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The Arizona Center for Rural Health received the 2019 SORH Award of Excellence from the National Organization of State Offices of Rural Health (NOSORH) at its annual meeting in Albuquerque, New Mexico. NOSORH presents the award to a State Office of Rural Health making outstanding contributions to rural health. Nominations are made by NOSORH members, national rural health partners and other organizations. 

Jennifer Peters, Program Manager for the Arizona State Office of Rural Health Program, accepted NOSORH’s 2019 Award of Excellence on behalf of the Center. She said, “The recognition from our national peers is a reflection of the vigorous efforts by the Arizona Center for Rural Health and its collaborators to promote health equity and address the health disparities faced by rural and underserved communities.”

Heather Carter, EdD, Associate Director for the Arizona Center for Rural Health, stated, “Arizonans living in our diverse, rural communities deserve high quality health care. Thanks to our many community partners we are able to identify and address unmet health needs in these areas and inform health policy at the local, state and federal levels.”

The Arizona Center for Rural Health serves Arizona through its core mission of over 40 years to improve the health and wellness of Arizona’s rural and underserved populations. It houses programs including the State Office of Rural Health (AzSORH), the Rural Hospital Flexibility Program (AzFlex), the Rural Health Professions Program (RHPP), Health Workforce & Data Analysis (CRHWorks), Arizona First Responders Initiative (FR-CARA), Data to Action and others. Learn more about the Arizona Center for Rural Health at www.crh.arizona.edu

NOSORH provides capacity building and support services to State Offices of Rural Health (SORH) in their efforts to improve access to, and the quality of, health care for rural Americans. 

Learn more about NOSORH can be found at https://nosorh.org/about-nosorh/

By Anikka Abbott, Cronkite News | Thursday, Nov. 7, 2019

PHOENIX – For more than three decades, Jill Guernsey de Zapien has fought to improve public health in underserved communities across the Southwest. She helped start a program in southeastern Arizona to bring better care to rural residents, and farmworkersin particular.

She was inspired by her father, a labor organizer.

Guernsey de Zapien, director of border, transborder and binational public health collaborative research at the University of Arizona, spent time with Cronkite News to discuss her efforts and a program in the colonia of Winchester Heights, north of Willcox, to bring more health care to more people. 

What is the Arizona Area Health Education Centers Program (AHEC)?

AHEC has five centers and it has a centralized office here at the University of Arizona. The five centers cover the entire state. … There’s one in Nogales … Yuma … Flagstaff … Globe, and there’s one in Maricopa County. Its purpose is to deal with the maldistribution of health professionals. It’s not saying necessarily that we don’t have enough health professionals, it’s saying that they’re not distributed well.

How does AHEC work?

Each one of those centers works in the elementary schools, high schools, etc. to get kids interested in health professions. … The second prong is here at the university, where we … work with the centers to identify students to go out and do rotations in those areas. … And then the third piece is really (to address) why many health professionals, once they’re in an underserved area, why they leave – because they don’t have access to a community of continuing education. So the role of those centers is really to provide that continuing education and connection for health care professionals once they’re in there.

Why are you passionate about farmworkers’ health care?

My father was a labor organizer. As a child, I was very impacted by the film “Harvest of Shame,” by Edward Murrow. … I learned as a child what was going on in terms of the invisibility of farmworkers. Even as a child, it’s so easy to make the connection and go, `Well, wait a minute. Why don’t we support farmworkers? Why don’t they get a decent wage? Why don’t they have good housing? Because everything I’m eating, I couldn’t make it without them being here.

I had a real sense of the injustice of it. As citizens and people who care about social justice, we cannot be spending the rest of our time on this planet allowing the very people who produce the food and harvest the food that we’re eating not to be recognized and have decent wages, decent living conditions, and all the things that everybody else has the right to.

