AHA's Rural Podcast Series

00:00:00:18 - 00:00:10:16
Ashley Blake, D.O.
You have to love it. You have to love your job. You have to love your community. And really, it helps if you just think your feet in and embrace it.

00:00:10:19 - 00:00:32:28
Julia Resnick
Welcome back to Frontiers, a rural maternal health podcast series from the American Hospital Association. I'm your host, Julia Resnick. Voice you just heard was Dr. Ashley Blake, an OBGYN in Cynthiana, Kentucky. In our first episode, we heard from rural hospital leaders who made the choice to invest in maternal care and keep it close to home. But leadership alone isn't enough.

00:00:33:01 - 00:00:49:15
Julia Resnick
Even the most committed leaders can't sustain maternal care without the people to provide it. Today, we'll hear how rural hospitals are rethinking the maternal care workforce so that they are prepared to care for the next generation of rural families.

00:00:49:18 - 00:01:18:00
Julia Resnick
In rural communities, maternal care is deeply personal. Providers care for neighbors, coworkers, and oftentimes generations of the same families. Those relationships create a sense of purpose and connection. Many of the rural clinicians we spoke with chose rural medicine because of those relationships. At the top of this episode, you briefly heard from Dr. Ashley Blake, an OBGYN at Harrison Memorial, her hometown hospital.

00:01:18:02 - 00:01:20:09
Julia Resnick
Here's Dr. Blake.

00:01:20:12 - 00:01:43:02
Ashley Blake, D.O.
One of our labor nurses - I now see her sister, I see her mother in law, I see her cousins. They send pictures of me delivering her babies. They're three year-olds now that I delivered. Or color me pictures and bring me in gifts. You know, it's just like that is a reward and a benefit that no one like prepares you for how much of an impact it has.

00:01:43:07 - 00:01:54:21
Julia Resnick
In our first episode, you also heard from Jill White, chief nursing officer at Hutchinson Regional Medical Center in Kansas. She returned to her hometown to continue caring for the community that helped shape her.

00:01:54:24 - 00:02:19:13
Jill White
So I grew up here in Hutchinson, moved here at a very young age and spent my growing up years here through high school. I did move away, but quickly found that I missed it and wanted to move home and be back close to family. And as I've spent my adult years here, there's so much value in the size of the community that we are in raising a family here.

00:02:19:14 - 00:02:29:26
Jill White
I'm friends with people I work with, and we see each other, you know, outside of work, and there's so much to be said for that. It really is a big family.

00:02:29:28 - 00:02:40:13
Julia Resnick
If big families and relationships are what make rural medicine so rewarding, how do you help clinicians and training see the value of practicing in rural communities? Here's Dr. Blake again.

00:02:40:18 - 00:03:04:23
Ashley Blake, D.O.
I think that that is probably our biggest struggle, because all of the training takes place in these large cities that have targets, and they have Starbucks and they have malls and all the things that you need. And then you get your med school occurred there, your residency occurs there. And then the thought of going to somewhere without those things, I think, is sometimes hard for some physicians.

00:03:04:24 - 00:03:10:27
Ashley Blake, D.O.
The thing that makes it work the best is if you just plant your roots and, you know, embrace it and enjoy it.

00:03:11:00 - 00:03:26:10
Julia Resnick
But for rural hospitals to build a sustainable maternal health workforce, they have to create opportunities for students and trainees to experience rural practice firsthand. At Western Wisconsin Health, CEO Eilidh Peterson has made building that pipeline a strategic priority.

00:03:26:13 - 00:03:28:15
Eilidh Pederson
That pipeline starts at

00:03:28:15 - 00:03:57:27
Eilidh Pederson
different levels of training, so we do host rural residents. That's a wonderful opportunity to expose new physicians to rural medicine. We partner with all of our local colleges and universities to host midwifery students, to host medical students. And then recently, we've actually expanded the way in which we've hosted students to create that passion for rural medicine, namely obstetrical care.

00:03:57:27 - 00:04:22:10
Eilidh Pederson
So we do host high school students through our local scrub pumps. And then we started mentoring middle school students. We call it Mentored in Medicine. They are exposed to various careers in healthcare. And of course, we're going to talk to them about obstetrical care and the joys of entering into that practice. So we're starting early, but really through many channels and pipelines.

00:04:22:13 - 00:04:44:21
Julia Resnick
The future of rural maternal care is multidisciplinary teams where patients receive the right care from the right provider at the right time. For many rural hospitals, building that kind of team may be one of the most important strategies for sustaining maternal care into the future. Eilidh Peterson believes that diversity within the workforce has been one of the keys to strengthening maternal care at Western Wisconsin Health.

00:04:44:28 - 00:05:12:06
Eilidh Pederson
A diverse workforce has really been the number one solution for us. Not putting all of our eggs in one basket, but making sure that we have a number of different professionals for patients to choose from. To extend and expand our pipeline from where we can get qualified obstetrical providers has really been key. And a diverse workforce is really critical. For us

00:05:12:06 - 00:05:23:13
Eilidh Pederson
that looks like certified nurse midwives, obstetricians, family medicine with OB, and we'd love to hire our family medicine with OB and C-section.

00:05:23:15 - 00:05:51:07
Julia Resnick
One important member of that multidisciplinary team is the family physician with obstetrical training, often called an FMOB. In many rural communities, these physicians provide prenatal care, deliver babies including C-sections, and care for entire families, making them an important part of a sustainable workforce. Benjamin Anderson, CEO of Hutchinson Regional Medical Center, has become a strong advocate for expanding high quality training opportunities for FMOBs.

00:05:51:09 - 00:06:19:22
Benjamin Anderson
This is a passion point for me and I've seen the very best of full scope family medicine. There are a handful of residencies, maybe a dozen or two dozen residences in the United States that are consistently graduating board certified family physicians that are ready to do surgical OB. it's important to know the difference, and a lot of them are in training in what are called unopposed family medicine programs, where they're not competing against any other specialty for their numbers.

00:06:19:22 - 00:06:42:27
Benjamin Anderson
They're graduating with 200 deliveries and 101 hundred plus primary C-sections, where they are the surgeon, the primary surgeon on that. And so those are programs where there's a strong relationship between the OBGYN department and the family medicine residency. So they're getting that kind of exposure and that kind of direct, hands on experience. And so those are the ones from which we recruit.

00:06:42:27 - 00:07:02:21
Benjamin Anderson
And so there is a need to grow the number of unopposed family medicine slots in the United States. And there's some rural hospital transformation funds that are focusing on that to, to the program's credit. But those are the ones that it's really important to, to, to look at. We're looking for the Peyton Manning and Serena Williams of that. In Hutchinson

00:07:02:21 - 00:07:14:07
Benjamin Anderson
we're a larger community to accommodate full scope family medicine. But right on the right, right on the brink, we believe we have the capacity for and the volume to accommodate both.

00:07:14:09 - 00:07:38:25
Julia Resnick
Certified nurse midwives are another example of how rural hospitals are expanding the maternal care workforce. Working alongside physicians and nurses, certified nurse midwives provide prenatal, labor and delivery, post partum, and well woman care. Let's meet Samantha Crouch, a certified nurse midwife and director of the nurse midwifery program at University of Arkansas for Medical Sciences, also known as UAMS

00:07:38:27 - 00:07:40:16
Samantha Crouch, DNP
Midwifery care

00:07:40:19 - 00:07:42:01
Samantha Crouch, DNP
is, I mean, the

00:07:42:01 - 00:07:43:10
Samantha Crouch, DNP
reason that people are drawn

00:07:43:10 - 00:07:44:15
Samantha Crouch, DNP
To it,

00:07:44:15 - 00:08:14:26
Samantha Crouch, DNP
for a few different reasons. Really, the art of midwifery and the midwifery model of care, which places a really big emphasis on building trusting relationships within the health care provider and patient relationship. We spend a lot of time focusing on social determinants of health. And what's the holistic picture here for this patient? Not just checking in on mom and baby and what are the vital signs and what do the heart tones sound like.

00:08:14:27 - 00:08:51:26
Samantha Crouch, DNP
But really, how are you feeling about, you know, how is your partner feeling? What does your support system look like? What things are you nervous about? And really diving into some of the more emotional and psychological components of pregnancy. That really comes through for a lot of people and translates really well to rural health, because we do have a lot of specialized training in providing community based health care and providing continuity of care, which builds trust and builds partnerships and improves outcomes as well.

00:08:51:28 - 00:09:14:16
Julia Resnick
Recognizing the important role midwives can play, UAMS is investing in the next generation of the profession. This fall, they are launching the state's first publicly funded nurse midwifery education program to help address the growing need for maternal care providers and expand access to midwifery services across rural Arkansas, including many communities where midwifery services are not currently available.

00:09:14:19 - 00:09:57:27
Samantha Crouch, DNP
I have spent a lot of time looking into and kind of reflecting on as we've built is how to create better recruitment and better awareness about nurse midwifery as a career path in our areas across the state that don't currently have exposure to midwifery within the workforce. Trying to find ways where we can get certified nurse midwives practicing in some capacity, even just a day or two a week, so we can create exposure for the nurses and for the families of these rural communities, so that we can then recruit them into our program and send them back to their communities to practice.

00:09:58:00 - 00:10:11:22
Julia Resnick
The greatest impact comes when these professionals work together as a team. For Hutchinson Regional, building those connections across disciplines has transformed the way they deliver maternal care. Chief Nursing Officer Jill White shares more.

00:10:11:25 - 00:10:36:16
Jill White
OB itself can't sustain the health system. So how do we layer that to where you know someone who has that family med background, they can care for that entire life continuum, starting with OB and newborns, building that practice, building that relationship with their with their patients and families. And that really has had a huge impact in our delivery numbers as well.

00:10:36:19 - 00:10:41:02
(Dr. and Baby Background)
Okay. Next contraction. I think you're going to have a baby.

00:10:41:04 - 00:11:01:01
Jill White
We are on pace for over 100 more deliveries this year than we did even just last year, with onboarding of some new providers and working closely with the nurse midwives and getting them actual privileges to bring their patients on site. If they have that patient who, you know, can't deliver at the birth center, but they want their nurse midwife to follow them, great.

00:11:01:01 - 00:11:21:28
Jill White
We can do that here. The people that we serve are better the more that we serve. And so it's so important that we really maintain frequent touchpoints with patients like this, keeping those skills up, keeping our presence up. You know, it's so much about trust and relationship building in that patient population.

00:11:22:01 - 00:11:48:18
Julia Resnick
In low birth volume hospitals, providers may encounter obstetric emergencies less often than their colleagues in larger hospitals. That makes ongoing training, simulation, and peer learning especially important because every team needs opportunities to practice for the moments that matter most. Dartmouth Health partners with rural hospitals in northern New England to facilitate simulation drills. Emily Brayton, a perinatal outreach nurse, shares how that works.

00:11:48:20 - 00:11:52:15
Julia Resnick
You'll hear more about Dartmouth Health's work in the next episode.

00:11:52:18 - 00:12:28:27
Emily Brayton
Simulation and skills has been really beneficial to teams. We have one hospital in the North Country that has done a lot of work with a group at DHMC. We are teams that are kind of existing together, but we're not necessarily the same exact team. They are well supported, and so being able to go into that hospital and provide those teams with dedicated time with a neonatologist, and it really said it all with the people that showed up.

00:12:29:00 - 00:12:43:06
Emily Brayton
We didn't just have people who were there from their inpatient unit. We had all of the people who come and help when there's an emergency happening, regardless of whether it's happening on the OB side or with the baby.

00:12:43:08 - 00:13:09:21
Julia Resnick
Simulation is one way to maintain clinical skills. Another is creating opportunities for rural clinicians to spend time in higher volume settings, and then bring that experience back to their communities. At Banner Health that idea has become the rural OB pathways program. Here's Dr. Blake McLaughlin, an OBGYN and senior medical director of women's services at Banner Health. You'll also hear more from Dr. McLaughlin in the next episode.

00:13:09:24 - 00:13:36:27
Blake McLaughlin, D.O.
So something that we have done within Banner, we've created what's called the rural OB pathways program. And so what we do is we offer this program that folks can opt into where they will come from a rural facility like Paige, Arizona, or from Washakie, Wyoming, and they will come to one of our large volume facilities in Phoenix, and they'll spend seven, ten, 14 days embedded with that obstetrics team on labor and delivery.

00:13:36:27 - 00:14:06:06
Blake McLaughlin, D.O.
So they'll get high volume, high complexity of all of the things. But particularly they're focusing in on their optimization of their surgical skills and their obstetric skills. So we have had tremendous positive feedback from everyone involved in those experiences. Both for the physicians that are going and being embedded in that team, they're able to go back to their facilities and their communities that they came from, and they just have maintained that skill set and optimization.

00:14:06:08 - 00:14:17:14
Julia Resnick
Dr. McLaughlin believes that the same philosophy should begin during residency. Rather than asking clinicians to choose between urban and rural training, Banner is intentionally connecting the two.

00:14:17:16 - 00:14:38:12
Blake McLaughlin, D.O.
Those interns will spend their first year at the mothership there at the North Colorado Medical Center in Greeley, and they really get that foundational direction and education and training that they need. And then they'll go out to rural communities like our hospital in Sterling. So Sterling Regional Med Center, and they'll spend their last two years of their residency program embedded in that role community.

00:14:38:12 - 00:14:57:01
Blake McLaughlin, D.O.
And so they're really anchoring their heart, their mind, their attitude, their perspectives to rural medicine, but they're staying directly connected to that source program where they're getting that premier residency and fellowship equivalency training. Really ingrained them then, this connectedness.

00:14:57:03 - 00:15:27:08
Julia Resnick
Building a strong workforce is about creating a continuum of learning from early exposure and multidisciplinary teams to ongoing training and mentorship throughout a clinicians career. Together, these investments are helping ensure that role providers have the knowledge, skills and support they need to care for mothers and babies close to home. But no rural hospital can do it alone. Even the strongest workforce benefits from connection to colleagues to specialists, and to partners who can help expand what's possible.

00:15:27:10 - 00:15:52:03
Julia Resnick
That's where we'll go next. Join us for the final episode of Frontiers, as we explore how regional collaboration, digital tools, and new models of care are helping role communities strengthen maternal care for the future. This series is supported by the Commonwealth Fund, a national private foundation based in New York City that supports independent research on healthcare issues and makes grants to improve healthcare practice and policy.

00:15:52:10 - 00:15:59:10
Julia Resnick
The views presented here are those of the author and not necessarily those of the Commonwealth Fund, its directors, officers or staff.

00:00:19:07 - 00:00:44:25
Chris DeRienzo, M.D.
Hi, this is Dr. Chris DeRienzo, the chief physician executive of the American Hospital Association. Welcome back to Advancing Health. We've got a really interesting conversation today with a colleague of mine at Banner Health. Joining us on the podcast is Dr. Corey Casper. He's the senior vice president and chief research officer, the inaugural chief research officer at Banner Health and also a professor of medicine and clinical translational science.

00:00:44:25 - 00:01:02:21
Chris DeRienzo, M.D.
I had to try that one. I had to practice it a couple of times to get it right. Professor of medicine and clinical translational science at the University of Arizona. And we are very lucky to have him on the podcast today to talk about some of the interesting work they're doing to integrate research findings into a large community health system.

00:01:02:21 - 00:01:05:07
Chris DeRienzo, M.D.
Corey, thank you so much for being on the podcast.

00:01:05:13 - 00:01:10:14
Corey Casper, M.D.
What an incredible mouthful to begin with. But thank you for having me and I really look forward to our conversation.

00:01:10:19 - 00:01:28:21
Chris DeRienzo, M.D.
Well, you know, I think it would be helpful, for starters, to just help our listeners understand the arc that brought you out of what I might describe as a more traditional background in academic medicine into this unique partnership that Banner has with its academic partner at University of Arizona.

00:01:28:27 - 00:01:49:14
Corey Casper, M.D.
Yeah, thanks for asking that question. You know, there's a dirty secret, which is that every single healthcare worker working in the United States right now essentially has to come through an academic medical system to get to where they are. It's the way you become a health care worker. And so we all are very used to a very traditional academic medical system, and it works really well for lots of things.

00:01:49:15 - 00:02:23:27
Corey Casper, M.D.
I mean, it's incredibly the best in the world for training healthcare workers. It's exceptional at generating great research and often it's the source of amazing care. So when the model works well, it's incredible. I think what I was seeing in my career, after almost 25 years in a very traditional academic medical setting, is that there are increasing pressures and strains on that traditional model that make it more and more challenging to translate the incredible research that we're doing into teaching, and, more importantly, to every patient who needs to access care in this country.

00:02:23:28 - 00:02:38:13
Corey Casper, M.D.
You know, we're in such a golden age of research where research findings are accelerating and becoming so much more impactful, but getting them to every patient that needs them. And that's why I was so excited about the opportunity to join Banner as their first inaugural chief research officer.

00:02:38:14 - 00:02:52:07
Chris DeRienzo, M.D.
Let's build for a moment on what exactly does Banner look like? Many of our listeners might not be familiar with the reach of Banner as a health system, much less the nature of its partnership with your academic partner.

00:02:52:09 - 00:03:12:20
Corey Casper, M.D.
It's a great question. I wasn't familiar with all of the ins and outs of Banner either before joining about a year and a half ago. So Banner Health is an integrated healthcare delivery system, and we're one of the largest in the country. So we operate 33 hospitals, literally hundreds of clinics. We are the largest employer in the state of Arizona, employing over 65,000 individuals.

00:03:12:20 - 00:03:40:21
Corey Casper, M.D.
And we reinvest $1 billion a year back into our communities as a nonprofit healthcare delivery system. So it's a very large, very unique system that's run incredibly well. The way that we provide high quality care to so many people in so many areas, rural areas, urban areas, at our partner referral hospitals, you know, at our rural referral hospitals is through highly standardized, highly quality driven care.

