdle to receiving proper care. From Slayton, the nearest larger medical facilities are either 40 minutes or an hour and a half away, resulting in a difficult drive for an elderly patient with a health condition.

The challenge of operating efficiently

Our facility, therefore, provides an important service for patients in our rural community. We pride ourselves on the range of services that we offer, but it does require a great deal of coordination to organize the various healthcare providers, along with their equipment and supplies. Even something as simple as storing supplies can present a problem. Fortunately, our facility’s operating suite was constructed just five years ago, at which time the planners had the foresight to give us extra storage room. However, many rural facilities do not have this luxury and are faced with the task of storing equipment and supplies for procedures they perform only infrequently.

Obtaining the proper equipment presents a challenge as well, especially for procedures which are only performed once or twice a month. We recently invested in an expensive piece of specialty equipment on a doctor’s request, only to have him tell us later that he prefers to do that particular procedure in his own clinic. Effectively communicating with the outreach physicians and strategically acquiring and updating equipment is an additional hurdle for rural facilities, in both financial and operational aspects.

An outsourcing model

In the case of cataract surgery, however, we have the luxury of not concerning ourselves with investing in equipment or storing supplies. This is due to our agreement with Sightpath Medical, a mobile provider of ophthalmic surgical equipment. Our facility began offering cataract surgery 19 years ago, and from the beginning, we have worked with Sightpath Medical. With this arrangement, a Sightpath Medical technician transports the necessary equipment and supplies to and from our facility for each surgery day. The clinic pays Sightpath Medical for the service on a per-case basis, and the facility has no capital investment, no maintenance fees, and no inventory management.

On a typical cataract surgery day, the Sightpath Medical technician, who is certified by the National Board of Surgical Technology and Surgical Assisting, will arrive to set up the equipment instruments, surgical supplies and intraocular lenses (IOLs). All of the necessary packages of supplies are laid out at the beginning of the day. An average caseload ranges from 8 to 10 patients, who are scheduled in groups for the left eye or right eye, which allows us to save turnover time by only switching the room over once. Using our staff and the Sightpath Medical technician, turnover time for the room averages three to four minutes between procedures, allowing us to make the most efficient use of the surgeon’s time. The doctor can specify what brands of equipment and IOLs he prefers, and can also upgrade as new technology becomes available or as his preferences change.

The technicians who travel with the equipment are highly trained and accustomed to adapting to the individual needs of each facility in which they work. They are also helpful to the rest of our team in running the procedures efficiently, assisting if needed, and making sure the equipment is functioning properly. The expertise of a person who does these procedures every day—versus our staff members who perform them once a month—is invaluable in helping keep our team fresh in cataract surgery.

With this arrangement, our cataract services are a significant contributor to revenue for our facility, making up 10 percent of an average month’s caseload. We are able to market our state-of-the-art equipment for cataract surgery, and word of mouth for the procedure has been an effective awareness tool in the community.

Benefiting the community

Our experience with Sightpath Medical demonstrates an effective way for rural facilities to stay competitive with healthcare providers in larger areas. More importantly, we are able to provide a much-needed service for the community and help patients stay close to home for their treatment. With this state-of-the-art care, we are able to strengthen our ties to the area and showcase our abilities in providing service that rivals much larger facilities.