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The Arizona Medicare Rural Hospital Flexibility Program (AzFlex), a program of the UA Center for Rural Health has been awarded a $3.5 million, five-year grant from the Health Resources and Services Administration (HRSA) to continue its vital efforts in medically underserved areas of the state. This new five-year HRSA award will allow the program to expand its longstanding relationship with the hospitals, clinics and the Arizona Bureau of Emergency Medical Services and Trauma System. Founded in 1999, the AzFLEX Program offers support and technical assistance to CAHs in core areas including:

• Performance and Quality Improvement

• Operational and Financial Improvement

• Population Health Management and Emergency Medical Services Integration

PAYSON ROUNDUP | by Peter Aleshire consulting publications editor | Aug 27, 2019

Rural Arizona counties are preparing for the apocalypse.

Well — providing they get the grant.

Hey. Better late than never.

To be specific, Navajo County along with Apache and Gila counties are all lining up for state and federal money to plan a comprehensive response for the kind of pandemic that killed 50 million people after World War I — as a virulent strain of the flu flashed across the world.

The Navajo County Board of Supervisors at its last meeting approved the application for a $250,000 grant from the Arizona Department of Health Services and the federal Centers for Disease Control to establish a system to distribute antibiotics, vaccines and newly developed drugs if a pandemic rips through Arizona. The grant application will come before every county in the state in the next several months, courtesy of the Arizona Bureau of Public Health and Emergency Preparedness.

It sounds like science fiction spawned by a dark mind, but public health experts warn that the nation remains woefully unprepared for fast-spreading, potentially incurable diseases. A recent case in point is Ebola, now once again rippling through the Congo. The easily spread viral disease has a 65 percent mortality rate. The Congo has had 10 outbreaks in the past 40 years, with the most recent spread killing 1,800 people.

Most Americans think of the threat of such pandemics as a Third World problem, held at bay here by modern sanitation and health care systems.

However, Bill Gates has been battling AIDS, malaria and other diseases for more than a decade through the world’s largest charity — the Bill and Melinda Gates Foundation. At a conference, he recently warned that the world remains woefully unprepared for deadly viruses and bacteria incubated by overcrowding, poor sanitation, overuse of antibiotics and global travel patterns.

Medical researchers have developed only a handful of effective vaccines against viral diseases. Many poor countries can’t afford the vaccinations and in many rich countries exaggerated fears of vaccine side effects have left much of the world vulnerable to even well-known viral disease like measles.

The Navajo County Board of Supervisors at its last meeting approved the development of a public health emergency preparedness program to train county workers to receive, distribute and stockpile critical items — like vaccines, antibiotics and other medications needed to cope with a pandemic or “outbreak event.”

The program would also help local hospitals to set up protocols and systems to handle the huge number of potentially infectious patients such an outbreak could generate.

Each county will have to provide a detailed budget to qualify for the state and federal support. The county will establish a point person in the event of such a medical emergency, train workers to handle the crisis and pull together local coalitions of health care workers and public safety officials.

The state has set up four regions to coordinate responses. Navajo and Apache counties are in the northern region, along with Coconino and Yavapai counties and the Hopi, Kaibab-Paiute and Navajo reservations. Gila County’s in the central region, along with Maricopa and Pinal counties and the Gila River, San Carlos Apache, White Mountain Apache and Salt River Pima-Maricopa tribes and communities.

Each county and tribe can apply for state and federal money to pull together its public health emergency plan.

Rural counties have lower population densities, which reduces the speed with which a pandemic can spread. However, rural areas in Arizona also have less access to health care — including vaccines. One survey showed only 51 percent of people living in rural America have job-based health care covered, compared to 57 percent in urban areas. The Affordable Care Act drove down the percentage of Americans without health coverage to the lowest levels in decades, but rural areas still lagged. About 30 percent of rural residents in the state get their health care covered through the Arizona Health Care Cost Containment System (AHCCCS), but the state-run health care system for low-income workers has far fewer health care clinics and facilities in rural areas.

Vaccination rates lag even for established diseases easily preventable with safe vaccines. It requires a 95 percent vaccination rate to acquire “herd immunity” from common viruses like measles, mumps and rubella. But statewide, the vaccination rate has fallen to 93 percent, according to the state department of health resources.

Only about 40 percent of the state’s kindergarten students have a vaccination rate high enough to prevent the spread of a measles outbreak — much less still incurable diseases like Ebola or the kind of flu strain that proved so lethal worldwide in 2018.