00:03:40:24 - 00:04:05:09
Corey Casper, M.D.
You know, that is the hallmark of what we do at Banner, and that's all incredibly exciting. But what really attracted me as our chief research officer was kind of taking that next step. So, sure, we have 1.2 million patients under care. We have large health care system that is integrated with an insurance plan, as well as with ownership partly of Quest Labs in our region.

00:04:05:09 - 00:04:35:21
Corey Casper, M.D.
And so a truly integrated system of data that you could really begin to make some important observations using research about health outcomes and how to improve them. But what was really exciting too is some of the traditional partnerships that we've had for many years. So for over a decade, our academic partner has been the University of Arizona. So it's two colleges of medicine in Phoenix and Tucson are our partners in our delivery, and we oversee all of the clinical and translational research at the University of Arizona.

00:04:35:21 - 00:04:54:14
Corey Casper, M.D.
And we partner with them to deliver care and to train the next generation of healthcare workers. So it's an incredibly strong partnership. We're also, I think and I don't know this for sure, but I think we're one of the only, if not the only, large health care delivery system that's partnered with two NCI designated comprehensive cancer centers.

00:04:54:16 - 00:05:15:07
Corey Casper, M.D.
So the University of Arizona has a comprehensive cancer center in Tucson. And then we partner with MD Anderson in Houston to provide our cancer care in all regions other than Tucson. So it's an incredible embarrassment of riches that we have in terms of our partnerships. And that's really one of the things that hallmarks, you know, what makes us so successful.

00:05:15:09 - 00:05:48:04
Chris DeRienzo, M.D.
Well, let's build on those partnerships and to help our listeners understand, given the footprint that you've described, with a huge reach across 33 hospitals into the communities, but also this this fairly robust research pillar that you that you now lead. How are you bridging that gap from the discoveries that happen in labs, you know, at Banner. But all over the country, this bleeding edge of research with a community health system that is using your words, they're reaching 1.2 million patients a year.

00:05:48:04 - 00:05:55:03
Chris DeRienzo, M.D.
That is that is not a small gap. And my guess is the translational part of your title is exactly where that lives.

00:05:55:06 - 00:06:13:00
Corey Casper, M.D.
Yeah. Thanks so much. So there's three ways that I think we really try and address taking the research gains that we make and translating them to every single patient that we have. And I'll talk about these three ways and give you some examples because I think they're really quite exciting. So first and foremost our research is really focused or strategic.

00:06:13:00 - 00:06:37:18
Corey Casper, M.D.
So, you know, having been at the University of Washington, trained at the University of California, San Francisco, you know, went to medical school at Cornell, at New York Hospital. These are huge academic health systems that well, reputed and really do lots of things really well. I'm not saying that we don't, but for an organization that's primarily a healthcare delivery organization that also does some very good research, it's really important to focus.

00:06:37:18 - 00:06:57:04
Corey Casper, M.D.
So one of the first things that we really did was to think about where are those areas where we're making unique contributions and unique contributions within our region that really benefit our patients, but we can also learn from those patients. And so obviously, we operate our headquarters is in Phoenix, Arizona. We operate out of the southwest. Before coming to Phoenix

00:06:57:04 - 00:07:14:04
Corey Casper, M.D.
I often thought that, you know, Phoenix was sort of the home of some of the oldest people in the country, but that's actually not true. I learned that our median age is actually not that dissimilar from New York or other cities, but we do definitely have a bimodal distribution where we have many elderly people and many young people.

00:07:14:07 - 00:07:40:19
Corey Casper, M.D.
So a lot of our research is focused on diseases again in our patient population. So what are the diseases that are common that we focus on? We have a huge program in neurological diseases, especially memory and movement disorders because that's a huge problem in our region. As I mentioned, we have two large, you know, partnerships and a large research program in cancer because, you know, oncology is a critical portion of our part of the world. Cardiovascular disease,

00:07:40:19 - 00:08:04:22
Corey Casper, M.D.
so, you know, again, a disease that's often associated with aging, but structural heart disease, rhythm disorders and coronary heart disease. Fourth is our programs and orthopedics. Again, you know, our bones are what tend to fail us as we start to get older. And so we focus on how to keep them healthy and rehabilitate them when they're not. And then lastly, we have a very large program because of our breadth and transplantation.

00:08:04:22 - 00:08:22:21
Corey Casper, M.D.
And so how do we sort of make sure that these gains that we're making in transplantation are available to everyone? So first one way we just make sure that our research is getting to as many people as possible is we focus on the areas in our region and in those areas that we think can be applicable to the world.

00:08:22:25 - 00:08:43:18
Corey Casper, M.D.
The second way that we really do this is that we are laser focused, like our like, mission in the world right now is to think about the types of research that will change the practice of medicine. What we're really good at is protocolizing and standardizing the practice of medicine. So if we can define a best practice we can get that out there.

00:08:43:18 - 00:09:05:12
Corey Casper, M.D.
And so our research is laser focused on that. And I'll give you a couple of examples. So we have a preeminent Alzheimer's Institute, probably one of the best in the world. Scientists that are Alzheimer's Institute helped to develop one of the first blood tests to early detect Alzheimer's disease. We're very much, in part, developed and finalized or finished at Banner.

00:09:05:14 - 00:09:35:04
Corey Casper, M.D.
Terrific. Like wonderful that there's a blood test that's available. But what we then recognized is that still there's gaps in people's ability to get this test. So our researchers took it a step further. What if you could develop a device that would collect a small sample of blood at home and allow that blood to be shipped to a central laboratory where you can get a test for dementia that is as accurate right now as a spinal tap and as a, you know, MRIs that you used to need to get PET scans to diagnose Alzheimer's disease.

00:09:35:06 - 00:09:55:14
Corey Casper, M.D.
That test can now come to your home. So we've now allowed that test to go to people's homes in all sorts of rural parts of Arizona, and even a collaboration in rural parts in sub-Saharan Africa. So it's a great example of how we take technology, we develop new technology and make it fit for purpose. But more than that, we find a way to democratize it.

00:09:55:14 - 00:10:20:09
Corey Casper, M.D.
So we find a way to get that technology to every person who needs it. And I'll take that example one step further. We had a huge NIH grant to develop an imaging center where we actually developed some of the first ways PET scans to image people's brains, to look for dementia and other memory disorders. Fantastic. But very few people can travel to our quaternary care hospital, to our premier research clinic and get that test.

00:10:20:09 - 00:10:51:01
Corey Casper, M.D.
So what did we do? We worked with some other investigators in the Phoenix region from some of our collaborating institutions, and we came up with - it sounds crazy - but essentially behind a little RV, we were able to build this thing that kind of looks like a portable pizza oven, and it's a portable MRI machine. And this machine to rural communities throughout the southwest and offers people the ability to get scans, brain scans, to diagnose and to prevent deterioration in brain health.

00:10:51:01 - 00:11:00:15
Corey Casper, M.D.
So, again, a way that we're taking the research we've made at a sort of highly specialized referral center and making sure they're available to every person out there.

00:11:00:18 - 00:11:20:24
Chris DeRienzo, M.D.
And to me, these are examples that highlight exactly the connection we're trying to lift up. You know, there are only a handful of academic medical centers in America relative to the 6000, I think 51 at last count, total hospitals in the country. But I've seen this strength in community health systems of getting to execution. And in the communities they serve,

00:11:20:26 - 00:11:29:00
Chris DeRienzo, M.D.
what I'm hearing you describe is a model that really links the leading edge of research with the populations who can most need it.

00:11:29:01 - 00:11:30:08
Corey Casper, M.D.
That's exactly right.

00:11:30:09 - 00:11:33:26
Chris DeRienzo, M.D.
I want to make sure we get to your third. And so what's the third one?

00:11:34:02 - 00:11:55:25
Corey Casper, M.D.
Yeah. So the third thing that we're doing is we're trying to make sure that we can do this research as quickly and efficiently as possible. Now, why is that important? I mean, I'm sure, you know, with you doing the work that you do, you speak with a lot of people. And I'm sure you've heard a lot about all of the medical research now in the United States, funding cuts, changes in priorities, changes in the regulatory landscape.

00:11:55:26 - 00:12:18:07
Corey Casper, M.D.
It is not an easy road to navigate right now. But one thing that is really clear is that given all of those uncertainties and given the challenges, you need to have a laser like focus on the research that you do and you need to do it efficiently. What we've done is we've really established a new program to rapidly open clinical trials and have them available to our to our patients.

00:12:18:08 - 00:12:39:00
Corey Casper, M.D.
We are working towards a goal of getting new clinical trials open within 40 days of being approached by a sponsor. Like, that's incredible. Like, if we can do that, and we're making, you know, we've already reduced the time to activating a clinical trial at Banner fourfold. So we're making huge strides towards that. But it's such a simple example of something that we take for granted,

00:12:39:01 - 00:13:05:20
Corey Casper, M.D.
right? Like if, if our value proposition in the world as being a, you know, a health system with a strong academic partner and doing academic clinical research, if that's our value proposition, then we've got to get these studies to the patients who need them by doing them quickly and by doing them as distributably as possible. So right now, our research, we don't just do at our primary quaternary referral hospitals, we do them across our network.

00:13:05:20 - 00:13:22:14
Corey Casper, M.D.
So if you're in Northern Colorado and you're at one of our more rural sites, you have that same access that someone in downtown Phoenix has. And so to us, that's a model of research that we feel like truly will be able to bring the gains that we're making in medical research now to every patient and needs them.

00:13:22:16 - 00:13:45:06
Chris DeRienzo, M.D.
Corey, this has been a spectacular conversation. If I could read back what I'm hearing, I think your combination of focus, of depth and of reach is really what's driving this translation of research out into the 1.2 million patient community who you serve at Banner. Again, most folks on our podcast or listening to our podcast aren't going to be based in an AMC.

00:13:45:06 - 00:14:12:08
Chris DeRienzo, M.D.
So my last question for you. We've only got about a minute or two left, and I'd love to ask it of everybody who I get to interview for our show is if you had one thing that you would hope our listeners take away that they can bring back to possibly their rural hospital in Mississippi or in western Oregon and say, I want to help my home get better at translating this cutting edge research to reach my communities.

00:14:12:08 - 00:14:19:02
Chris DeRienzo, M.D.
What guidance would you give them? What first step should they take after they finish listening to our conversation?

00:14:19:04 - 00:14:43:24
Corey Casper, M.D.
Such a great question. I mean, I have an easy answer to that. I think we overcomplicate research, right? We think about it as a as a highly falutin academic exercise that is often frustrating and inaccessible to many. But research is simply the process of sitting at the bedside, recognizing a question that's important, and asking the question in a way that's answerable, measurable, and impactful.

00:14:43:26 - 00:15:08:10
Corey Casper, M.D.
If your eyes are open, if you see the problems that you're confronting at your health center, no matter how big or how small, single bed, clinic, hospital, tiny clinic, whatever it is, find a way to ask and answer those questions because it'll be to the benefit of your patients. And there's lots of people out there, whether they're at large academic medical centers or whether it community networks like ours that are there to partner with you.

00:15:08:10 - 00:15:22:13
Corey Casper, M.D.
So keep your eyes open. Look for those questions that present to us every day as clinicians. Ask those questions and find ways to answer them efficiently, impactfully. Because all of our patients and all the world will benefit from it.

00:15:22:15 - 00:15:28:28
Chris DeRienzo, M.D.
Corey, thank you so much for joining the podcast. Listeners, thank you for tuning in. This has been a lot of fun.

00:15:29:01 - 00:15:37:24
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:20:09 - 00:00:26:08
Eilidh Pederson
There's one way we all come into this world.

00:00:26:10 - 00:00:46:18
Eilidh Pederson
And the safest and best way to do that is in hospital. And so it is so important that we preserve rural obstetrical care. For us, it's not just been about preserving, it's been about growing and thriving. And to do the right thing in the face of adversity.

00:00:46:20 - 00:01:13:14
Julia Resnick
You just heard from Eilidh Pederson, CEO of Western Wisconsin Health, a critical access hospital in Baldwin, Wisconsin. It's an agricultural community with three stoplights, where a traffic jam means you're waiting behind an Amish buggy. In just the past few years, six hospitals in her region have closed their labor and delivery departments. Workforce shortages, financial pressures and declining birth volumes have created extraordinary challenges for rural hospitals.

00:01:13:16 - 00:01:36:07
Julia Resnick
We set out to better understand how rural hospitals are sustaining maternal care in the face of these challenges. Again and again, we heard the same message. For rural hospital leaders, maternal care is more than a service line. It's a commitment to the families they serve and an investment in the future of their communities. Welcome to Frontiers, a new podcast series from the American Hospital Association.

00:01:36:08 - 00:02:00:09
Julia Resnick
I'm your host, Julia Resnick. Throughout this series, we'll explore how rural hospitals across the country are working to sustain maternal care in their communities through committed leadership, workforce innovation, and regional collaboration. Our story begins with the leaders who make the choice to invest in maternal care. Even when the path forward isn't easy.

00:02:00:12 - 00:02:28:08
Julia Resnick
When we talk about rural America, it's easy to picture a single kind of place. But rural communities are incredibly diverse. Some are surrounded by farmland, others by mountains, deserts, rivers, or forests. They vary in size, geography, and the opportunities and challenges they face. Before we explore the future of rural maternal care, let's take a moment to meet some of the communities at the heart of this story.

00:02:28:14 - 00:02:37:04
Julia Resnick
We'll start in upstate New York with Sinéad Ingersoll, chief operating officer of Canton Potsdam Hospital in the Saint Lawrence region of Rochester Regional health.

00:02:37:07 - 00:02:41:00
Sinéad Ingersoll
The Saint Lawrence County is the largest, most geographically

00:02:41:00 - 00:03:12:25
Sinéad Ingersoll
isolated county in New York State. We're 30 minutes from the border. We are by two to 2.5 hours away from the nearest highest level of care - tertiary care - that's either going into Vermont or south to Syracuse. We are the main provider of health care services in this broader community. There's about 110,000 people that live in this county, and they are scattered throughout this huge county, which also presents as you can imagine, unique challenges and very harsh winters, kind of want to throw that in there as well.

00:03:12:25 - 00:03:15:16
Sinéad Ingersoll
So we get a lot of snow up here.

00:03:15:19 - 00:03:29:09
Julia Resnick
Next, we'll head to the heart of the Sunflower State, Kansas. I spoke with two leaders from Smith County Memorial Hospital: Sarah Ragsdale, the CEO, and Laken Lyon, the chief nursing officer. Here's Lakin.

00:03:29:12 - 00:03:30:02
Lakin Lyon
We are

00:03:30:03 - 00:03:46:28
Lakin Lyon
in the middle of nowhere. We're 12 miles from the center of the contiguous 48 states. We're a rural community. We're out in the middle of an OB desert. We don't have a lot of facilities around us that deliver anymore.

00:03:47:04 - 00:03:47:13
Lakin Lyon
And

00:03:47:13 - 00:04:00:15
Lakin Lyon
some of that has been recent changes. So it's at least one hour of travel time to the nearest OB facility from us in any direction that you go.

00:04:00:18 - 00:04:04:16
Julia Resnick
Here's Sarah Ragsdale, CEO of Smith County Memorial Hospital.

00:04:04:19 - 00:04:08:12
Sarah Ragsdale
Critical Access Hospital here where we labor, deliver and

00:04:08:12 - 00:04:10:21
Sarah Ragsdale
do postpartum all in one room.

00:04:10:24 - 00:04:11:10
Sarah Ragsdale
We're very

00:04:11:10 - 00:04:22:04
Sarah Ragsdale
patient-centered here. You feel like if we didn't have that, those maternity services here, that we may lose the families coming to our rural health clinic.

00:04:22:07 - 00:04:34:03
Julia Resnick
One thing you'll hear from leaders across rural America is how deeply connected they are to the communities they serve. This is Dr. Ashley Blake, an ob/gyn at Harrison Memorial Hospital in Kentucky.

00:04:34:06 - 00:04:59:20
Ashley Blake, D.O.
I live in central Kentucky in a small community, Salvia, Kentucky. We do around 200 deliveries a year. Sometimes we get to the 250 mark, and sometimes we're right below the 200 mark. Salvia is a very small community. We all went to school together. We all know your grandmother and your children and your siblings. All of our children play ball together.

00:04:59:20 - 00:05:15:10
Ashley Blake, D.O.
So we work together, and we also go to the ballparks together and support our kids together. Our kids play on the same very small travel soccer or softball or baseball community. We all go to church together. It's a very, very small community.

00:05:15:13 - 00:05:37:08
Julia Resnick
While these communities may differ. One thing is remarkably consistent. In many places, the local hospital has cared for generations of the same families and is woven into the fabric of community life. That sense of connection shapes the decisions hospitals make. Across the country, leaders are committed to ensuring families can welcome a child into the world safely and close to home.

00:05:37:09 - 00:05:46:06
Julia Resnick
And that commitment starts at the top with hospital executives and governing boards. Here's Eilidh Pederson again from Western Wisconsin Health.

00:05:46:08 - 00:05:49:07
Eilidh Pederson
A hospital really has to make a decision

00:05:49:08 - 00:05:51:04
Eilidh Pederson
on where you're going to put

00:05:51:04 - 00:05:53:24
Eilidh Pederson
your funding and your priorities.

