BOWMAN, N.D. — Retta Jacobi stepped onto a steel platform that lifted her to an entrance on the aspect of a custom-designed semitrailer. As soon as inside, she lay down on a platform that technicians slid into an MRI machine. Jacobi hoped the scan would assist pinpoint the supply of the ache in her shoulders.
The cell MRI unit visits Southwest Healthcare Companies, the hospital in Bowman, North Dakota, every Wednesday. With out it, the group’s 1,400 residents must drive 40 minutes to get to an MRI machine, an costly piece of medical gear the hospital couldn’t afford by itself.
Southwest Healthcare Companies and 21 different unbiased, rural North Dakota hospitals are a part of the Tough Rider Community, which used its members’ mixed affected person rolls to barter higher costs for the cell imaging truck.
Unbiased rural hospitals are more and more becoming a member of what are referred to as clinically built-in networks, collaborative teams that enable them to keep away from promoting out to bigger well being methods whereas sharing assets to save cash and enhance affected person care. Many are motivated by the possibility to mix their affected person rolls for value-based care contracts, a rising reimbursement mannequin by which insurers pay suppliers primarily based on the standard of care they supply and the well being outcomes of their sufferers.
Supporters of the networks are exploring whether or not funding from the $50 billion Rural Well being Transformation Program — a part of President Donald Trump’s latest tax and spending invoice — can be utilized to assist begin or develop such organizations.
For unbiased, rural hospitals, the networks are a substitute for shutting down or decreasing companies, or to giving up native autonomy and becoming a member of a big hospital system.
“Anything that can help our rural hospitals and add services is awesome,” stated Jacobi, who supplies speech remedy to kids within the native college district.
Since 2010, 153 rural hospitals within the U.S. have shuttered utterly or stopped providing inpatient companies, in response to the Sheps Middle for Well being Companies Analysis on the College of North Carolina. A far bigger quantity, 441, merged with or have been acquired by hospital methods between 2011 and 2021. That’s in response to a report commissioned by the Coalition to Strengthen America’s Healthcare, an advocacy group comprising hospitals and well being associations.
The Tough Rider Community supplies negotiating leverage to its members, which serve about two-thirds of rural North Dakotans, stated Dennis Goebel, CEO of the Bowman hospital.
Well being care distributors “probably wouldn’t be talking to us if we’re by ourselves,” he stated. “They’re not looking for the little, tiny crumbs. They want a big contract, and they’ll give you better pricing.”
Some rural networks share specialists who aren’t wanted full time at anybody hospital, in response to the Commonwealth Fund, a nonprofit targeted on enhancing the well being care system. Some networks additionally spend money on broadband, housing, and different group improvement initiatives that may assist individuals keep wholesome and entry care.
Hospitals can pool staffers for a network-wide worker medical health insurance plan, stated Nathan White, CEO of Cibolo Well being, an organization that helps launch and handle networks in rural areas. He stated they’ll additionally enter shared contracts for telehealth, prescription drug applications, and different companies.
White stated he began Cibolo Well being after a frontrunner from an unbiased, rural North Dakota hospital requested him about collaborating with comparable amenities. The Tough Rider Community launched in late 2023 with help from the corporate and $3.5 million from the North Dakota Legislature.
Since then, Cibolo Well being has helped begin networks in Minnesota, Nebraska, Montana, and Ohio. As soon as a sixth one opens in September, Cibolo-affiliated networks will symbolize greater than 120 hospitals, with service areas overlaying 4.7 million individuals, White stated.
The networks, that are nonprofits owned by the hospitals, pay an annual payment to Cibolo Well being, a for-profit firm, for administration companies. White stated leaders from 10 different states are contemplating becoming a member of this mannequin.
Related networks have been round for greater than 30 years however grew to become extra standard after the passage of the 2010 Inexpensive Care Act, in response to a report by the Rand Corp., a analysis nonprofit.
Rural well being care suppliers are more and more excited by forming such networks, stated Marnell Bradfield, government director of the Group Care Alliance, a community of hospitals and unbiased main care places of work that launched in 2015 in rural western Colorado. About as soon as a month, she stated, she will get a name from well being care leaders exploring comparable networks and asking about her expertise.
The Rand Corp. wrote in its 2020 paper that it didn’t discover any educational research that examined whether or not these networks do what its supporters declare — get monetary savings and enhance affected person care.
“In theory, quality should improve with the alignment of health care organizations, but there is no evidence,” the report stated. The paper additionally stated such networks might find yourself growing costs, one thing that may happen with conventional mergers and acquisitions.
Bradfield and White stated they’ve the proof, a minimum of for his or her organizations.
Group Care Alliance members have lowered their insurance coverage prices whereas enhancing affected person outcomes, equivalent to decreasing their want for inpatient and emergency care, Bradfield stated.
White stated information from a pilot program between Caret Well being, a care coordination firm, and SMP Well being-St. Kateri, considered one of Tough Rider’s hospitals, confirmed this system helped a major variety of sufferers meet up with preventive care.
Gabby Wilkie, finance director on the St. Kateri hospital, in Rolla close to the Canadian border, stated Caret Well being workers referred to as and texted sufferers who have been behind on annual physicals, most cancers screenings, vaccinations, and different visits. She stated staffers defined to sufferers why this preventive care is essential for his or her well being earlier than establishing a three-way name with St. Kateri workers to schedule an appointment. White stated it took a median of 11 outreach makes an attempt earlier than sufferers got here in for any visits.
“To be honest, we didn’t have the resources to reach out,” Wilkie stated.
She stated St. Kateri would have spent an estimated $300,000 to do this type of outreach for 1,000 sufferers. In the meantime, she stated, the hospital estimates it should earn greater than $100,000 when that many sufferers are available in for his or her preventive care. Cibolo Well being and the Tough Rider Community each contribute to the price of the Caret Well being service, which is now rolling out to different community hospitals.
Goebel stated becoming a member of a community to stay unbiased can also be helpful for the financial system of rural areas, the place hospitals are sometimes main employers. He stated well being methods typically reduce companies and workers at rural hospitals they purchase.
Jacobi is taking medicine and doing bodily remedy after a physician examined her MRI outcomes. If that doesn’t work, she could have to make a five-hour spherical journey to Bismarck to get an ultrasound-guided steroid shot. Jacobi was grateful she might get a analysis and remedy recommendation with out having to journey far for the MRI.
“Anytime we can maintain more local control, it’s a good thing for our small towns,” she stated.