The vaccination rates by county for kindergartners in 2019 stood at 92 percent in Apache County and 93 percent in both Gila and Navajo counties, according to the state department of health resources. All three counties fall below the 95 percent threshold for “herd immunity,” which dramatically slows the spread of a virus through the population.

The potential for lethal damage from a new viral threat is possibly even greater, since such a virus would spread quickly without an effective vaccine and only limited drug options for treatment. That’s why the state is scrambling to get each county to set up an emergency response system in case such a virus gets loose.

The history of the 1918 flu epidemic remains a haunting reminder of what can happen, despite a century of advances in battling bacteria and viruses. The flu virus in 1918 spread from birds to humans, which meant most humans didn’t have natural defenses against the bird-based strain. About 500 million people were infected, about one-third of the world’s population. The strain killed roughly 10 percent of those infected, especially those younger than 5 and older than 65. The virus also had an unusually high mortality rate among those 20 to 40, a population normally resistant to fatal side effects from viral infections.

Medical experts are still not sure why that strain proved so lethal, although the lack of a vaccine or effective antibiotics coupled with the worldwide disruption of public health systems by World War I all likely played a role.

Less lethal flu pandemics afflicted the world and caused millions of deaths in 1957-58, 1968 and 2009.

And that’s just the flu — one of the most intensively studied viruses in the world, whose effects are limited by a sophisticated, worldwide flu vaccine system.

The state hopes to at least lay the groundwork for a coordinated response with grants to each county in the state to prepare an emergency response.

By Jeannette Hinkle | AzCentral Arizona Republic | September 2, 2019
Full article at azcentral.com (subscription required)

BENSON - The people of Benson didn’t know it, but their hospital was on the brink of closure. The management team at Benson Hospital kept the increasingly dire financial position from patients - even from staff members - as they searched for ways to bring the budget back into the black. But when the hospital couldn’t meet payroll, management decided it was time to send out an SOS. 

Benson Hospital’s board reached out to Tucson Medical Center. Without a significant donation, the 22-bed “frontier” critical access hospital, open since 1970, would have to shut its doors. 

Tucson Medical Center agreed to take Benson Hospital under its tent last year, a move welcomed by most everyone at Benson Hospital. Staff members, who maintained a high quality care rating throughout the turmoil, say they’ve since seen improvements they’d waited years for.  
A one-time state appropriation of $900,000 for the current fiscal year gave Benson Hospital an added financial boost.  

Earlier this summer, the halls of Benson Hospital, which are decorated with dozens of paintings by local artists, shuddered with the sound of drills and hammers. Workers were renovating the lobby, painting the walls and replacing the carpet, a color described as “just old,” with clean-looking synthetic wood planks.  

Benson Hospital’s new CEO, Julia Strange, also vice president of community benefit at Tucson Medical Center, pointed to peeling, outdated wallpaper borders ringing the hospital’s hallways. Those are next, she said. 

The aesthetic improvements at Benson Hospital are perhaps as important as giving staff long-overdue pay bumps. 

Like most rural hospitals in the state, which provide medical care to vast areas that otherwise would be uncovered, Benson is facing a physician shortage. Talented new doctors want to work in hospitals with resources, and a tired lobby offers a bad first impression. 

A glaring shortage 
Arizona is just beginning to quantify its rural doctor shortage. 

In 2019, the state Legislature passed a bill that will give researchers studying the shortage access to granular, standardized data that paints a more complete picture of health-care personnel needs than the dated county-level estimates being used now. 

But even with imprecise data, the current shortage of doctors in rural Arizona is glaring. Several rural hospitals in the state either currently are experiencing a shortage or expect to experience one in coming years. 

In 2018, an outside consultant evaluated Benson Hospital’s professional needs. According to that consultant, Benson currently has a deficit of doctors in family medicine, internal medicine and pediatrics.  

Looking ahead to 2023, that deficit will worsen as a wave of current doctors retires. In Cochise County, where Benson is located, the consultant predicted a deficit of 51 full-time equivalent doctors, with a moderate deficit of doctors in family practice and a high deficit of doctors in internal medicine and primary care. 