00:05:53:24 - 00:06:00:28
Eilidh Pederson
And at our hospital, we said, if we're going to be here for our community, truly from the start,

00:06:00:28 - 00:06:01:14
Eilidh Pederson
it

00:06:01:14 - 00:06:27:03
Eilidh Pederson
means we have to make obstetrical care a pillar and a foundational element in our hospital operations. And for us, that starts with our board of directors. They have helped us at the Foundation for we are going to provide obstetrical care. We're going to do it well. And to do that, we're going to put funding in place. We're going to ensure safe staffing.

00:06:27:10 - 00:06:49:15
Eilidh Pederson
We're going to ensure that we have all of the resources and equipment that we need to do this to the best of our ability. And so that's where it's really started, is at the board and indicating to everyone out there that obstetrical care is worth fighting for. And to do that well you must make it a priority.

00:06:49:18 - 00:07:11:20
Julia Resnick
For many rural hospital leaders, sustaining maternal care comes down to a choice. When Benjamin Anderson became CEO of Hutchinson Regional Medical Center, the organization was at a crossroads. Rather than scale back, he and his leadership team made the decision to invest in and strengthen maternal care. Here's Benjamin and Chief Nursing Officer Jill White describing why they chose that path.

00:07:11:24 - 00:07:15:19
Julia Resnick
You'll hear more of their story in our next episode.

00:07:15:21 - 00:07:33:14
Benjamin Anderson
At Hutchinson our obstetrics program...go from 800 plus deliveries a year down to 270 last year. We'd seen a lot of outmigration around OB. We had to decide, are we going to do this? Because if we're going to do it we need to do it well, and if we're going to do it well, we need to do it often. And we've got to double down and invest

00:07:33:14 - 00:07:54:24
Benjamin Anderson
and so rather than saying how much money can we make through this service line, we say, because we've already decided we're going to do it well, how do we sustain it? But the moral decision, ethical decision was already made and then we back in from there. And so it's important because birth rates are important. It's important because it's connected to community growth and health.

00:07:54:25 - 00:08:02:04
Benjamin Anderson
It's important because moms are important. We all have a mom. And it's important because through mothers we connect with everyone else in the community.

00:08:02:07 - 00:08:21:01
Jill White
If women don't have that place that they can start that healthcare journey for their families, they'll seek it elsewhere and they may lose it. You know, they're not going to return back for maybe family care or pediatrics or where are they going to refer their mom or their dad or sister or whoever it might be in their family that needs care.

00:08:21:01 - 00:08:35:07
Jill White
It's going to be wherever they've established and had that great interaction and relationship. And so it really is a very foundational stepping block for what you build an entire health care system and really community off of is those young families.

00:08:35:09 - 00:08:51:25
Julia Resnick
Sustaining maternal care takes more than financial investment or clinical expertise. It takes leaders who are willing to champion it. Not just within their own hospitals, but across the communities in rural America. Let's hear from Sinéad Ingersoll again. It's not just a service.

00:08:51:27 - 00:08:52:26
Sinéad Ingersoll
You know,

00:08:52:28 - 00:08:53:22
Sinéad Ingersoll
women's health

00:08:53:22 - 00:08:54:07
Sinéad Ingersoll
is really

00:08:54:07 - 00:09:00:02
Sinéad Ingersoll
essential to the survival of your community. If families don't feel safe delivering locally,

00:09:00:09 - 00:09:00:22
Sinéad Ingersoll
they may

00:09:00:22 - 00:09:01:16
Sinéad Ingersoll
not stay.

00:09:01:18 - 00:09:28:26
Sinéad Ingersoll
And, you know, it requires really intentional investment even when your volumes are low. Strong, team based care models, I think are really important. But it also means looking beyond maternal care like I just talked about and looking at that full women's health journey from preventative care to behavioral health to chronic disease management. You know, pregnancy is just one moment in that continuum.

00:09:28:28 - 00:09:40:01
Julia Resnick
Eilidh Pederson also speaks to how rural healthcare leaders can balance strategy with advocacy, making thoughtful decisions for their organizations while championing maternal care for their communities.

00:09:40:03 - 00:10:02:03
Eilidh Pederson
It's important that we think about obstetrical care in a different way. What does that mean for your region? What does that mean for care for the entire family? So often where you have your baby is where you will make your medical home. It's where you're seen for your prenatal care, where you'll have your lab work done, your imaging studies, surgeries down the road.

00:10:02:03 - 00:10:29:00
Eilidh Pederson
So it's truly a front door moment. So administrators to think about obstetrics care not just as a financial loss on the balance sheet, but what does it really mean for your region and for the hospital as a whole? Number two is advocacy work. As hospital administrators, I believe it is our duty to fight for the right things, to be the voice of those who don't have a voice.

00:10:29:00 - 00:10:55:03
Eilidh Pederson
And to do that in the space of obstetrical care, we must advocate. We must have conversations like this to bring awareness. We must speak with our lawmakers. We must speak with insurance companies and payers to bring about reimbursement reform. Because at the end of the day, that's what's needed. And then the third thing is to set up an infrastructure for obstetrical care, where the number one priority is quality.

00:10:55:06 - 00:11:19:07
Eilidh Pederson

This is a very risky specialty. There are deep clinical concerns that can come with having a baby, and it's our role as administrators to ensure that the team is as well prepared as they can be, that they can train where they fight, so to speak, and that they can practice as often as they can those maneuvers that bring about healthy outcomes.

00:11:19:09 - 00:11:39:04
Julia Resnick
After listening to these leaders, one thing becomes clear. The decision to sustain maternal care is about so much more than keeping a service open. It's about investing in families, strengthening communities, and ensuring that the next generation has the opportunity to grow and thrive close to home. Here's Sarah Ragsdale from Smith Center, Kansas.

00:11:39:07 - 00:12:02:03
Sarah Ragsdale
It shows thriving and growing communities, and it just shows sustainability across the system. You know, we're all here to take good care of people. We want to keep access local, and the more services we offer shows that we're a thriving facility and thriving community. All goes back to just giving back.

00:12:02:06 - 00:12:15:03
Julia Resnick
Which raises an important question what is at stake, not just for patients and families, for the future of rural communities if this care disappears? Here's Sinéad Ingersoll again.

00:12:15:06 - 00:12:34:18
Sinéad Ingersoll
So you know what would be lost? It's kind of hard to even articulate that. You know, when you think about women's health and I always think about people talk about, you know, OB services, maternal health, I think about women's health as  a continuum. It's a journey. And you know, it's not just access that will be lost, right?

00:12:34:19 - 00:13:01:24
Jill White
It's trust. It's safety. It's the ability for families to build their lives here. You know, we have four colleges that are within a ten mile radius of this little community. We need to have strong, high quality services to attract folks to move to this area, to want to stay in this area. And so, you know, this really our whole community hinges in my opinion on our ability to safely provide these services.

00:13:01:26 - 00:13:10:28
Julia Resnick
The challenges are real, but so are the opportunities. Here are Sinéad and Eilidh on why they are optimistic about the future of rural maternal care.

00:13:11:01 - 00:13:29:09
Sinéad Ingersoll
What gives me most hope is the people you know, rural teams are incredibly resilient. They're deeply committed to their communities. And rural health care has always been very resourceful. And I think now we're becoming resource enabled. And that's where I think you could really see real transformation happen.

00:13:29:12 - 00:13:54:03
Eilidh Pederson
It takes all of us fighting for the same thing, really working from the same playbook. And that's what the rural Wisconsin hospitals have done. We've seen great success to date, and I'm excited about what the future holds. There are about 50 rural hospitals in the state of Wisconsin, and we are all working together on quality outcomes, on reimbursement reform and workforce enhancement.

00:13:54:06 - 00:14:16:27
Julia Resnick
At the heart of these stories is a simple idea. Rural maternal care does not happen by accident. It happens because leaders choose to prioritize it. They make that choice because they understand what is at stake, not just for their hospitals, but for the families and communities they serve. The leadership commitment must be backed by the people who make maternal care possible -

00:14:17:02 - 00:14:43:12
Julia Resnick
skilled care teams who support patients throughout pregnancy, labor, delivery and postpartum. Join us for the next episode of Frontiers for a look at how rural hospitals are strengthening their workforce and creating new pathways to ensure maternal care is available for generations to come. This series is supported by the Commonwealth Fund, a national private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy.

00:14:43:19 - 00:14:50:18
Julia Resnick
The views presented here are those of the author and not necessarily those of the Commonwealth Fund; its directors, officers or staff.

00;00;00;08 - 00;00;20;01
Tom Haederle
Welcome to Advancing Health. It's now been one year since Congress allocated $50 billion aimed at upgrading and expanding access to health care in America's rural communities. So, is the funding making a difference? What can rural residents expect? We explore these questions and more in today's podcast.

00;00;20;04 - 00;00;38;13
Shannon Wu
Hi everyone! My name is Shannon Wu. I am a director of payment policy here at the American Hospital Association. On this episode, we're going to talk about something very near and dear to my heart, the Rural Health Transformation Program Fund. As of this taping in June 2026, we are a little bit more than halfway through the first year,

00;00;38;18 - 00;01;02;25
Shannon Wu
where about $10 billion will be awarded to all 50 states. We thought it'd be a good time to talk about how the program is going, and what policymakers can do to further support rural communities. So with that, I'm really happy to introduce my fellow podcaster, Maya Sandalow from the Bipartisan Policy Center, joining me today to talk about everything Rural Health Transformation Fund related.

00;01;02;26 - 00;01;22;21
Shannon Wu
Maya is an associate director for BPC’s Health Program, where she leads work on health innovation policy. Her portfolio includes digital health, artificial intelligence, rural health, behavioral health, and nutrition. So with that, Maya, would you mind just describing a little bit more about the center and the work that you all do there?

00;01;22;23 - 00;01;44;24
Maya Sandalow
Thanks so much, Shannon. It's great to be with you today, and I'm so glad to be talking about the Rural Health Transformation Program. As you mentioned, I work at the Bipartisan Policy Center, and we're a nonprofit that's been around since the start of the 2000s, founded by former Senate majority leaders. And we work across the full political spectrum on domestic policy issues.

00;01;44;24 - 00;02;08;07
Maya Sandalow
So we aim to bring together diverse perspectives to craft solutions focused on lowering the everyday cost of living for families, expanding opportunities and strengthening the American economy. And we have a pretty robust health program that focuses on a range of topics, including rural health care, which is an area that we focused on for years, because one in five Americans live in rural areas.

00;02;08;07 - 00;02;12;27
Maya Sandalow
And so therefore, it's important to make sure that they can access the care that they need.

00;02;13;00 - 00;02;40;09
Shannon Wu
So we're really happy to have you here. Before I let you describe some of the key initiatives each of the 50 states are undertaking — I know you all have done a lot of work in that in the past couple of months — I'm just going to briefly describe the basic structure of the Fund for our listeners. So the basic structure of the Fund is that all 50 states had to apply for this funding, of which half of that $50 billion will be equally given to every state that applies.

00;02;40;09 - 00;03;02;24
Shannon Wu
And the other half is based on an application process the states went through at the end of last year in 2025. The program will run for five years, and the application process, as I mentioned, began at the end of last year. And the Centers for Medicare and Medicaid Services, which is the agency tasked for administering the fund, announced those awards the end of the year in 2025.

00;03;02;26 - 00;03;23;14
Shannon Wu
The Bipartisan Policy Center and the AHA have put out excellent primers on the notice of funding opportunity, if our listeners want to learn a little bit more about that application process, and you can find both of those primers on our websites. So, that's kind of the basic structure of the Fund. We’re into year one of the program now.

00;03;23;16 - 00;03;46;00
Shannon Wu
So Maya, I know the Center has done a lot of work in analyzing the applications, the key initiatives and projects that states have applied for. Do you want to talk a little bit more about, you know, kind of the broad programs each of the states have applied for, and then one or two key programs that you and the Center is focused on diving into a little bit further.

00;03;46;02 - 00;04;16;19
Maya Sandalow
Yeah, absolutely. And just to pick up on kind of the broad overview of the Fund, I think that it's important to note that CMS has a stated goal for the use of these funds to really transform healthcare delivery, right. So this $50 billion program was included in last year's reconciliation package, largely in response to concerns about federal Medicaid funding cuts in the years ahead and the impact on rural areas.

00;04;16;19 - 00;05;02;12
Maya Sandalow
But the Fund itself isn't necessarily intended or designed to directly replace those funding cuts to providers. Rather, it's focused on broader healthcare transformation. So CMS has a variety of strategic goals, including addressing the root causes of disease, investing in technology innovation, workforce development, value-based care. They really outline several strategic goals. And so what my organization BPC did was we reviewed all 50 state plans, state proposals, that they put together as part of their application process in the fall, to try to pull out some common themes and look at really across these strategic priorities that CMS has outlined.

00;05;02;14 - 00;05;32;15
Maya Sandalow
Where are states really committed to investments? The level of detail varied widely in their state applications. But that said, we were able to discern that every single state plans to invest in technology and workforce in some way. So those are really two of the biggest themes that we picked up on. And we outlined specific categories of how they plan to invest in technology and workforce in several publications.

00;05;32;15 - 00;05;35;16
Maya Sandalow
So I'm happy to walk through the details of those, if helpful.

00;05;35;19 - 00;06;05;16
Shannon Wu
That'd be great. I know on the topic of workforce, especially, for example, you know, the AHA believes that the needs of rural providers and rural communities and rural hospitals are really fundamental, and one key initiative and support that we're really looking for is a workforce development, both in recruitment and retention of current workforce, but also really building that pipeline out to make sure that access to care in rural communities is maintained and even expanded.

00;06;05;16 - 00;06;18;17
Shannon Wu
And so we really strongly believe that the funds should really prioritize these fundamental priorities in rural communities. So I would love to hear from you, the workforce type of initiatives that you are seeing in these state applications.

00;06;18;23 - 00;06;41;09
Maya Sandalow
Yeah, absolutely. Workforce is a central priority of the states, and to your point, it's no surprise, right? Because the rural areas have long suffered from workforce shortages and providers who are fantastic but really stretched thin. So we identified broadly three ways in which states are planning to invest in workforce development and workforce issues. The first is training and bringing along new providers.

00;06;41;09 - 00;07;13;26
Maya Sandalow
So the pipeline piece that you mentioned, and that's from a pretty young age, we see some states investing in healthcare training at the high school level. We see some states investing in medical school. So Delaware, for example, is proposing the state's first ever four-year medical program. Also, investments in new rural residency programs. And then many states focused on how can we retain those new providers through things like housing bonuses and incentive structures?

00;07;13;27 - 00;07;43;21
Maya Sandalow
That whole bucket a lot of that is subject to a five-year service requirement. So every investment that's tied to an individual and leads to a credential or a degree of some type, based on CMS's requirement, those individuals are required to stay in that rural area for a minimum of five years. The second category that we kind of pulled out is upskilling and building the infrastructure needed to sustain the existing workforce, right?

00;07;43;22 - 00;08;14;19
Maya Sandalow
So that's everything from training providers who are stretched thin. They may not have the time or the resources to really ensure that they're kind of practicing at the top of their license. So investing in training for those providers, things like how to use telehealth, or like robotics and surgery, right. So various types of training initiatives. Also, states focused on closing the data gap so that they have the information that they need to know where are their workforce shortages, so that they can kind of allocate resources efficiently.

00;08;14;19 - 00;08;43;12
Maya Sandalow
And then also lots of focus on non-clinician workers right. So community health workers, peer support specialists. These really important workers making sure that they're reimbursed adequately. And I'll just say the third theme that we pulled out relates to policy actions. So through the Rural Health Transformation Program, states received points in the potential for more funding if they commit to certain types of policy actions. Two with a lot of relevance for workforce are interstate licensure.

00;08;43;17 - 00;09;06;00
Maya Sandalow
By default, providers have to be licensed in the state that the patient is, in order to deliver care, but states can join what are called interstate licensure compacts, which makes it easier for providers to practice in other states. And so states are incentivized and some states are committing to joining interstate licensure compacts through the Rural Health Transformation Program.

00;09;06;01 - 00;09;25;15
Maya Sandalow
And then the second policy piece is scope of practice. right? So that relates to what healthcare workers are allowed to do based on their state medical licensing board requirements. So some states are proposing to, for example, expand what pharmacists or nurse practitioners or physician assistants can do with their funds.

00;09;25;15 - 00;09;51;21
Shannon Wu
And I know another piece of some key programs and initiatives that I think all 50 states applied for, as well is related to technology, whether it's AI, whether it's telehealth. I also know that the Center has put out some great primers on the projects and initiatives states have applied for in that regard. Do you want to talk a little bit about what you all are seeing across the states, in some key themes that are coming out from that bucket of funding?

00;09;51;27 - 00;10;26;00
Maya Sandalow
Yeah, technology investment is a really big focus across all 50 states. We identified four broad categories. So the first is states investing in the foundational health IT infrastructure that's needed as kind of a prerequisite for broader transformation. And that's really important, right? So modern healthcare really runs on data, but right now rural facilities might not necessarily have the resources that they need to make sure that the data of a patient is moving with them when they, for example, see a specialist in another town.

00;10;26;00 - 00;10;49;29
Maya Sandalow
And that can lead to duplicative tests and unnecessary care. So states are investing in that foundational infrastructure. Also in that category, cybersecurity readiness. We know that rural healthcare facilities have been subject to cyberattacks in recent years. So states are investing in kind of ensuring that healthcare facilities are prepared for potential cyber. That first bucket is really foundational.

00;10;49;29 - 00;11;11;26
Maya Sandalow
We also see states investing in expanding access to digital health, things like telehealth and remote patient monitoring. Patients in rural areas tend to live pretty far from providers, have to travel really long to get the care that they need. So you can imagine this telehealth and patient monitoring being really valuable for patients, but rural areas tend to have less access.

00;11;11;26 - 00;11;44;07
Maya Sandalow
So states are focused on closing that gap. One story that really illustrates the potential here. I talked to a patient named David last year, and he's in his mid-80s and he lives in rural North Carolina. And he really credits his remote patient monitoring program with keeping him out of the hospital consistently. Like every morning he checks his blood pressure, he uses a weight scale, and his data is automatically sent to a remote healthcare provider who, if there's something out of range, can call him, adjust his medications.

00;11;44;07 - 00;12;12;28
Maya Sandalow
So there's really a lot of potential here for it to help patients health and also save money. The third bucket is artificial intelligence, which everybody is talking about right now. Same story here. Rural areas tend to have less access to AI. You know, AI is long been used in areas like medical imaging. Increasingly it's used a ton in clinical documentation, which can help to reduce burnout and kind of administrative burden on rural areas.

00;12;13;04 - 00;12;39;07
Maya Sandalow
Then the fourth and final category that we pulled out are something called rural technology catalyst funds. And these are created by the Rural Health Transformation Program. States are allowed to invest up to 10% of their money into this. And it's really meant to be a catalyst for innovation. So states partner with external entities. So maybe a startup incubator to vet technology proposals.

00;12;39;07 - 00;12;51;25
Maya Sandalow
And then those external entities can also bring in outside capital, so it's a way to combine public investment with private investment. So that fourth bucket is definitely something to keep an eye out for.

00;12;51;27 - 00;13;16;06
Shannon Wu
That really runs the spectrum of kind of the core infrastructure needs of setting up health IT. You know, for us, we tend to think of kind of the broadband needs of rural communities, right, kind of having that initial infrastructure. But now you also describe the fourth bucket in terms of really innovative care using drones, etc. So this will be a really interesting, I think, bucket of funding to see what states do.

00;13;16;09 - 00;13;56;27
Shannon Wu
Well, I know that, you know, with this funding, as we said before it's a five-year program. The AHA and BPC have suggested to policymakers other initiatives and models of care for rural communities. You know, that this funding could use, but also beyond the scope of this Transformation Fund, right? So for us, for the AHA we publish our Rural Advocacy Agenda every year at the beginning of the year, which our listeners can find on our website. For this year, in addition to understanding and seeing where the progress of this Transformation Fund is going, one of our main focus is also holding commercial insurer actions accountable so that patients have timely access to care.

00;13;56;27 - 00;14;23;22
Shannon Wu
And these actions include prior authorization denials for patient care, delayed payments to providers, among other actions used by commercial insurers. I'm curious, does the BPC have any particular recommendations or policy that you are thinking about now or in the future, that's really aimed at ensuring that access to care in rural communities is maintained or expanded on? We would love to hear kind of what you all are thinking in this space as well.

00;14;23;25 - 00;14;51;20
Maya Sandalow
Yeah, absolutely critically important, and we are focused on a lot of the same areas that AHA is. We're coming out with an issue brief in the next month that will really elevate federal bipartisan policy priorities to bolster rural healthcare. And that will include really re-upping recommendations that have existed for a long time, as well as some new ones, to help to kind of sustain and maximize the investments of the Rural Health Transformation Program.

00;14;51;22 - 00;15;15;07
Maya Sandalow
There's going to be a lot of recommendations in that. I'll highlight two. Both relate to Medicare funding, because Medicare is really a primary payer for many rural hospitals and rural health care facilities. So the first one that I'll talk about is something called Medicare rural hospital designations. Those are extra funds that are given to hospitals with low volume in geographically-isolated areas.

00;15;15;07 - 00;15;40;25
Maya Sandalow
And there's a really strong track record for a lot of these programs and incentive designations. Yet, several of them lack permanent authorization. And so Congress has extended them year after year. And that makes it harder for providers to really have the security to be able to invest in kind of supports for their hospital and know that there's going to be financial stability over time,

00;15;40;25 - 00;16;11;09
Maya Sandalow
so we think that those should be made permanent. And then another thing that we think should be made permanent is access to telehealth and telehealth funding through Medicare, right? Telehealth is a fixture in the U.S. healthcare system at this point, yet Medicare payment for most of telehealth relies on temporary extensions. And we saw the repercussions of that this fall when there was a government shutdown, actually. Authority for Medicare financing for telehealth lapsed,

00;16;11;10 - 00;16;23;08
Maya Sandalow
right? And so this is a big barrier to long-term investment in the telehealth infrastructure is the need for these temporary extensions. So we call for permanency on that as well.

00;16;23;11 - 00;16;47;15
Shannon Wu
We really appreciate those recommendations. We support all that and especially on the Medicare-dependent designations and low volume, I think that's been a long -standing AHA policy as well, making those permanent, because we do hear from our members that having that security in payments, in these really geographically-isolated and Medicare-dependent hospitals, it really makes a big difference.

00;16;47;15 - 00;17;12;14
Shannon Wu
So we appreciate all the work that you all are doing to spearhead all that as well. Maya, we really appreciate you, appreciate your time and coming on to the podcast and of course, efforts from the Center and supporting rural communities. I know you all are hosting a virtual event coming up this month, right on the Transformation Fund? So do you want to give our listeners a little bit of detail on how to sign up for that, and what you guys will be talking about during that virtual event?

00;17;12;19 - 00;17;40;26
Maya Sandalow
Yeah, absolutely. Thank you for highlighting that. So BPC will be hosting a webinar on June 30th. You can go to our Events page at bipartisanpolicy.org to sign up. And we're going to bring in some experts that represent different state perspectives and can kind of speak to implementation, transparency, sustainability, some of the key questions that experts are raising when it comes to the Rural Health Transformation Program.

00;17;40;26 - 00;17;59;23
Maya Sandalow
And then we'll also outline some of the key themes that we've picked up as we reviewed all the state plans and give a preview to some of those federal policy recommendations, that are important for sustaining access to rural healthcare. So definitely tune in. We've got lots of great experts joining that event.

00;17;59;28 - 00;18;24;20
Shannon Wu
That's great. I'll definitely be tuning in. I know we're really looking forward into how that transparency piece is going to play out for the Fund and knowing where the funds are going, how they're being awarded, where they're being used. We really are looking into that as well. So, as the Fund continues into years two through three through four through five, we'd love to have you back on other episode of the podcast.

00;18;24;21 - 00;18;43;06
Shannon Wu
Just discuss how things are going, how progress is doing, what other programs and models of care that you all are suggesting to policymakers at the Bipartisan Policy Center as well. So again, we really appreciate you coming and joining us on this episode of this podcast, and we look forward to having you back. Thanks very much.

00;18;43;08 - 00;18;48;10
Maya Sandalow
Yeah, thank you so much for having me. Look forward to coming back in the years ahead.

00;18;48;13 - 00;18;57;03
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00;00;00;08 - 00;00;18;01
Tom Haederle
Welcome to Advancing Health. Today we learn about geriatric psychiatric programs offered by two rural New England hospitals, and how both organizations are leaning in to meet the mental health needs of older adults in their communities.

00;00;18;04 - 00;00;43;10
Rebecca Chickey
My name is Rebecca, and I'm the vice president of the Health and Trustee services for the American Hospital Association. And it's my honor today to be joined by three leaders at rural hospitals who are improving access to mental health services in their rural communities. I am joined by Holly McCormack, who is president and chief executive officer of Cottage Hospital.

00;00;43;13 - 00;01;24;09
Rebecca Chickey
I'm also joined by Doctor who is a consultant psychiatrist and medical director at senior Behavioral Health unit at Sharon Hospital, which is part of Northwell Health, and as well the CEO and president of Sharon Hospital, part of Northwell Health. Christina McCullough rounds out this wonderful panel discussion today. So I'm going to jump right in. And Holly, I'm going to start with you, if I may share with the listeners a little bit about Cottage Hospital and why you decided to open your unit for older adult behavioral health care called the Ray of Hope.

00;01;24;15 - 00;01;49;05
Holly McCormack, DNP, RN
Sure. Happy to. So Cottage Hospital is an independent critical access hospital located in Woodsville, New Hampshire. We were founded in 1903, and at the time, the community built this hospital to respond to a lot of surgical type needs that were happening, from injuries related to working in logging and other industry in the area. And so we have been here supporting our community for over 123 years now.

00;01;49;10 - 00;02;20;06
Holly McCormack, DNP, RN
We are a 35 bed critical access hospital, and that's because we have our 25 bed hospital with our med surge unit and our ICU beds, but we also have a ten bed distinct part unit that is focused on geriatric behavioral health. And so we call that unit the Ray of Hope unit. We also have multi-specialty rural health clinic across the street from a hospital campus which has internal medicine, podiatry, endocrinology and behavioral health integrated into the care there as well.

00;02;20;14 - 00;02;44;16
Holly McCormack, DNP, RN
So the Ray of Hope unit was opened in 2016 as a response to the behavioral health crisis that was happening in New Hampshire. We found that a lot of hospitals were boarding behavioral health patients in the emergency department, and we decided to do something to become part of the solution. The demographic of Woodsville, New Hampshire, tends to be older, and we have a lot of older adults in our community and in communities that we serve.

00;02;44;17 - 00;03;05;10
Holly McCormack, DNP, RN
So this made a lot of sense for us. So early in 2016, we had a unit that we were using for physical therapy. We moved them to a different part of the building, and we were able to redesign this unit to safely house acute beds for ten Jerry psych patients. And so on October 1st of 2016, the unit opened.

00;03;05;16 - 00;03;15;16
Rebecca Chickey
What is the unit look like for the listeners? If you can paint a picture of what it looks like and also how it's staffed, because with only ten beds, I know that can be a challenge.

00;03;15;23 - 00;03;53;28
Holly McCormack, DNP, RN
Yeah. So the unit has ten private bedrooms. The unit is painted in calming colors that you would see in nature. So sage green, a lovely cream yellow color that we find to be very soothing. The artwork on the walls is inspired from local landmarks, but also things that might inspire. Reminiscing when patients are to tour the unit. One of the pictures is very popular is we have a photo of older trucks that look like they're rusting in a field, but you wouldn't believe how many patients actually gather on the picture and talk about having had a truck like that in their younger years, or knowing what kind of truck that was, or knowing somebody that

00;03;53;28 - 00;04;16;01
Holly McCormack, DNP, RN
had that truck. So it's very interesting. We have an activities room. We have a quiet room so that we can separate patients if they need a space that's quieter while we're doing group therapies. And then we also have an outside area with a patio where patients can go and be in a covered space outdoors. And we have raised garden beds so that they can work in the garden beds.

00;04;16;01 - 00;04;51;11
Holly McCormack, DNP, RN
Or sometimes we'll just do our morning activities and our morning stretch out there. The unit is staffed with registered nurses, lens nursing assistants. We have a recreational therapist, a licensed clinical social worker, and we have a psychiatrist that is affiliated with the local academic medical center that oversees the aprons, who are on site seven days a week, and that relationship with the local academic medical center, providing the expertise has been a way for us to have this specialized care locally, where we don't have to transfer people to a higher level of care.

00;04;51;13 - 00;05;14;24
Rebecca Chickey
I think that is great. I grew up in rural Alabama, and so I know how important it is for individuals to be able to stay close to their community, to stay close to their homes. And that provides a healing element that I think is hard to measure. But when you talk to the patients, equally important. And so that's my next question to you.

00;05;15;00 - 00;05;26;00
Rebecca Chickey
What type of patients do you treat in terms of diagnoses, and what impact have you seen? What's been the response from the community and from the families that you've helped as well of those you treat?

00;05;26;06 - 00;05;42;03
Holly McCormack, DNP, RN
The patients and families that we treat are very thankful to be able to have a place in the state of New Hampshire where we can care and provide the specialty care for them. But we've not only cared for patients in the state of New Hampshire, we provide care to patients in the state of Vermont and also Maine and Massachusetts as well.

00;05;42;10 - 00;06;10;21
Holly McCormack, DNP, RN
These specialty units are very hard to come by, and typically we'll have a waiting list for patients to get into the beds on our unit. In the state of New Hampshire, there are 221 towns, and we have represented patients from 110 of those towns so far. And we typically see diagnosis such as depression, bipolar or dementia schizophrenia. But the providers on the unit describe Jerry psych as complex and involving overlaps of psychiatry and neurology, internal medicine and palliative care.

00;06;10;27 - 00;06;14;12
Holly McCormack, DNP, RN
Those are the types of things when you see patients in this particular age group.

00;06;14;17 - 00;06;42;09
Rebecca Chickey
It's interesting. There's been a lot of discussion over the last couple of decades around med psych units. And I think that geriatric psychiatric units by default are medical psychiatry units, because by the time you're over 65, more than likely you have more than one comorbid physical condition, much less a mental illness or addiction. So such an important aspect of care to bring to a critical access hospital, to any rural hospital itself.

00;06;42;16 - 00;06;58;24
Rebecca Chickey
So thank you so, so much. It is my honor now to transition to Sharon Hospital. So doctor, tell us a little about Sharon Hospital and why the organization decided to open your senior behavioral health unit.

00;06;58;27 - 00;07;30;06
Sabooh Mubbashar, M.D.
It was established more than 20 years ago, and this was in response to a growing recognition that the rural communities, they really lacked adequate resources for older adults suffering from severe psychiatric and neurobehavioral illnesses. And as Holly mentioned, this is truly an area of great need. Just given the statistics of geriatric psychiatric problems that we are dealing with, which are actually expected to double in the coming decade.

00;07;30;08 - 00;07;59;24
Sabooh Mubbashar, M.D.
I personally have been involved in this role as the medical director with a unit for about 18 years. Probably also goes to show how much I believe in the work that we're doing. Despite the hospital and the unit being located in a rural community. You know, we started out with an 11 bed geriatric unit, and the demand increased so significantly that we then expanded into a 17 bed inpatient unit, as Holly was mentioning.

00;07;59;26 - 00;08;30;17
Sabooh Mubbashar, M.D.
We received referrals from much larger metropolitan areas, including New Haven, Hartford, Albany, upstate New York areas, Massachusetts. And I think some of that all to do with the unique location of Sharon Hospital, because we're at the northwest border of Connecticut. So we are right at the at the border of New York and Massachusetts. But also it has a lot to do with the with the very unique patient population that we serve.

00;08;30;22 - 00;08;38;16
Sabooh Mubbashar, M.D.
Expansion is really part of, as I said, much larger national reality with the patient population that we serve.

00;08;38;22 - 00;09;01;23
Rebecca Chickey
Well, the baby boomers are aging. And I think I heard a statistic about something like 10,000 people turned 65 every day. So if one out of every four of those has a psychiatric or substance use disorder in the year, then the math is clear that the demand is going to increase. Holly shared what her unit looks like physically and how it's staffed.

00;09;01;24 - 00;09;06;01
Rebecca Chickey
Can you share some similar perspectives for the listeners?

00;09;06;04 - 00;09;35;04
Sabooh Mubbashar, M.D.
Absolutely. So, you know, I think that given the uniqueness of this population, as Holly was describing it, I could hear a lot of overlapping themes. So what makes geriatric psychiatry unique is that, you know, their symptoms in psychiatry are rarely isolated from the rest of medicine. These are patients with significant medical frailties, mobility limitations, swallowing difficulties, chronic medical illnesses.

00;09;35;04 - 00;10;13;08
Sabooh Mubbashar, M.D.
So as far as the multidisciplinary care model is concerned, all patients getting admitted to our 17 bed unit get evaluated by a psychiatrist and an internist within 24 hours of admission, or multidisciplinary team has physical therapy, occupational therapy, speech therapy, and these evaluations are all completed within 24 to 48 hours of admission. Because these are again frail patients from nursing homes, sometimes from community, high aspiration risks functional decline around their mobility.

00;10;13;09 - 00;10;51;23
Sabooh Mubbashar, M.D.
So we really like to get a sense from the get go about what we're working with from the moment they come in. A staffing includes registered nurses, licensed practical nurses, mental health workers, full time social workers, activity therapists and we also actually incorporate massage therapy several days per week. And we also have pet therapy several times a month as part of our therapeutic environment, because we find that both these modalities actually go a really, really long way in helping some of these patients.

00;10;51;23 - 00;11;16;14
Sabooh Mubbashar, M.D.
So the structure of the unit is that we have five private rooms, we have six semi-private rooms, we have two large day rooms and two small TV rooms. We also have a quiet room, as Holly mentioned, which is to, you know, separate if a patient is looking for a relatively low stimulation environment. So we can utilize that from time to time as well.

00;11;16;16 - 00;11;39;17
Rebecca Chickey
Both of those units sound so phenomenal, both in their structure, their staffing, and the incredibly integrated way in which you treat the whole person, not just their mental illness or addiction, but all of their health and getting upstream about it when they're first admitted so that you're not dealing with complications later on. Thank you so much for that.

00;11;39;18 - 00;12;03;06
Rebecca Chickey
I'm going to turn now to Christina, president of Sharon Hospital. And Christina, the two programs that have been described here are really for older adults in need of acute inpatient psychiatric care. But Sharon has begun to go upstream to provide prevention services. Can you share a bit about the senior meals program for adults aged 65 and older?

00;12;03;08 - 00;12;40;02
Christina McCulloch, RN
Yes. Thank you Rebecca. So our senior meals program has really been an honor to stand up here at Sharon Hospital. Our journey really started over a year ago and looking at our community through our community health needs assessment, through assessing our service area that we serve. And there were a few themes that were identified through that assessment. The first is really emphasizing that we are serving an aging population, and we really needed to implement new measures and initiatives to really support the full well-being of the seniors in our community.

00;12;40;07 - 00;13;17;18
Christina McCulloch, RN
28% of Sharon Hospital's service area is age 65 or greater, compared to the average 19% nationally, the significantly higher. And when we look at our future predictions, we know that that population is only going to grow as both Holly and doctor had mentioned. Also, through our assessment, we identified two other opportunities, one being food security, especially in a rural setting where transportation isn't as easily accessible as some other communities in the in the last being mental health.