In Yuma County, 100% of residents live in a primary-care shortage area, according to the Arizona Hospital and Healthcare Association. 

“In the winter, if you want to get an appointment with a primary doctor in town, it is possible that you will wait six weeks for something urgent, three months for something not urgent,” said Dr. Kristina Diaz, a family medicine practitioner at Yuma Regional Medical Center. 

Without action, that wait will only lengthen. Roughly 50% of Yuma County’s primary-care physicians likely will retire in the next five years, Diaz said. 

A ‘vicious cycle’ 
The shortage of physicians is especially pronounced in primary care. Arizona ranks 44th out of 50 states in total active primary-care physicians, and that shortage is worse in rural areas, according to the Arizona Hospital and Healthcare Association. 

Doctors say the shortage can be dangerous. 

With a dearth of primary-care physicians, patients discharged from rural hospitals who need follow-up appointments often can’t get them. Sometimes, that means patients end up back in the hospital; other times, it means patients elect to go without needed medical treatment or advice for weeks. 

Recently, one of Diaz’s patients was discharged from the hospital with congestive heart failure. When the patient left the hospital, he had been prescribed a specific kind of medication, one he couldn’t afford. 

For two weeks, until his appointment with Diaz, the patient went without the medicine he needed. By then, he was having trouble breathing.  

“I had to admit him again,” Diaz said, “hoping that somebody will listen to him when he leaves the hospital and says, ‘I can't afford that expensive medicine.’ This is this vicious cycle, and I worry that it’s going to get worse as more people start retiring, if we don't start replacing the workforce.” 

Benson Hospital’s Dr. David Brower is one of only a few primary-care physicians serving patients in the area. Benson itself has a population of just under 5,000. 
Since Brower began working for Benson Hospital in 2018, he’s been inundated with patients who have let health problems fester because of a lack of access to primary care. 

“There's like four doctors here and they're booked,” Brower said. “Patients come to you and they're like, ‘I have high blood pressure. That's all I know.’ Then you start kind of peeling back the layers and they have this condition and this condition and this condition and this condition.” 

‘A special type of physician’ 
Springerville is a trading-post-turned-town nestled in the White Mountains. Incorporated in 1948, Springerville is home to about 1,900 residents, more than one-third of whom live below the poverty line. 

On Main Street, across from the town’s post office, stands a reddish stone statue of a stern-looking woman in a bonnet. She holds a baby in her arms, and a small boy tugs at her flowing skirt. She is Madonna of the Trail, a tribute to “the pioneer mothers of the covered wagon days.” 

Springerville was remote when pioneer mothers ferried their broods through the ponderosa pines that green the air in nearby Apache-Sitgreaves National Forest, and it’s remote now. 

It’s not for everyone, said Greg Was, CEO of White Mountain Regional Medical Center. 

After a protracted search that involved blanketing websites with hiring advertisements, the hospital turned to a costly outside agency to recruit a primary-care doctor, an expense that many rural hospitals can’t afford.  

At Benson, rising costs associated with recruiting doctors, exacerbated by the high demand, contributed to the financial emergency that led Tucson Medical Center to assume control. It’s not a unique situation. Since 2010, nearly 90 rural hospitals have shut their doors, and many more are at risk of closure. 

Eventually, the agency that White Mountain Regional Medical Center hired found a former neurosurgeon looking to finish out his career at a slower pace. But the area still needs practitioners who specialize in family medicine, general surgery, women’s health, urology and psychiatry. 

It’s just hard to convince doctors to practice in rural areas, Was said. 

Some doctors want to work in hospitals with the latest medical equipment, some discount rural hospitals because they expect the pay to be lower, and others are uncomfortable shouldering so much responsibility for patients’ health. But for many hospitals, selling doctors on a rural lifestyle is the most difficult part of the hiring pitch. 

“You need a special type of physician, one that wants to come in and settle here,” Was said. “We don't have the shopping conveniences or the entertainment that would attract a physician and his family to a larger city, so it makes it a more difficult sell. We have hiking, fishing, a lot of outdoor activities, but to go to Walmart you have to drive an hour to Show Low.” 