00;13;17;19 - 00;13;46;25
Christina McCulloch, RN
And so when we looked at these opportunities, we saw a program at one of our sister hospitals that they called the Senior Supper Program, and we set forth to implement that program on a small scale. Here in Sharon, we call it the Senior Meals Program. We started with providing meals at lunchtime at a discounted rate. So we were able to provide affordable, healthy meals to seniors in our community here at the hospital.

00;13;47;02 - 00;14;12;28
Christina McCulloch, RN
We saw that there was great interest in the program. There was a lot of demand. So over the year we grew. We added days that the service was available. We added educational seminars, we invited clinicians, we hosted dinners, and the program really has grown into what it is today, which we call the C program. It's a senior education and engagement program.

00;14;13;04 - 00;14;38;18
Christina McCulloch, RN
We're looking to further expand this program so that we can have these offerings outside of the hospital, out in the community. We've already hosted a couple of events at different settings in different towns in our community, where seniors can go out to a venue, have a nice meal, listen, connect with one of our clinicians on a topic related to aging.

00;14;38;21 - 00;14;59;08
Christina McCulloch, RN
We've done seminars on heart healthy fall prevention, and so our goal over the next year is really to continue to expand. In addition to having affordable, accessible meals, this is really helping to combat that social isolation that so many of our seniors are facing in our community.

00;14;59;09 - 00;15;35;20
Rebecca Chickey
So it sounds to me that you're addressing the loneliness epidemic that you are addressing food insecurity that you're able to perhaps prevent, as you indicated, the social isolation, which can often trigger depression, and really getting into the prevention mode so that perhaps you won't have to expand the unit again by more beds. I'd like to ask each of you to maybe give a sentence or two of what call to action would you share with the listeners?

00;15;35;21 - 00;15;37;11
Rebecca Chickey
Holly, I'll start with you.

00;15;37;15 - 00;16;00;26
Holly McCormack, DNP, RN
Well, I think what we've already discussed regarding the aging of our country and how important it is that we provide services for patients that need our help, especially the geriatric community. But it's not only the patients, it's the families. What we see with the caregivers often is there's a high degree of burnout trying to care for their loved one, trying to find the services they need for their loved one for many, many years now.

00;16;00;26 - 00;16;18;23
Holly McCormack, DNP, RN
And they are feeling guilty about not being able to provide that support. And so that's something that we need to consider. And it's also important for us when our patients come to us, they're frightened. They're often grieving. They're confused. Sometimes there's a loss of independence. And so we need to help them cope with that. And we need to help families cope with that.

00;16;18;24 - 00;16;40;13
Holly McCormack, DNP, RN
The last thing I'd like to leave with all of you about the Ray of hope is we say that we measure success differently at the ray of hope, and this came directly from my nurse practitioner that works on the unit. She likes to say we help people sleep through the night. We reduce fear, we reduce stress, we avoid restraints, and we return them safely to their community or to long term care environment.

00;16;40;13 - 00;16;46;20
Holly McCormack, DNP, RN
And we provide families with hope and guidance so that we can help them get through a very overwhelming time period.

00;16;46;22 - 00;17;06;00
Rebecca Chickey
I mean, if each and every one of us could go home every day saying that that's what we did with our time, what a beautiful place this would be. So thank you for that very much, doctor. I'll turn to you. How would you inspire others to go on this journey, since you've been doing it for 18 of the 20 years that the unit has been open?

00;17;06;02 - 00;17;47;25
Sabooh Mubbashar, M.D.
Yeah, I really believe that when it comes to serving this patient population, rural hospitals can make a profound difference when it comes to treating older adults with dignity, humanity and clinical sophistication. With the right model development that I'm very proud that we have been able to emulate at senior behavioral health, multidisciplinary infrastructure and a long term institutional commitment, rural programs can actually develop a highly specialized, niche serving population at times that larger tertiary care hospitals come to rely upon.

00;17;47;25 - 00;18;12;06
Sabooh Mubbashar, M.D.
So this only is not only is an area of great need, this can actually be a lifeline on many levels for rural hospitals. And I think I strongly feel that this is how it should be looked at as not only a clinical need, but something that actually would probably help the bottom line of most rural and small hospitals that are struggling.

00;18;12;10 - 00;18;40;19
Sabooh Mubbashar, M.D.
I'm very aware of the almost crisis like shortage of specialists, especially psychiatrist. Not well. Health now also has a residency program and we actually have residents rotate for about three months. And I can tell you as a as a teacher and mentor that they will routinely say that out of all of their rotations, working with geriatric patients is actually some of the most satisfying work that they do.

00;18;40;19 - 00;18;46;02
Sabooh Mubbashar, M.D.
So there is plenty of hope for us to be able to deal with this shortage of psychiatrists as well.

00;18;46;05 - 00;18;59;04
Rebecca Chickey
We need to get that message to every medical school across the country. So, Christina, I'd like you to bring us home. What are you going to leave the listeners with in terms of inspiring them to go on this journey with you?

00;18;59;04 - 00;19;31;04
Christina McCulloch, RN
So my call to action is for more advocacy. We need advocates not only for seniors and their families, but we need advocates for our hospitals, our communities. We need funding. We need resources in order to provide these services that have such a great impact on this population. And so advocacy is critical. And so my call to action is advocate for your community, advocate for your hospital, both at a local, state and federal level.

00;19;31;05 - 00;19;42;13
Christina McCulloch, RN
Because in order for us to provide these this comprehensive care to support the full well-being of our seniors, what we all do is crucial.

00;19;42;16 - 00;20;07;07
Rebecca Chickey
That's phenomenal. So, Holly, Christina, doctor, thank you so much for being willing to share your time and expertise with the listeners to inspire them to consider the fact that their rural hospital can become a center of excellence for the treatment of older adults with mental illness and or addiction. Thank you so much for what you do each and every day.

00;20;07;09 - 00;20;16;01
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:06 - 00:00:16:02
Tom Haederle
Welcome to Advancing Health. In this episode, we hear from a father-daughter physician team who are delivering babies in their hometown, keeping care in the family, and exploring what it means to care for families across generations.

00:00:16:04 - 00:00:45:18
Julia Resnick
It's not every day you get to practice medicine alongside your family, let alone deliver babies together. Today's guests are doing just that. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. Today, I'm joined by a father-daughter duo from Southwest Health in Platteville, Wisconsin. Dr. Kevin Carr is a family medicine physician who also provides obstetric care, and his daughter, Melissa Carr, has returned to her hometown to practice as an obstetrician and gynecologist.

00:00:45:25 - 00:00:56:00
Julia Resnick
We'll talk about what it's like to work and even deliver babies together, and what it takes to provide high quality maternal care in a rural community. Drs. Carr, welcome to the podcast.

00:00:56:04 - 00:00:56:26
Kevin Carr, M.D.
Thank you.

00:00:56:27 - 00:00:58:00
Melissa Carr, M.D.
Thanks for having us.

00:00:58:01 - 00:01:13:24
Julia Resnick
So this episode feels especially meaningful as we think about Father's Day. And the two of you are not only colleagues, but father and daughter working side by side. What has it been like to build a professional relationship alongside your personal one? Kevin, I'll start with you.

00:01:14:00 - 00:01:38:06
Kevin Carr, M.D.
Well it's awesome. It's obviously very exciting to see your daughter do well and be well liked in the community. She's actually now starting to deliver people that I actually delivered. So I think fair amount of those has happened. It's also very nice to have somebody very knowledgeable that I can walk down the hallway and ask questions to that I think knows more than I do right now.

00:01:38:07 - 00:01:40:22
Kevin Carr, M.D.
So it's pretty it's pretty awesome all the way around.

00:01:40:26 - 00:01:43:03
Julia Resnick
Amazing. Melissa, what's it been like for you?

00:01:43:06 - 00:02:03:06
Melissa Carr, M.D.
Yeah, kinda just to reiterate that, I think it's just it's really an amazing experience. I mean, he's such a great role model and just an overall mentor. I mean, he's been practicing medicine here at this location for 35 plus years. So, you know, with that, he brings a wealth of knowledge and all the experience that comes with it.

00:02:03:06 - 00:02:23:28
Melissa Carr, M.D.
And he's just so willing to offer that advice both clinically and, you know, from a personal standpoint as well. So, you know, there's just so insightful. And it's like you said, his office is down the hall. So, you know, you can just pop in and, you know, ask questions and bounce ideas off of him. And it's just it's so such a nice resource to have, you know, readily available to me.

00:02:24:00 - 00:02:28:04
Melissa Carr, M.D.
So I take advantage of it as much as I possibly can.

00:02:28:06 - 00:02:36:12
Julia Resnick
That's amazing. And my dad used to work in the building next to us, so we'd have lunch all the time. But that's different than being in the same profession and actually working together.

00:02:36:14 - 00:02:54:27
Kevin Carr, M.D.
And I'll have one more little anecdote. My dad was a veterinarian, and so for many years when I heard Doc Carr, I was looking around because it was my dad they were talking to. And I think Melissa will share that same anecdote that it's we're used to having that in the background.

00:02:55:02 - 00:03:01:01
Melissa Carr, M.D.
Yes. In fact, I had a patient this morning bringing up Doc Carr, who is Grandpa Carr, the veterinarian.

00:03:01:01 - 00:03:07:08
Julia Resnick
I love that. And I imagine that your dad being in this field influenced your decision to go into it as well.

00:03:07:10 - 00:03:14:22
Kevin Carr, M.D.
I was not sure if I was going to do veterinary medicine or people medicine, so obviously I made what I think is a very good choice.

00:03:14:25 - 00:03:18:07
Julia Resnick
And Melissa, you stuck with delivering babies.

00:03:18:09 - 00:03:46:15
Melissa Carr, M.D.
Yeah, same thing. I mean, I had a front row seat to, you know, to healthcare from a very early age. Growing up, I just remember seeing, you know, number one, seeing, you know, get up in the middle of the night to go deliver a baby or, you know, that side of things. But then, you know, you'd walk into the grocery store or to a ball game and there would be a patient that would track him down and telling stories about their family members or their loved ones that he took care of, and just or just being thankful and expressing their gratitude for the care he provided them, you know,

00:03:46:16 - 00:03:59:26
Melissa Carr, M.D.
so I saw from a very early age kind of how meaningful that was. And I feel like that's kind of a perspective that not a lot of people get going into healthcare. If you haven't been exposed to that, especially in more rural type setting.

00:03:59:28 - 00:04:08:16
Julia Resnick
Absolutely. So as you've been working together, what have you learned from each other, both as clinicians and his family members? How does that shape how you're caring for patients?

00:04:08:20 - 00:04:29:10
Melissa Carr, M.D.
Well, again, to kind of just like as I mentioned, you know, I saw the relationships that he developed with patients, both in the clinical setting and outside. You know, how patients just felt so grateful for their care. And I just I got to see how, you know, how you played that role in their lives. And I would just, you know, thought that was really pretty amazing.

00:04:29:11 - 00:04:36:07
Melissa Carr, M.D.
And so that really kind of impacted, number one, me to go into medicine. And then, you know, continuing to build those types of relationships with my own patients.

00:04:36:09 - 00:04:37:06
Julia Resnick
And Kevin.

00:04:37:12 - 00:04:54:12
Kevin Carr, M.D.
Well, again, I kind of go back to my parents again, I think kind of I was always taught you show up, be there and care for people and the rest will take care of itself. We're small town of 10,000, and it's just different care out here than using the big city because of that. And I think the patients see that.

00:04:54:13 - 00:04:59:14
Julia Resnick
Say more about that. What makes providing maternal care in rural communities special?

00:04:59:16 - 00:05:22:25
Melissa Carr, M.D.
So our model for maternal health care here is a little bit different than what you're going to get in some of the bigger health care systems. And we tend to have one provider that follows their patients through their prenatal care from the first visit through delivery and then postpartum. And so because of that, we really start to build these relationships with patients.

00:05:23:00 - 00:05:38:09
Melissa Carr, M.D.
You get to know them at a much more personal level. And I just think that that brings a whole other level of care to these moms and babies. So it is a little bit more of a unique experience here. And I think that that's part of what makes us special.

00:05:38:15 - 00:05:40:18
Julia Resnick
Kevin, anything you want to add to that?

00:05:40:20 - 00:05:55:27
Kevin Carr, M.D.
Yeah, I think especially with OB, once you take care of somebody and see them 12, 13, 15 times, they kind of remember you forever because it's one of the biggest days of their life that they're going to remember for every single day. And you're a big part of it.

00:05:55:28 - 00:06:15:06
Julia Resnick
Absolutely. And it's one of those few times in healthcare where you're getting care for a happy reason, and it's amazing that you get to be there for them throughout that entire journey. So, Kevin, I know you're an FM who does OB and Melissa, you're an obstetrician/gynecologist. And you know, how does that work together, working as a care team?

00:06:15:12 - 00:06:19:26
Julia Resnick
And how can those kind of collaborations help improve care for patients?

00:06:19:28 - 00:06:42:26
Kevin Carr, M.D.
Yeah, it works amazingly well. We have five family practice docs that deliver OB patients, and one of the family practice docs actually does C-sections, along with three of the OB doctors here. We still take care of our own patients. Obviously, they're very available for any consult, anything that happens, and if a C-section happens on their patient, we're also there first assisting.

00:06:42:26 - 00:06:58:19
Kevin Carr, M.D.
We're helping out and taking care of the baby. So it absolutely works very seamlessly. There's no turf battles. There's a lot of helping each other out and very willingness to answer questions if there's any problems or concerns about any kind of care.

00:06:58:24 - 00:07:15:24
Melissa Carr, M.D.
And we are located in the same building. We're two separate clinics or two different offices, but we're separated by hallway. So people will pop into my office all the time just to bounce ideas or ask questions, and vice versa. I'll do the same thing. I'll put my head in and say, okay, I got this patient. What do you think of this?

00:07:15:25 - 00:07:28:09
Melissa Carr, M.D.
And everybody is always so willing to, you know, to help out and provide advice and, you know, just kind of help coverage. And like you said, it's, you know, we're a pretty well oiled machine and it works really well for us.

00:07:28:12 - 00:07:43:24
Julia Resnick
That's amazing. And in a lot of rural communities these days, we're hearing about hospital closures or hospitals that are having to retract their OB services. But it sounds like you all are doing the opposite of that. So what do you think has been driving that growth and how are how are you adapting to meet that need?

00:07:43:26 - 00:08:14:28
Melissa Carr, M.D.
So we've seen that firsthand. We had a hospital in a neighboring county closed their maternal health services probably about ten years ago, give or take. And so those patients now had to travel further for their obstetrical care. Many of them do come our direction now. Another hospital, neighboring hospital, has also lost some of their OB providers and their gynecologist for whether it was from those providers relocating or retiring.

00:08:15:01 - 00:08:36:08
Melissa Carr, M.D.
So there's just less access to care. And so we have seen more patients coming our direction because of just there isn't as many options available to them. And they're now having to travel further. So to kind of combat that, number one, we've increased our OB providers since I've been here. We have more physicians that are providing OB care, whether it's family medicine, physicians and OBGYNs.

00:08:36:10 - 00:08:56:00
Melissa Carr, M.D.
And we've also opened outreach clinics through our organization. So that's where OB care is available. So people aren't having to drive as far for their prenatal care visits. They still come to our main hospital campus for deliveries, but at least for their visits, they're not having to travel as far.

00:08:56:07 - 00:08:58:20
Julia Resnick
Fantastic. Kevin, anything you want to add?

00:08:58:26 - 00:09:19:26
Kevin Carr, M.D.
Just to show you the numbers, in 2010, we were about 140 deliveries, and I believe this year we're going to be at 240 delivery. And some of it's the culture of the hospital. The whole hospital has exploded over this period of time. Going back to the American Hospital Association meeting a few years ago, quite a few years ago, we started a Journey to Excellence program

00:09:19:26 - 00:09:40:27
Kevin Carr, M.D.
after one of the meetings, we learned at the Rural Health Leadership Conference. And our hospital does that, and patients that walk in the door from the outside can tell the difference in every single employee the attitudes, the smiles, the willingness to help out everybody from the janitor to the CEO, every single step along the way. Every person is important.

00:09:40:27 - 00:09:57:07
Kevin Carr, M.D.
And it shows in how we take care of patients and how patients respond to what we do. And it's every single one of our sort of different programs, you know, OB, ortho, everything has literally exploded because of some of the things we've done.

00:09:57:09 - 00:10:05:22
Julia Resnick
That's fantastic and really just speaks to, you know, your organizational culture and how that exudes between providers and also to the people you care for.

00:10:05:25 - 00:10:31:02
Melissa Carr, M.D.
And I think there's a lot of word of mouth that spreads too, you know, people are very grateful for their care here. And they really enjoy their experience. And they spread that to their friends, their family members. And, you know, so that catches on. And we're starting to see patients that are willing to travel further for their OB care, even if they have options that are closer to home, because they're choosing to come to our facility to come to deliver and coming to see us for their prenatal care.

00:10:31:04 - 00:10:44:28
Julia Resnick
That is great. And so you've both really been talking about like, the human piece of this. And I know a lot of hospitals, including yours, are using technology to help extend care. Can you talk about how you're thinking about incorporating technology into your work?

00:10:45:01 - 00:11:03:15
Kevin Carr, M.D.
They are starting to do AI to help with notes here. We just started six months ago. So we're learning from many of the providers. There's some very good things about it. There's some things they got to learn. But it sounds like so far so, so good that it's saving some time so they can spend more time with the patient and do those things.