Benson Hospital has it a little easier than most rural hospitals. One of the biggest draws for potential employees is the small town’s proximity to Tucson. About half of Benson Hospital’s staff commutes. 

The pipeline problem 
Doctors raised in rural areas are far more likely to build a career in rural medicine, which is why health-care advocates in Arizona are working to convince people in towns experiencing a doctor shortage to study medicine, then go back home. 

“It’s a pipeline issue,” said state Sen. Heather Carter, a Phoenix-area Republican and chairwoman of the state Legislature’s Health Committee. 
Carter said the pipeline to rural medicine should start in elementary school with strong science programs and pitching kids from small towns on health care as a career.

But until that infrastructure is strengthened, the state is betting that exposing new doctors to rural medicine will fill the growing gap. 

Brower was raised in Phoenix, a decidedly urban setting, but his internal medicine residency in Sierra Vista, not far from Benson, gave him a window into what rural practice could look like. He was “enamored.” 

When he was offered a job at Benson, Brower accepted enthusiastically. 

“I tell my patients all the time, ‘I plan on being in Benson for a long time, so if you're planning on being here a long time, we'll get to know each other,’” Brower said. “I see very little that I can see someone else offering me that I don't already have here. And I see a lot that Benson Hospital and this community offers me that I can’t get other places.” 

Brower said that while his role as one of Benson's few doctors has been stressful at times, it has also allowed him to practice a type of medicine that is deeply personal and fulfilling. 

“I’ve had patients where it’s been the case that they haven't seen the doctor for 20 years,” he said. “Now, six, nine months later, them being like, ‘Doc, you changed my life. You absolutely changed my life. I didn’t think I was going to live five years and now I'm hopeful for the future.’ That’s not something you can get from city practice.” 

Doctors aren’t choosing rural medicine because, unlike Brower, they haven’t been exposed to it, Carter says. They go to medical school, then they go to residency, and that residency is usually at an urban hospital, too often in another state.  

Only 42% of Arizona’s medical students remain in the state after graduation, according to a report by the Association of American Medical Colleges. When doctors do complete a residency in Arizona, they stay to practice in the state 48% of the time, the report found. 

“Typically where a student completes his or her residency is where they will set up practice, because during their residency they're building those professional and community relationships,” Carter said. 

“That is typically where they will remain in their professional career.” 

Carter argues that the state offers too few opportunities for medical students to find a residency in Arizona, let alone in rural Arizona.  
In the 1990s, the federal government froze funding dedicated to helping hospitals subsidize the cost of resident placements, and after the Great Recession, Arizona cut all state spending on residencies, Carter said. 

In years since, health-care advocates have worked to marshal private dollars to make up for the lack of state funding for residencies, called graduate medical education in budgetary terms, but it wasn’t enough. According to the Arizona Hospital and Healthcare Association, the average cost to train a physician resident is about $165,000 per year. 

State finds money to help grow doctors 
In May, partly because of Carter’s advocacy, the Legislature passed a budget that included residency funding for the first time in roughly a decade.  

In fiscal year 2020, a total of about $5.6 million in combined state and federal dollars will go toward funding graduate medical education in rural areas. That number will rise to about $11.1 million in fiscal year 2021, then to $16.7 million in fiscal year 2022. The funding is expected to result in hundreds of new residency slots. 

The budget also included funding for telemedicine and broadband improvements in rural areas, money aimed at helping hospitals like Benson fill patient health needs for specialists without having to hire or contract with doctors to take patients at rural hospitals in person. 

“This is a very big deal,” Carter said. 

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There’s also been movement to address the pipeline problem on the federal level. In July, U.S. Sen. Kyrsten Sinema, D-Ariz., joined other lawmakers in signing a letter supporting a policy that reimburses medical students for their residencies at critical access hospitals like Benson Hospital.  

Sinema also supports the Resident Physician Shortage Reduction Act of 2019, which would increase the number of residency positions eligible for graduate medical education funding through Medicare. 

Staff at Yuma Regional Medical Center are already planning to use the funds to reinvest in the hospital’s residency program, which has been successful in keeping doctors in Yuma after they finish residency there. 