00:11:03:15 - 00:11:05:19
Kevin Carr, M.D.
So that's one of the things they're doing.

00:11:05:24 - 00:11:10:00
Julia Resnick
And wasn't there a piece about a telemedicine program for neonatology.

00:11:10:02 - 00:11:42:02
Kevin Carr, M.D.
Oh yes. We were the first - and it might still be the only program in the state - that has a telemedicine NICU program, neonatal intensive care unit program associated with University of Wisconsin-Madison. And it's been going on for a couple of years. It took us a while to tweak and fine tune some things, and it's really nice in the sense of in our newborn nursery, we have computer set up, we have cameras set up, and we basically call a number and usually within minutes we have a neonatologist on the phone.

00:11:42:02 - 00:12:01:03
Kevin Carr, M.D.
We can see them, they can see us. There's a video on us, there's a video on the baby. And back in the day where we take care of lots of babies who need a little bit of oxygen, need a little bit of help, a little CPAP to help them get through the breathing, and you kind of sit there and try to decide, okay, is this baby sick enough to be transferred?

00:12:01:03 - 00:12:20:06
Kevin Carr, M.D.
Can I watch for another two hours? Well, now we make that call right away and we talk to them and we go, hey, I'm pretty comfortable with this, but I just want to make sure that I'm doing the right thing. And you have them on the phone, they assess the baby, they help you sometimes in making the decision, do we order a few tests and then, hey, we'll keep an eye on things and get back to us an hour.

00:12:20:07 - 00:12:29:20
Kevin Carr, M.D.
And if the baby transitions and looks great, wonderful. If the baby doesn't do well, then we already have the numbers in and they're ready to send the transport team.

00:12:29:25 - 00:12:34:28
Julia Resnick
That sounds incredibly helpful for rural hospitals that probably don't see a ton of cases like that.

00:12:35:00 - 00:12:57:27
Melissa Carr, M.D.
We also have a new SIM lab here as well, so we can run different types of simulations for both physicians and the rest of the hospital staff that are on the OB unit. And that's been really helpful, especially in a rural setting, because, you know, our volumes are lower, which also means that our types of high risk clinical scenarios are also going to be lower.

00:12:57:27 - 00:13:18:09
Melissa Carr, M.D.
So you may have a nurse that might not experience a postpartum hemorrhage or a shoulder dystocia or those types of situations, but have only heard about it. So this allows people to, you know, get that training and doing that repetition through simulation, even if we don't necessarily see it very often to keep those skills up.

00:13:18:12 - 00:13:33:00
Julia Resnick
Absolutely. And to close, I just want to bring this back to Father's Day, since that's when we're releasing this. And you are a father-daughter duo, so can you just share a moment or a story that reminds you why this work is so important to your community?

00:13:33:02 - 00:13:54:16
Kevin Carr, M.D.
I called a patient this morning to ask if I could share this story without saying her name. Obviously, I've delivered a lot of patients and this specific family, I delivered all four of the girls. Several of them, I believe they're all going into nursing school. And so back in the start of Covid in 2021, she was in nursing school and came to me with symptoms.

00:13:54:24 - 00:14:13:18
Kevin Carr, M.D.
You just get gut feelings if something isn't right. And I basically did a chest X-ray and she had an apple sized lesion by her heart. And I immediately had my nurse call her mom, said I want her mom here now. I want to talk. I want to get her here before I get my CAT scan. I did a CAT scan. The next day

00:14:13:18 - 00:14:42:18
Kevin Carr, M.D.
I got her in with the hospitals at UW hospital to get a biopsy, and she ultimately had lymphoma. She did take six months in nursing school off and is now cured. Now, to add to that story, three years later she came, wanted to see me and she was somewhat tearful, so I wasn't sure what was going on until she got here and found out she was pregnant. And she was somewhat tearful because she just is finishing school.

00:14:42:20 - 00:15:07:19
Kevin Carr, M.D.
She's not married yet and she's worried, how are my parents going to take this? And we had a long discussion, and I kind of used some old quotes from my former nurse who was outstanding and said, this won't define who you are as a human and won't define who you will be in your lifetime. And she asked if she could give me a big hug and two days later told her parents and her dad was in tears,

00:15:07:19 - 00:15:23:09
Kevin Carr, M.D.
he was so excited. Because three years before that, they're worried they're going to lose their daughter. And now their daughter is bringing a life into this world. And so there's a huge turnaround. And that's why we go into medicine. Now I'm going to add to one step further to that I know this, I know her very, very well.

00:15:23:09 - 00:15:36:01
Kevin Carr, M.D.
I know this family very well. She told me there is nobody else that's going to deliver her baby except for me. Except unfortunately, that few days I was in Canada fishing. So guess who delivered my baby?

00:15:36:02 - 00:15:37:24
Julia Resnick
The other Doc Carr?

00:15:37:26 - 00:15:57:06
Kevin Carr, M.D.
The other Dr. Carr. And so she got to experience the best of both worlds. And now she had her second baby about eight months ago. And so I did deliver that one. So she was thrilled that both of us had an opportunity to care for her. And to be blunt, when I called her and asked if I could use her story today, I could tell she was in tears on the phone.

00:15:57:06 - 00:16:02:27
Kevin Carr, M.D.
She's an outstanding family, just core the earth people from southwest Wisconsin.

00:16:02:28 - 00:16:05:27
Julia Resnick
Amazing. And Melissa, on your end.

00:16:06:00 - 00:16:27:14
Melissa Carr, M.D.
One that comes to my mind is so my very first delivery that I did as a brand new grad or fresh out of residency was a C-section that I did with my dad. It was his patient and she needed a C-section. And so I was the primary surgeon. And then he was my first assist.

00:16:27:14 - 00:16:48:06
Melissa Carr, M.D.
So, you know, looking back, you know, you're just you're eager to do the delivery and, you know, be there for your patients. But at the same time, you know, looking back, it was just such a special cool moment. And now the other really neat thing is that particular patient, she takes care of my kids at daycare. So, you know, I see her every single day when I drop my kids off and, you know, so it's just it comes full circle.

00:16:48:08 - 00:17:07:01
Kevin Carr, M.D.
And to add to that story, the grandmother of that patient was an OB nurse here that I have delivered 500 babies with. And so she was in the operating room. And this is one in the morning, we're doing the C-section. And she thought it was the coolest thing ever, that her granddaughter was in there in the room with both of us.

00:17:07:03 - 00:17:22:00
Julia Resnick
That's amazing. And it's keeping in the family, both your blood family and your community family. So, Doc Carr, Doc Carr, thank you both for the work you do for your communities, for sharing your stories. And Happy Father's Day to all of our listeners out there.

00:17:22:02 - 00:17:24:19
Kevin Carr, M.D.
Thank you. Thank you very much.

00:17:24:21 - 00:17:33:14
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:23:02
Tom Haederle
Welcome to Advancing Health. In February's Leadership Dialogue podcast, Dr. Marc Boom, president and CEO of Houston Methodist and the 2026 Board chair of the American Hospital Association, speaks with a top rural health care leader about how creativity and excellence can address the unique challenges facing rural providers.

00:00:23:05 - 00:00:44:06
Marc Boom, M.D.
Well, greetings and thank you, everybody for joining me today. I'm Marc Boom. I'm the president and CEO of Houston Methodist, and I'm excited to be the chair of the, American Hospital Association this year. As I mentioned during my first leadership dialog in January, I believe innovation is just a critically important part of ensuring that patient care is absolutely unparalleled.

00:00:44:09 - 00:01:09:02
Marc Boom, M.D.
So my plan to hopefully weave innovation as a theme throughout each of these discussions. And so today we're doing exactly that again, but this time through the lens of a rural hospital leader. I know that all of our colleagues, whether they're leaders of big health systems or small independent hospitals, are committed to innovating to deliver the best possible care to the people they serve and also navigating big changes and challenges in our field.

00:01:09:04 - 00:01:42:03
Marc Boom, M.D.
And we know that when it comes to challenges, the leaders of our rural hospitals, frankly, have a whole extra degree of complexity. I mean, recruiting staff. The administrative and reimbursement challenges, transportation, just to name a few. And I know I'm anticipating our guest today will share that amidst those challenges, many opportunities for growth and innovation. You know, just, two weeks ago, I attended the AHA's Rural Health Care Leadership Conference, and I was totally energized by the sessions and the discussions that were there on building innovative approaches to transformative care delivery.

00:01:42:05 - 00:02:11:15
Marc Boom, M.D.
So today, we have as our guest, Mark Boucot. Mark is the president and chief executive officer of Potomac Valley Hospital in Kaiser, West Virginia. He attended the conference as well. I met and chatted with him there because he was the recipient of the AHA’s Rural Hospital Excellence in Innovation Award. That's an award that recognizes rural hospitals that demonstrate responsiveness, creativity, and excellence in developing or sustaining programs that address the unique challenges that face rural and frontier communities.

00:02:11:15 - 00:02:14:26
Marc Boom, M.D.
So, Mark, welcome today. I'm glad to have you here.

00:02:14:29 - 00:02:17:17
Mark Boucot
Well, thank you for having me. I'm honored to be here.

00:02:17:20 - 00:02:35:24
Marc Boom, M.D.
And we'll keep it nice and confusing with two Marks today. And maybe we'll pronounce them slightly differently. Mine's with the C, yours is with a K, but it is great to have a fellow Mark here for our podcast today. So I want to dive right in. And first off, I know Potomac Valley Hospital, which you lead, is part of WVU medicine.

00:02:35:27 - 00:02:45:03
Marc Boom, M.D.
Which, if I'm not mistaken, you are a 25 bed critical access hospital. So let me start. Tell me a little bit more about the hospital and the community you serve.

00:02:45:03 - 00:03:11:18
Mark Boucot
Yeah that's correct. We're a 25 bed, critical access hospital. Although you'd be very surprised about the amazing array of services that we provide there. The hospital, basically has, general surgery, orthopedics, very strong orthopedics program, along with multiple specialty services. We opened a hematology oncology center there in our geography to serve the patients that we were blessed to take care of.

00:03:11:21 - 00:03:36:28
Mark Boucot
We have, urology. We have along with that. We have colorectal surgery, we have pain management. So there's a there's a pretty vast array of services. We serve a market area of really I think it's a three county area that that comes to the hospital, our community near Potomac Valley Hospital, about 50,000 residents. But we serve a much broader area.

00:03:36:28 - 00:04:06:07
Mark Boucot
People come from about an hour away. And really, I think one of the things that I for me, that is a hallmark of our organization is, is that we have adopted a mission statement that we care for every patient like we would our own family. And so with that as our Northstar, we are able to innovate and develop patient care services for our community, always knowing that we're going to care for them, we're going to include them, we're going to incorporate their needs

00:04:06:07 - 00:04:09:18
Mark Boucot
most importantly, because everything that we do is for them.

00:04:09:20 - 00:04:31:19
Marc Boom, M.D.
I'd love to hear about your technology journey. We believe, and that's why I'm weaving this in these series that, you know, innovating through technology can really transform innovation. And when you talk about that Northstar, which I love of it's all about the patients, right? That's why we're all in health care. I assume when you're looking at technology as a critical access hospital, it's all about the patient, how you do that.

00:04:31:19 - 00:04:39:11
Marc Boom, M.D.
So how do you think about, technology solutions, the infrastructure improvements, care management, all of the above, in that setting?

00:04:39:13 - 00:05:10:16
Mark Boucot
Yeah. Like most organizations, we have a pretty strong governance infrastructure around the development of our technology services. We're blessed to be part of WVU medicine. And because of that, we are able to have advancements in technology that many small organizations that are independent or standalone don't get the opportunity to have. But we've integrated AI into our physician practices and it's one of the most amazing things for them because they're direct face to face care now is much different.

00:05:10:23 - 00:05:33:26
Mark Boucot
So we're serving the patient more than the computer, in that environment. And as we build and grow, we think our way through and develop strategies that would enable us to really provide the academic medical center level of care at our small hospital. And I think that that has been a hallmark of how we decide what we're going to do and how we're going to move forward.

00:05:33:28 - 00:05:55:07
Marc Boom, M.D.
And we'll pull that thread a little bit. So you say, as part of WVU medicine, we have many critical access hospitals out there, as you alluded to, that are standalone on their own. I'm sure you think about that. I know there's pros, I know there's cons, but how would you approach that if you didn't have the WVU medicine as that, as that kind of feeder of some of those technologies?

00:05:55:09 - 00:06:24:28
Mark Boucot
A great example is this program that we were recognized for with the virtual ICU program. Very low cost infrastructure, just with some very simple tablets. We implemented a virtual ICU program where we were able to care for patients. We partnered with a large organization, which is Ruby Memorial, part of our own health system. But you could do that with any other academic medical center that you work with.

00:06:25:00 - 00:06:56:21
Mark Boucot
And basically what we do is we created a partnership where they can monitor our patients. The surgical intensivist in their ICU and critical care intensivist can care for our patients through just a very simple virtual hook up. This, this infrastructure actually, I think cost about $5,400 to implement. So it doesn't have to be rocket science. And it doesn't always have to be complicated in order to be successful.

00:06:56:26 - 00:07:21:12
Mark Boucot
I would also say for me, I've been the independent organization, and we had to make some decisions about making sure that what we provide is as close to the state of the art as we can possibly get. And even so, I would say the most important thing for us is that nothing is going to take away from the face to face care for the patients with our providers.

00:07:21:15 - 00:07:42:14
Mark Boucot
And so we try to enable them to be able to to care. And so even with some when we had antiquated technology or antiquated IT systems, we still were able to utilize Dragon and other scribing techniques that would try to keep the providers as close to the bedside as possible.

00:07:42:17 - 00:08:00:03
Marc Boom, M.D.
So you have 25 beds. You described obviously a lot of very key specialists and talented people there. In those 25, in any given time, how many people are in the ICU? I'm just trying to parse out a little bit more how you know, what you won the award for and exactly what you're doing so it can inspire some others.

00:08:00:05 - 00:08:21:09
Mark Boucot
When I started there, the ICU was closed and all of the equipment was draped with towels or sheets. Basically, the light hadn't been turned on for about 18 months leading up to this. I think we just decided that no matter what, this ICU needs to be open, it needs to be open for this community. And so we're going to figure out a way to make it work.

00:08:21:11 - 00:08:45:15
Mark Boucot
And, we took this pilot program to the health system and said, look, you know, hey, if we're able to partner with you, what that will also help us do is keep our patients local so that we don't have to transfer as many patients out, which would help the health system with overcrowding and very high centers, which is what we are all living through today.

00:08:45:18 - 00:09:10:16
Mark Boucot
We opened up the ICU. Basically, we had to make some investments in equipment, new IV pumps, made sure the beds, everything was working properly. And once we implemented the virtual ICU program with the health system, we found that it created an environment where the hospitalist felt much more safe and secure and supported to be able to admit more patients.

00:09:10:16 - 00:09:22:21
Mark Boucot
And therefore, it drove the census up quite a bit. So when we started, there was an ADC average daily census of two patients who were in the hospital on my first day and in

00:09:22:22 - 00:09:24:21
Marc Boom, M.D.
Hospital overall or in the ICU?

00:09:24:24 - 00:09:26:02
Mark Boucot
Yes, in the entire 25 bed hospital..

00:09:26:02 - 00:09:28:04
Marc Boom, M.D.
Okay. Yeah, that's a small

00:09:28:07 - 00:09:56:14
Mark Boucot
Yeah, there was it was pretty empty. And so now I would say a good 70 to 80 days a year we're at 100% occupancy. The ICU is always full now at this point. And, you know, we combined this implementation for virtual ICU, which is different than an EICU. And we combined it with a pretty rigorous performance improvement in our emergency department.

00:09:56:16 - 00:10:16:25
Mark Boucot
We've got our door to doc time down around ten minutes. And we've got our door to bed time within like four minutes. So basically when you come in, you register, you go right to a bed. And so that requires a pretty significant community of people that are working together to make sure that the rooms are turning over fast.

00:10:16:27 - 00:10:41:29
Mark Boucot
And we went from about 12,000 visits in the emergency department a year, five years ago. We're up now around 22,000 visits in that same emergency department. So obviously we're expanding. We're investing in the community and growing and developing. But we had to create the service that people wanted. And people do want convenience. They want they don't want long wait times in the emergency department.

00:10:42:00 - 00:10:55:26
Mark Boucot
I think that combined with the virtual ICU, meaning that they would then be admissions in a way to create the admissions into the facility, those two things combined were pretty significant change initiatives.

00:10:55:28 - 00:11:03:01
Marc Boom, M.D.
So you must have gotten really positive feedback from the community, I would imagine, in terms of that ability to stay local.

00:11:03:03 - 00:11:37:23
Mark Boucot
Oh my goodness. Yes. The community is rallied around the hospital. When we have events, we just had a ribbon cutting for a new building. Honestly, it was standing room only. The community has been wonderful and I think every like every community, our community just desire to have a great hospital and one that they could rely on. And I think that this program and our service and our] caring toward really wanting to just do the right thing and always be that that organization that would care for every patient, like your own family.

00:11:37:25 - 00:12:09:03
Mark Boucot
That is our North Star. So those things resonate with people. They resonate with the employees that work here and our reputation built. I didn't have to do a lot of advertising. It really happened by word of mouth, just by the fact that we were a different organization. And it's funny, Mark, I'll tell you, one of the things that was really interesting is just renovating and putting in new flooring and painting walls and making the place look different also created a lot of excitement in the community that they knew a new day was coming.

00:12:09:06 - 00:12:13:17
Mark Boucot
There was going to be care and investment back in the local hospital.