“For the class that starts in July of 2020, we will go from 18 residents to 24 residents,” Diaz said. 

The newly appropriated state funds, bolstered by a federal match, mean the hospital can fund a sports medicine fellowship, and it’s now considering starting two new residency programs, one of which would be for psychiatry.  

Currently, Yuma County, with a population of about 208,000, has only one psychiatrist. 

The new state funds are “huge” for Yuma, Diaz said. 

“We've been sitting at the starting line to be able to move so many things and meet the needs of our community, but we haven't had the funding for it, so we've had to stay at the starting line,” Diaz said. 

“Now we can run the race. And I'm really excited for that.” 

Diaz, who graduated from Yuma High School, said she’s confident that when residents come to Yuma, they’ll choose to stay. 

This summer, Diaz attended a conference to speak with potential residents. She brought a banner that read “Experience the warmth of Yuma.” 

“We're not talking just about the heat,” Diaz said. “We're also talking about the people. There is a strength in our community, and that has been our recruiting tool.” 

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PEW ARTICLE | August 9, 2019 | By: John Grant

Six states have passed laws in the past 12 months authorizing dental therapists to practice in a role similar to physician assistants in medicine. The addition of Connecticut, Idaho, Nevada, and New Mexico in 2019—along with Arizona and Michigan in 2018—brings to 12 the number of states that allow dental therapy in some capacity. 

Nearly as many are considering dental therapy laws or regulations intended to increase access to oral health care, particularly in underserved communities. Just five years ago, only three states had put any similar measures in place. 

Dental therapists work under the supervision of a dentist, providing preventive and routine restorative care, such as filling cavities or placing temporary crowns. Although they first entered the U.S. workforce in 2005, these midlevel providers have been practicing elsewhere for nearly 100 years. More than 50 countries allow this approach to expand the reach of dental practices. 

Most recently, Nevada and Connecticut joined the list of states that have passed laws authorizing dental therapy. In Nevada, dental therapists support safety net providers, such as federally qualified health centers, rural health clinics, tribal health clinics, and other entities that serve Medicaid patients or those who are low-income and uninsured.

Legislation authorizing dental therapy received broad support in New Mexico and was signed into law this past spring. Just weeks before the law passed, Ben Larzelere, a retired Lutheran pastor in Santa Fe, made the case for the change in the Sante Fe New Mexican as lawmakers were considering what to do. “We can no longer ignore a health crisis that plagues our state and so many of our most vulnerable. We know how to remedy this health crisis,” Larzelere wrote. “All it takes is a concerned community, an enlightened and caring government, and the laws needed to turn hope into reality.”

Allowing dental therapists to practice represents a proven path to broadening access to care. Research from Alaska demonstrates that oral health outcomes improve in places where these providers work. A 2018 study published in the Journal of Public Health Dentistryfound that children and adults in Alaska Native communities served by dental therapists had lower rates of tooth extractions and more preventive care than those in similar communities that did not have these services.

In Minnesota, which authorized dental therapists to practice in 2009, case studies show that patients and other dental team members report high satisfaction with dental therapists. Similarly, staff reported good collaboration and positive relationships with the dental therapists. 

Some state dental associations that may not have supported the idea of dental therapists early on now acknowledge the profession and its role. 

For example, this year’s legislative material from the Alaska Dental Society highlights the importance of dental therapists. “Together with dental hygienists, dental therapists, and other dental team members, the dentists of Alaska, whether in private practice, tribal entities, or federal clinics, work hard daily to improve the oral health of Alaskans,’’ the appeal to lawmakers says. “Oral health in Alaska, as reported by Alaskan residents, ranks noticeably higher than the overall U.S. population.”

And patients appear enthusiastic as well in states that have allowed dental therapists to practice.

“It’s been a fantastic response from our patients,” Minnesota dentist David Gesko said in a recent interview. “The patients have accepted dental therapists from day one. Patients love that these new providers are willing to see them, help them, and deal with their dental problems.”