00:12:13:19 - 00:12:38:17
Marc Boom, M.D.
So this is really a win for everybody. The community loves it. The patients get really top notch care. The doctors there feel more comfortable taking care of somebody sicker, knowing they have probably pretty immediate back up to make decisions and manage critical patients. And it decompresses some of the referral center that. So when you do have somebody you need to move or other places need to move somebody because they still need that referral center, it's more likely to get them in there, I suspect.

00:12:38:17 - 00:12:41:05
Marc Boom, M.D.
So it's been a it's been a win on all rounds.

00:12:41:07 - 00:13:01:26
Mark Boucot
It's a win win all the way around. And I'll tell you, one of the one of the unique things is, is that our physicians, who were the hospitalist team, once they really started admitting patients and they started to feel more secure by having that safety net with a virtual ICU, because if the patient ever then decompensated, they could just go right into the virtual ICU.

00:13:01:26 - 00:13:25:04
Mark Boucot
They'd get additional help in a consult. Once that happened, it's interesting - there began to be mutual learning in both directions. And our health system is so awesome in that, there's a great deal of humility on both sides of our organizations that they actually learn some things from our hospitalists and our hospitals learned a lot from them.

00:13:25:04 - 00:13:34:15
Mark Boucot
So it was a great mutual learning opportunity and just a really wonderful partnership of working together in a really positive way.

00:13:34:17 - 00:13:52:18
Marc Boom, M.D.
Hospitals always, I think, are pillars in their community. But in a rural environment, when you have a hospital that the people can be proud of, I mean, they rally around and it's such a core part as an employer, as a caregiver, I mean, so critical to the United States that we have amazing rural hospitals like yours.

00:13:52:20 - 00:14:11:13
Mark Boucot
Oh, thank you for saying that. And I would say it's very important that we continue to support our rural hospitals and our local hospitals. This hospital, just by simply growing and having a Northstar of caring for patients and opening practices and bringing a lot of different specialists in. Again, that list I gave you is just a short list.

00:14:11:15 - 00:14:41:08
Mark Boucot
Those things are really important. Also for the economic engine of the community, this hospital created 300 jobs in the town of in Mineral County and in the town of Kaiser. So that we, you know, we have a bigger tax base. As an organization, we have come a long way. And I think this is an important part of the American Hospital Association with the work that the hospital association is doing to really help hospitals be strong and be healthy,

00:14:41:11 - 00:14:59:25
Mark Boucot
it's just amazing work. And like you said on the stage, it's God's work to make sure that we're caring for patients and that we're really doing the work that is healing and helping people. And so I've never actually worked a day in my life, to be honest with you, because I was doing what I was called to do in my life.

00:14:59:28 - 00:15:13:16
Marc Boom, M.D.
That's great. That's amazing. Well, you know, let me ask you this then, for the next aspiring rural hospital leader who wants to implement some of these, any lessons learned? And then what's next? I mean, where are you going next from an innovation standpoint?

00:15:13:18 - 00:15:33:21
Mark Boucot
Yeah. Thank you. I think from a lessons learned perspective, I think that one of the things that I would say for me is just making sure that I always approach things with an open heart and an open ear and an open mind, the way that I conceive things as a leader doesn't always mean that's the right way to do things.

00:15:33:23 - 00:15:58:27
Mark Boucot
We had some big lessons learned, I think, also around technology, what we expected for it to cost and what it had to be. No, actually, it didn't need to be like $1 million price tag on this. And we actually were able to implement this just by opening various portions of EPIC and then also utilizing simple tablets.

00:15:58:29 - 00:16:20:17
Mark Boucot
And I think that, you know, sometimes we think it's a much bigger obstacle to jump than it actually is. And I think once we believed we could do it, we could. There was nothing that could stop us. So I think as soon as we had the faith in ourselves and that we learned that we can do it.

00:16:20:20 - 00:16:46:10
Mark Boucot
We did do it and we did accomplish it. I think for our future, we're going to continue to grow the utilization of AI and to really try to keep the documentation work that's being done through AI and through a bridge. And the technology that we have today keeps that physicians much more happy and satisfied with their care, because they're really spending time with their patients now versus serving a computer.

00:16:46:13 - 00:16:57:19
Mark Boucot
I think that's been a wonderful thing for us. And I would say that making the investment in technology is really paramount to where to success in today's world.

00:16:57:21 - 00:17:15:15
Marc Boom, M.D.
You're working towards that NorthStar. You're seeing it as never working a day in your life. This is a very impressive program. I see 100% even more in detail now why you've won this award, and I think it's an inspiration in many other hospitals. So thank you for your time today. Thank you for your perspective and your commitment.

00:17:15:15 - 00:17:33:03
Marc Boom, M.D.
I really appreciate you being here. And as I close, I want to amplify a comment that I made at the Rural Conference. I was glad you were listening when you said the God's word part. And that's really we need to work together as hospital leaders to be defined not by the challenges we face, but instead by how we overcome them.

00:17:33:03 - 00:17:46:04
Marc Boom, M.D.
And that's precisely what you have done. And congratulations to you and you and your team. Thank you, everybody, for finding some time today to listen. We'll be back next month for another Leadership Dialog conversation. Thanks so much.

00:17:46:06 - 00:17:54:17
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:18:15
Tom Haederle
Welcome to Advancing Health. In the second of a two part conversation, we take a deeper dive into what hospitals and health systems can learn from an initiative from Georgia that's made tremendous progress in improving access to pediatric care closer to home.

00:00:18:18 - 00:00:46:15
Elisa Arespacochaga
Hi, I'm Elisa Arespacochaga from the American Hospital Association. And welcome back to part two of our conversation with Dr. Jean Sumner, dean of the Mercer University School of Medicine, and Marc Welsh from Children's Health Care of Atlanta. We're here talking about the partnership they have made to support health care in rural Georgia. We're going to dive a little bit deeper today on how they're supporting the care of today, the pipeline for the future, and some advice for you on how you might create one of these in your community.

00:00:46:17 - 00:01:13:17
Elisa Arespacochaga
Let me ask you, Marc, to then tell us a little bit about you guys have both hinted at the work that you're doing to build scholarships. We know that obviously supporting clinician training is amazing and absolutely necessary, but also takes time, right? You know, you don't grow a physician overnight. So can you tell me a little bit about how you've started prioritizing which of those roles you're focused on and how you're supplementing that pipeline of clinicians and again, that full team across rural areas.

00:01:18:21 - 00:01:45:01
Marc Welsh
There are a number of young people who are from rural communities who are receiving their medical education and are in many cases, the best candidates to return home to truly return home, to communities. And so we have in the pipeline right now 27 scholars. The first two will be in community this year. And so later this year, we will have our first two scholars who've completed residency and will return to rural communities to provide pediatric care.

00:01:45:03 - 00:02:05:07
Marc Welsh
And we're excited about that. I think this is what we look for in terms of a sustainable solution. When we thought about this at the beginning, it would have been easy for Children's to swoop into the community, do some work and then leave. And that community would have been, you know, better for it in the moment, but in the long run, that would not have created the change across the state that I think both myself and Doctor Sumner hoped to see. And so this opportunity presented us, this avenue for us to really build a sustainable workforce across the state. And these pediatricians will be exactly that. We started out with young people that were at all different years of their training, and that was a goal to accelerate how quickly we could get folks into community.

00:02:27:18 - 00:02:43:09
Marc Welsh
And now that pipeline is really strong, and we will introduce a next set of scholars in the coming months to continue that. So it's a really an exciting opportunity for us to ensure that those over 60 counties without a pediatrician will have one in the future.

00:02:43:12 - 00:03:09:19
Elisa Arespacochaga
That's amazing. Dr. Sumner, can you talk a little bit about the impact those scholarships have had on your classes and your students to be able to really accelerate that return back to to home? I know in so many states. The work that has really helped is when they've recruited from those rural areas to go back to those rural areas, because if you never lived there, it may be intimidating to move to a rural area.

00:03:09:21 - 00:03:36:09
Jean Sumner, M.D.
I think the scholarships are critically important, but I think it is even more important to pick the right student and then give the scholarship. You want a happy doctor, you want a doctor who feels called to that. I think there's no better job in the world in being a small town doctor. I spent my life there, and these young people that are carefully selected, interviewed by committee proved ... and we track them for years. They have opportunity through their school, through their years here to visit children's, develop alliances with subspecialists and people who may support them ten years from now, or who may be able to answer a call and have a relationship with them. So we give them incredible opportunities, but we pick the right student. The scholarship makes it possible because they very commonly come from people of lower socioeconomic status or lower income.

00:04:10:02 - 00:04:33:24
Jean Sumner, M.D.
The first one of the scholars this year, when he finishes, we'll go back to his home county that I believe never had a pediatrician -- and still doesn't. He will be the first pediatrician. So I think that that's the shining light. As time goes on, there's an army behind him that will come. And the second scholar that we named has not made up her mind finally, but I suspect she will be in an area of great need. But they commit willingly at something they won't. And all we do is try to make it easier for them.

00:04:43:15 - 00:05:06:11
Elisa Arespacochaga
I imagine that, yeah, they are. They want to see the community they grew up in just be better and have more access to care. And I love that connection. Marc, can you talk a little bit about what it's like for your clinicians at Children's to now have this network of folks that they are communicating with and supporting and being able to keep those kids not having to.

00:05:06:11 - 00:05:16:20
Elisa Arespacochaga
And I've driven in Atlanta traffic, man, I don't want to go back. So how do you keep those kids in their communities and keep that connection going and feeling supported there?

00:05:16:23 - 00:05:41:05
Marc Welsh
You know, I would say that the feedback here has been amazing. When we announced this work and began to share with our physicians across the system the excitement and energy and desire to participate and contribute to the work, was just overwhelming. And because I think for every one of our physicians, for every physician that goes, I would argue, into pediatrics, they go into it for a very specific reason. And that desire is purely to make an impact on the lives of kids, and for them to be able to be connected to impact communities across our state who otherwise are not having those resources, it fills their cup and it makes them better physicians. And they want to be connected to these young people who will return to community.

00:06:02:03 - 00:06:18:27
Marc Welsh
When those young people come to Children's for their rotations to learn, we have a long line of folks who want to engage them and want to be supportive of them. When we go to the Scholars Luncheon every year. It is the most amazing feeling to see those young people and to really energize us in the work that we do.

00:06:18:29 - 00:06:36:20
Marc Welsh
And so I will tell you that it has been a huge, huge win for us in respect to just morale amongst our physicians and employees, to know that we are committed to making this impact. And for us at Children's, it really allows us to fulfill our mission, ensuring that kids across the state have access to the best possible care.

00:06:36:22 - 00:06:52:15
Elisa Arespacochaga
I'm going to ask you both and Dr. Sumner, I'll start with you. The organizations that are listening to this aren't going to replicate exactly what you did, because they're not in your shoes, but they're going to hear something that's going to spark, a line of thought or a person they may not have thought to reach out to. So I'd ask, what advice would you have for an organization? In your case, Doctor Sumner, a medical school, and in your it a children's hospital. Subspecialty programs. What advice would you have for those listening if they want to create something like this?

00:07:08:27 - 00:07:32:18
Jean Sumner, M.D.
Well, first and foremost, understand the problem you're trying to solve. Understand the need. Understand the complexity of it if it's rural health, understand the complexity. It's not simple. And we say children are not little adults; well, rural communities aren't little cities. And there's a different it's a different place. People would come and they would run a clinic for three months and it was great and then they disappear, or they had a grant and they came and did research. And the community never heard from the research, but they see it written up somewhere. And so a lot of trust has been lost. And I honestly think part of that is academia, that we want them, that change the world. But we don't realize we're taking people who are human like us, and they want to be part of it, and they want to build trust with their providers.

00:07:57:00 - 00:08:17:21
Jean Sumner, M.D.
So we usually go when we go out to a community that has a need, we find out what they want, what they need, how can we help you and we say, "If we're going to commit to something in that community, you can't run us off unless you want us to leave. We're here. We'll find a way. We'll bring in partners to help."

00:08:17:23 - 00:08:41:04
Jean Sumner, M.D.
What we heard on all our counties is they have to have health care. They have to have care for their families because you don't have industry or economic development or education without good health care. So I would encourage anybody to do a little work in knowing the problem and knowing ... don't take the community as an equal part of that.

00:08:41:06 - 00:09:03:27
Jean Sumner, M.D.
This is an effort with Children's Healthcare Atlanta and Mercer University and then every county that we serve in a little different way, we're a little different in every county. We base it on need. They don't need something, we don't bring it to them. If they want something, we try to find it. Even if we can't provide it ourselves, we get a partner who can provide it.

00:09:03:29 - 00:09:31:08
Jean Sumner, M.D.
But having a physician in a rural community is important. Having colleagues who answer the phone at 2 a.m. when you've got a child dying in your E.R., is equally important. And it allows that young person to go there. Those communities want to have trust in their health system and yet many of them have lost trust. So it takes us time to convince them that we're there to stay.
And once we become true partners, the needle moves and that's the magic of it. We do what we say. We don't let them down. If we find that we can't do something, we tell them. But we value that third partner in this, and that is the community and being true to our word. So I would say, if you're the institution and you want to solve this problem, find out exactly what the problem is, understand it fully, go down and talk to the human beings you're going to be dealing with. Find out what they need, what their priorities are, and start there.

00:10:04:14 - 00:10:05:15
Elisa Arespacochaga
I love that. Marc?

00:10:05:17 - 00:10:26:27
Marc Welsh
Yeah, I mean Doctor Sumner said it so well, and I think I would sum that up for us is humility. I mean, it is the willingness to see folks who are collaborating as equal partners in advancing this work, of seeking to understand the needs of those communities and letting them guide you, letting them invite you in, and not assuming that you know better.

00:10:27:00 - 00:10:54:07
Marc Welsh
I think what I've learned more than anything else through this journey is that we have a lot of expertise here at children's, but there's a lot of things we can learn and have learned from our rural communities. From the way that, you know, health care has to be approached from what folks know on the ground. And so having that humility -- coupling that humility with trust and trust and empowerment of others to carry out the work. For us at Children's, we came into this with really two things: We said, "We want to lend our expertise and we want to lend the resources needed for this to work. But beyond that, we have to trust our partners to carry out the work that is important to them and entrust these communities to know what is best for their community." That is vitally important. We cannot look at these things through a city lens. I think we fail if we go into it with that mindset. And so I would implore anyone who's interested in this type of work to enter it with humility, to enter it with a desire to empower others to carry out what is best for their communities.

00:11:29:04 - 00:11:54:26
Elisa Arespacochaga
I love that this is about you have some expertise that can help support that community. let them guide you to what it is that they most need and how best to employ it. Well, thank you both for both the work that you've done and the humility and trust you brought to it. And I can't wait to hear about the hundreds of pediatricians across Georgia that will be serving in the next decade.

00:11:54:29 - 00:12:04:23
Jean Sumner, M.D.
I've worked in rural health my whole life, and I am so excited that if we can affect these families and these kids, we're going to have a healthier, rural Georgia.

00:12:04:25 - 00:12:13:06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:17:10
Tom Haederle
Welcome to Advancing Health. When a heart attack strikes, every minute counts. Today we hear about a new cutting edge communication platform that sends patient to EKGs directly from the ambulance to the cardiologist in real time.

00:00:17:12 - 00:00:40:09
Tom Haederle
I'm Tom Haederle, senior communications specialist with the American Hospital Association. Glad you can join us. And I'm also really pleased that Josh Neff could join us. Josh is president of Mercy Hospital in Durango, Colorado, an area of the state known as the Four Corners region, and is here today to talk about how Mercy is using a cutting edge communications tool called Pulsara to assist patients who are dealing with cardiac issues.

00:00:40:12 - 00:00:44:12
Tom Haederle
Josh, thank you so much for joining me on Advancing Health today. Really appreciate you being here.

00:00:44:14 - 00:00:50:14
Josh Neff
Yeah Tom it's a pleasure. It's a it's a great opportunity to talk about some really great things we're doing in southern Colorado for cardiac care.

00:00:50:16 - 00:00:54:27
Tom Haederle
Well let's start with the basics. What is Pulsara? And how is Mercy Hospital using it?

00:00:54:29 - 00:01:32:27
Josh Neff
So Pulsara is ultimately a field to hospital communication tool. And we've got a large and remote area. And sometimes our response times are lengthy in southern Colorado, especially in the Four Corners area we've got a lot of mountain passes. When it's snowy, it creates some really delayed times getting critical patients to the hospital. And so Pulsara is really a way for us to connect and communicate with our pre-hospital providers across our seven counties that we serve in southern Colorado and northern New Mexico, where for patients who are having chest pain and cardiac related issues, EMS has progressed over the last decade or two, and we've now got paramedics and other folks that

00:01:32:27 - 00:01:58:07
Josh Neff
are doing 12 lead EKGs in the field as soon as they arrive at the patient. And that's a really important thing for us to know and understand. How do we get that EKG to a cardiologist that's in a hospital, 20 or 30 miles away, or maybe more? And so, Pulsara really bridges that gap for us. It allows those pre-hospital teams to transmit that EKG and a HIPAA compliant manner directly to the cardiologist on call.

00:01:58:09 - 00:02:20:29
Josh Neff
And that cardiologist then is able to help the pre-hospital team manage that patient clinically. It also allows us to be more prepared if that patient is actually having a STEMI or a heart attack. It allows us to have our teams ready and prepared so that that patient goes directly to the cath lab and undergoes cardiac treatment, in a shorter period of time.

00:02:21:01 - 00:02:39:13
Tom Haederle
Take us inside the ambulance itself if you would for a minute. So you've got a patient in there who's having a cardiac issue enroute to the hospital. Could be a long drive ahead. What is happening in the ambulance itself and how EKG and other vital signs - how is that all being monitored and transmitted? How does that happen?