More states could soon join Minnesota. In Wisconsin, legislative proposals this year have come from both the governor and a bipartisan group of lawmakers. A hearing for legislation sponsored by Assistant House Majority Leader Mary Felzkowski is expected in the days ahead. Fifty organizations across the political spectrum back dental therapy in the state. And one recent study hints at the potential economic benefit: The data show more than 41,000 emergency room visits a year in the state for preventable dental conditions—at a cost of nearly $25 million annually. 

Additional research helps build the case. For example, a recent report by the Association of State and Territorial Dental Directors (ASTDD) says that state policymakers should consider dental therapy a best practice when assessing how to boost access to oral health care for underserved populations. And newly released polling data show that 71 percent of Americans said they would be willing to receive dental care from these lower-cost providers. 

So far, Alaska, Arizona, Connecticut, Idaho, Maine, Michigan, Minnesota, Nevada, New Mexico, Oregon, Vermont, and Washington have authorized the practice of dental therapy, and more are likely to follow. 

Although no single approach can fix every dental care need, these practitioners continue to prove their value and help practitioners meet the continuing demand. The 72 million children and adults relying on Medicaid and the Children’s Health Insurance Program face a scarcity of care. Meanwhile, 56 million Americans live in areas with dentist shortages. These populations and others benefit from increasing the ranks of dental therapists bringing care to their communities. 

John Grant directs The Pew Charitable Trusts’ dental campaign.

National Rural Health Association | Rural Health Voices 
Author: Angela Shultis | Monday, Jun. 24, 2019

In 2002, Meeker Memorial Hospital in Litchfield, Minn. – population 6,500 – was at risk of joining the growing number of rural hospitals in the U.S. unable to maintain positive profit margins. Eighty-one rural hospitals closed between 2010 and August 2017, according to University of North Carolina’s Cecil G. Sheps Center for Health Services Research, and many others are vulnerable. About 41 percent of rural facilities operated with negative margins in 2016, a Chartis Group and iVantage study of 2,100 hospitals revealed. Hospital closures in small towns like Litchfield mean patients lose access to their closest emergency room, and local economies suffer devastating blows.

A single phone call may have changed Litchfield’s fate. A hospital board member called Mark Madden, an old friend who had grown up in the small community. He knew Madden had become a search consultant, helping health care organizations find qualified executives to fill vacant leadership roles. Madden, whose 86-year-old mother still lives in Litchfield, happily accepted the challenge.

Battling the currents of health care change
Meeker Memorial was a century-old pillar of the community Madden loved, but for nearly a decade the facility had weathered shrinking health care margins. As a result, certain structures, equipment, and technology required modernization, and the small facility was unable to accommodate additional patient volume. These factors, among others, hampered both patient and physician attraction.

Madden’s first priority was to meet with the hospital’s board members, physicians, and direct reports to understand what it would take to turn things around.

“Mark had a way of getting to the heart of things and really helped us hone in on the precise competencies and profile we needed in our next CEO,” says former Meeker Memorial Board Member Mike Huberty, who worked with Madden on subsequent searches.

A pivotal moment in Meeker Memorial’s journey
It was time for Meeker Memorial to make some big changes. The hospital was on the verge of losing money, the board had developed a strained relationship with the exiting CEO, and relationships with local providers were poor. Madden set out to find qualified leadership candidates and educate the board on how they would need to change their working relationship with the incumbent, if he or she were to be successful.

The priority was to identify health care leaders with the following attributes:

• A firm grasp on the future of health care and a vision for how Meeker Memorial could develop a strategy to provide the community with high-quality, sustainable care.
• The ability to collaborate with board members, government and community leaders, physicians, and the greater medical community on a common vision.
• Strong financial and operational experience to ensure financial viability.

In May 2002, Mike Schramm was hired as CEO. He had turned around a smaller hospital and clinic system in Sibley County, Minn., about 50 miles from Litchfield. Meeker Memorial was a larger hospital with a strong medical staff, which appealed to Schramm.

“Mark has very good political instincts, he had a good read on the operational challenges, and his insights prepared me well for the role,” Schramm says of his experience working with Madden. “I knew exactly what I was getting into, which is a tremendous benefit when you’re entering a new organization.”

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