00:02:39:16 - 00:03:06:05
Josh Neff
There's both Bluetooth and direct wire technology and capability between. Basically it's transmitted over cell service. And even in the remote areas where cell service is a little bit patchy, the Pulsara system is accumulating this data in the background. And then as soon as it hits a signal, it automatically transmits which allows that pre-hospital team, that those paramedics and EMTs to be focused on working on that patient and providing care. As a former pre-hospital guy -

00:03:06:05 - 00:03:22:14
Josh Neff
so as a ground paramedic and a flight paramedic way back in the day - we didn't have this technology and and it's it's really comforting for the team to be able to know that they've got, a group of specialists just, at their fingertips that can help us and help them care for that patient. And so basically, they get the machines hooked up.

00:03:22:14 - 00:03:38:20
Josh Neff
Pulsara can connect directly to their cardiac monitors. And so it feeds through that system and and electronically can transmit a wide amount of data to us and to our caregivers that are at Mercy Hospital ready and waiting for that patient to come in.

00:03:38:22 - 00:03:44:06
Tom Haederle
And so what do they do with that information, once it is transmitted? That helps with treatment plans.

00:03:44:06 - 00:04:01:10
Josh Neff
It does. So during the day, we've got our cath lab. We have two cath labs at Mercy Hospital. We're the only cath lab program in the southern part of the state and serving northern New Mexico. And so we've got folks on call or in the department every day. However, if it's after 5 or 6:00 at night, we've got an on-call team.

00:04:01:13 - 00:04:21:17
Josh Neff
The goal is really with this to reduce the amount of time from first medical contact to device. And device is kind of that reperfusion or the treatment time that's tracked by all of the accrediting agencies. We know that the earlier we perfuse an artery, it leads to better outcomes. And that's both in-hospital mortality as well as long term recovery.

00:04:21:17 - 00:04:55:15
Josh Neff
And so what it allows us to do specifically at Mercy - before implementing Pulsara, we had about 130 minutes from first medical contact to reperfusion times. I mean, our cardiology team has worked with Los Pinos CMS, Pagosa Springs Hospital, Upper Piney EMS, all Durango Fire Department, and a number of other agencies. This year, since we've implemented Pulsara, we've been able to reduce that time from first medical contact to perfusion from 130 minutes to 84 minutes.

00:04:55:15 - 00:05:23:18
Josh Neff
So we've seen a 35% decrease in time Because typically what would happen is that patient would come to the ER, they'd have a repeat EKG, yes, you're having a STEMI. We should have the cardiac team here. You need to go to the cath lab. They'd have to, you know, drive in from where they were. And so what this has allowed us to do is our cardiologist directly receives this EKG on a cell phone, is able to interpret the EKG, and he or she makes the call in real time.

00:05:23:21 - 00:05:33:23
Josh Neff
This patient's having a STEMI. Hits the button, alerts our cardiac teams. And so that patient can come directly to the cath lab and undergo treatment immediately.

00:05:33:26 - 00:05:45:03
Tom Haederle
That's remarkable. And being able to shave that much time off from the older way of doing things prior to Pulsara, what kind of results has that yielded so far in terms of patient outcomes?

00:05:45:05 - 00:06:05:03
Josh Neff
So we know that that time is tissue. We are in the process of tracking the official data. What I can tell you anecdotally is we're seeing patients with shorter hospital stays getting back home and back to work and back to play in a shorter amount of time. And we're seeing better outcomes clinically for them as well.

00:06:05:11 - 00:06:17:10
Tom Haederle
That's just amazing. What kind of training is involved in using the Pulsara system, both for Mercy Hospital, ambulance employees, EMS people...is it a complicated thing to get the hang of, or not really?

00:06:17:12 - 00:06:37:25
Josh Neff
It is not. If you can operate your social media apps on your cell phone, you can understand and operate Pulsara. It is that simple. It's intuitive. It knows how to store the information, what to send. And so when those pre-hospital folks hit that send button, it just automatically alerts the team that's on the receiving end of it.

00:06:37:26 - 00:06:50:14
Josh Neff
Those folks who have the same Pulsara on their communication devices. They get an alert, they can go right in and tap the picture, look at the EKG. They can look at vital signs, a number of different things. So it is very easy to use.

00:06:50:21 - 00:06:57:00
Tom Haederle
What about the cost involved? Is that something that is within the budget, would you say, of many hospitals or health systems?

00:06:57:02 - 00:07:12:12
Josh Neff
Yeah, it is, it is not an overtly expensive investment. And it's an investment in clinical care and quality outcomes. So it made all the sense in the world for us to do it. We know that if we can save one life over the course of a period of time, then those investments are well worth it.

00:07:12:12 - 00:07:22:05
Josh Neff
But, I would say to any hospital CEO as well as the EMS programs are out there, it is an affordable program that you can and you can easily integrate.

00:07:22:07 - 00:07:30:27
Tom Haederle
Would it be as helpful, do you think, for hospitals in more urban areas that really aren't looking at the same transport times, you know, with that patient in the ambulance?

00:07:30:29 - 00:07:48:06
Josh Neff
I think it could be used widely across all markets. I mean, I was in on the Denver Front Range before I moved to Durango. And, you know, it may take you 45 minutes to go 6 or 7 miles if you hit traffic wrong or there's a wreck. And so time is still tissue, and it's still important for those patients to receive timely care as well.

00:07:48:06 - 00:08:06:00
Josh Neff
And so it extends our ability for our cardiac specialists to have eyes and ears in the field, in the ambulance and understand what's going on with the patient. It allows our clinical teams to be thinking about, you know, what kind of STEMI does this look like? What should we be prepared for when this patient comes in the door?

00:08:06:02 - 00:08:31:27
Josh Neff
You can have a heart attack and still have pretty stable vital signs. You can also have a heart attack and be really, really sick with unstable vital signs. And so being able to communicate that to our team just allows them to mentally prepare for what's about to come through the door. You know, listen, I was doing pre-hospital care in the early and mid 90s, and we didn't have this technology and we serviced some real markets. And, this would have been a game changer back then.

00:08:31:27 - 00:08:52:23
Josh Neff
I know for sure that this technology is saving lives and impacting the people who live and work in my community, and that's important to me. That's why I'm passionate about being the CEO of this hospital. That's our role in this world, is to make sure that we're taking great care of our community in a way that's meaningful, and this is just another tool in our toolbox that allows us to do that.

00:08:52:25 - 00:09:02:29
Tom Haederle
Well, thank you so much for your description of what it offers and how you're putting it to use. And,thank you for the great care that you're offering your patients every single day. Really appreciate you being on Advancing Health today.

00:09:03:01 - 00:09:06:21
Josh Neff
Yeah, it's a pleasure. Thanks for asking us to talk about this.

00:09:06:23 - 00:09:15:05
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:06 - 00:00:31:02
Tom Haederle
Welcome to Advancing Health. Being your best at anything usually boils down to practice, practice and practice. All across rural Iowa, first responders and other health care professionals are getting in that critical practice to improve patient outcomes, and the training that makes it possible is delivered right to their doorstep.

00:00:31:05 - 00:01:07:29
Tom Haederle
I'm Tom Haederle senior communications specialist with the American Hospital Association, and I'm delighted today to welcome two health care professionals to introduce us to Simulation in Motion, Iowa. That's a mobile clinical education initiative that delivers on-site simulation training to EMS providers and others who provide care to the about 43% of Iowans who live in rural areas. Joining me today to talk about this are Dr. Jacinda Bunch, an assistant professor at the Iowa College of Nursing, and senior advisor to the SIM in Motion Iowa program, and Tina Eden, who is CEO of Virginia Gay Hospital in Vinton, Iowa.

00:01:08:02 - 00:01:11:18
Tom Haederle
Tina and Jacinta, thank you so much for joining me on Advancing Health today.

00:01:11:21 - 00:01:12:27
Jacinda Bunch, Ph.D., R.N.
Thank you for having us.

00:01:12:29 - 00:01:13:23
Tina Eden, R.N.
Thank you.

00:01:13:25 - 00:01:27:01
Tom Haederle
Well, let me start with you, Jacinda. Maybe you could take a whack at this first. I'm sure that my introduction did not do full justice to this wonderful program. So what needs was it designed to meet? And what kinds of medical scenarios do the care teams get to practice?

00:01:27:03 - 00:01:59:26
Jacinda Bunch, Ph.D., R.N.
So Simulation in Motion Iowa or SIM Iowa, is a mobile simulation program where we have three trucks that we take across the entire state. We allow health care providers to practice to take care of our simulated patients. They can provide care for patients they don't see very often. They can take care of patients in new settings. It's a way to test new protocols and really just to refine the care that they're providing, across the state to really improve patient outcomes.

00:02:00:02 - 00:02:33:28
Jacinda Bunch, Ph.D., R.N.
And we really designed this because in rural Iowa, access to simulation education is a challenge. It's expensive. It requires special training to really do it well. And we all know that resources are somewhat limited in our rural areas. So this provides both EMS providers and hospitals with the opportunity to have their staff go through simulation education to really enhance the care that they're providing across the entire state, regardless of where they live.

00:02:34:00 - 00:02:36:05
Tom Haederle
How realistic are the scenarios?

00:02:36:08 - 00:02:59:28
Jacinda Bunch, Ph.D., R.N.
So we work together with both the hospitals and the EMS providers to really design the scenarios to best fit their location, what they're seeing and the things that they feel that they need to work on the most. We can do medical scenarios. We can do trauma scenarios. We have simulators that are adult, pediatric, infant and then a neonate, a 25 week premature baby.

00:03:00:00 - 00:03:24:19
Jacinda Bunch, Ph.D., R.N.
So we can really do almost any type of medical or trauma scenario. And then we also work to make sure that the scenarios match the local protocols. So we're going to ask you to use the same medications that you have access to, the same equipment, and really follow your protocols rather than having you do something if you travel to a mobile SIM center that might not match what you do locally.

00:03:24:21 - 00:03:35:29
Tom Haederle
And I guess in some cases, the EMS teams or the people that are getting the training or working on - I don't want to call them crash test dummies because I know they're not - but they're human bodies in a sense, right, that they get to do some of these things on?

00:03:36:01 - 00:04:03:17
Jacinda Bunch, Ph.D., R.N.
Yes. So our simulators are basically mini-computers. So they're little robots. They have heart sounds. They have lung sounds. You can take pulses, you can give them medications. We can amputate an arm and have arterial bleeding that they need to control. We can change heart rhythms based on medications that are given. So we really can create almost any medical or trauma scenario.

00:04:03:21 - 00:04:14:25
Jacinda Bunch, Ph.D., R.N.
We try to make it as realistic as possible. Again, we want to put the learner in that environment that they would be caring for a live patient and really try to recreate as much of that as we can.

00:04:14:28 - 00:04:25:17
Tom Haederle
Wow, that's really impressive. Tina, if I could get your thoughts as the CEO of a hospital and boss of some of the care teams that have received this training, how did it work out for your folks?

00:04:25:19 - 00:04:51:09
Tina Eden, R.N.
Really, with any simulation, muscle memory is so important to build confidence in our staff. Some of the experiences they have with the simulation mannequins are those that it would take a year in their training to receive that same experience. And so it's really invaluable. It does provide a lot of confidence and just creates more of a teamwork environment.

00:04:51:09 - 00:04:56:05
Tina Eden, R.N.
They do work with a group of other individuals when they go through their simulations.

00:04:56:07 - 00:05:13:20
Tom Haederle
Sort of circling back to some of the most valuable services that the program offers, I understand that, 32 of Iowa's counties are considered maternal care deserts, meaning they lack adequate labor delivery, postpartum care services. How has Sim-Iowa helped in that particular sphere?

00:05:13:23 - 00:05:40:12
Tina Eden, R.N.
At Virginia Gay hospital, we did actually have a maternal child simulation lab come as well as SIM-Iowa. In working with those pediatric patients, it's really important our staff just don't have the pediatric experience. And working in a critical access E.R., you can see anything on any given day. So it's really important to have that in lab experience to handle those situations,

00:05:40:12 - 00:05:43:06
Tina Eden, R.N.
everything from a burn to a crush injury.

00:05:43:08 - 00:06:07:10
Tom Haederle
SIM-Iowa, as I understand it, has now visited, I believe, all 99 counties in Iowa. I think some of the most important lessons learned in the field have not necessarily been hands on operations and emergency response, but more having to do with emergency protocols and things like that. Can you both speak to that aspect of the training and maybe not, you know, if it's not treating a patient who is up on a stretcher

00:06:07:15 - 00:06:14:18
Tom Haederle
what are some of the other big lessons and takeaways that that the care teams have benefited from as the program goes around the state?

00:06:14:20 - 00:06:34:26
Jacinda Bunch, Ph.D., R.N.
I know a couple of things that we have experienced with our educators is when we go into a either an EMS agency or a hospital and we're working with scenarios that they don't see very often, they may have read those protocols multiple times, but to really pull them out and go through the steps, do we really have this medication in stock?

00:06:34:26 - 00:06:58:10
Jacinda Bunch, Ph.D., R.N.
Does everyone know where it is? How do we access it? What about this piece of equipment that we don't pull out very often? Have we really had the chance to use it hands on? Does everyone know how to work it well? Tina mentioned that muscle memory...to actually get your hands on it and do the tasks and provide the care and use the equipment, especially when it's something that we may not see as often.

00:06:58:13 - 00:07:20:01
Jacinda Bunch, Ph.D., R.N.
So that has been a huge piece. Our EMS folks bring their bags in so they are going through their own jump bags and finding their equipment and pulling out those things that maybe they don't see very often. And we also are able to take our mannequins inside the hospital so that they are also providing care in the same location that they will be with a live patient.

00:07:20:03 - 00:07:50:16
Tina Eden, R.N.
We were able to do an onsite airway training with SIM-Iowa where they actually came into our emergency department and worked on difficult innovations with our E.R. staff, including our physicians and physician assistants, as well as our nursing staff. We were also able to do emergency procedures in their unit, and that's something that we would only use in an extreme emergency, and our staff weren't comfortable.

00:07:50:19 - 00:08:06:23
Tom Haederle
The program was recently gifted with, I think, more than $5 million in investment by the Wellmark Foundation to expand the reach and frequency of the training. I wonder if you both could speak to what the plans are for this funding. How do you see it helping and benefiting patients around the state?

00:08:06:26 - 00:08:32:06
Jacinda Bunch, Ph.D., R.N.
Well, the focus of this particular gift from the Wellmark Foundation is really has a focus on our rural hospitals and EMS providers. So what this gift is able to provide is two trainings every year for our rural and mixed urban rural counties. So those are our emergency departments' primary focus. So it's maybe a medical scenario in the E.R., like sepsis.

00:08:32:06 - 00:08:57:21
Jacinda Bunch, Ph.D., R.N.
It might be a trauma like a motor vehicle accident. But they will receive two of these trainings. And those costs are covered by the gift from the Wellmark Foundation. And then in addition, the maternal care desert counties are also provided one obstetric emergency training. And that is delivered in partnership with the IPQCC, which is the Iowa Perinatal Quality Care Collaborative.

00:08:57:23 - 00:09:11:08
Jacinda Bunch, Ph.D., R.N.
And so our educators are working together. We go out jointly and provide this education in the maternal care deserts. And the Wellmark Foundation is paying for these trainings to occur over five years.

00:09:11:11 - 00:09:27:07
Tom Haederle
That's fantastic. Is it your sense that there's a great appetite for this? Maybe, Tina, you can speak to that because you're one of the hospitals who have benefited from the training. Do you have the sense from your own folks that, wow, this was fantastic. You know, a great, great use of our time, and we'd love to see them come back and do more of this kind of work?

00:09:27:09 - 00:09:49:02
Tina Eden, R.N.
Absolutely. It's very engaging for the staff. They get to do those hands on skills that they may not necessarily do. And a lot of the apprehension that new staff will have working in the emergency department is they just haven't seen something before. So it really provides that access to think through, talk through, and work through an emergency situation.

00:09:49:05 - 00:10:04:24
Tom Haederle
I don't know this for sure, but this is the only program that I'm aware of in Iowa that is set up to do what it does and organized like this. If another state is considering doing something similar, what advice would both of you have in terms of what you've learned so far and what you know works?

00:10:04:26 - 00:10:30:19
Jacinda Bunch, Ph.D., R.N.
I would say from launching this program, some of the things that we learned and actually did were to partner with a state that was already doing something similar. The Helmsley Foundation, Helmsley Charitable Trust, provided the initial start-up funding for this program, and they have done so in four other states. Each of us run our programs just a little bit differently, but we collaborated with them and we learned from them.

00:10:30:19 - 00:10:54:12
Jacinda Bunch, Ph.D., R.N.
We learned the mistakes they made and also the things that they did well. And then really just getting out and talking to providers across the state to hospitals, to EMS agencies and finding out what their needs specifically are. We don't want to come in and say, you need A, B, and C, we want to know what you need, and then we can provide that for you.

00:10:54:14 - 00:10:56:21
Tom Haederle
Got it. Tina, any final thoughts?

00:10:56:23 - 00:11:07:21
Tina Eden, R.N.
If there are other facilities that haven't used SIM-Iowa, I would recommend it. It's been very time valuable and well worth the cost of training your staff.

00:11:07:24 - 00:11:17:21
Tom Haederle
It sounds like a marvelous program and really impressive. Thank you so much for spending some time with me on Advancing Health today to talk about this and share your insights and your knowledge.

00:11:17:23 - 00:11:18:14
Tina Eden, R.N.
Thank you.

00:11:18:17 - 00:11:20:02
Jacinda Bunch, Ph.D., R.N.
Thank you.

00:11:20:04 - 00:11:28:15
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.