RX for Change: Confronting the health care crisis in Kansas

Vickie Moss

The Ottawa Herald

Sometimes the little details make life more enjoyable.

For Pat Mourning, 57, Ottawa, that means taking long walks around town without pain.

It means not sitting in a car for 21/2 hours, three times a week while traveling between Ottawa and Kansas City, Mo., for physical therapy sessions after double knee replacement surgery.

And it means running into her physical therapist at the grocery store and hearing her say, "You look great."

Mourning, who underwent knee surgery in January at St. Luke's Hospital in Kansas City, discovered she could receive physical therapy at a new rehabilitation center in her hometown, saving her a 100-mile round trip trek three times a week to Kansas City.

The quality of care and variety of services offered at the Gollier Rehabilitation and Wellness Center in Ottawa surprised Mourning.

The center is unique for a town with a population of just 12,000, but it offers an example for smaller cities trying to compete with larger counterparts for health care dollars.

The rehabilitation center, which opened in January 2003, is one of several efforts in recent years by officials at Ottawa's Ransom Memorial Hospital to provide state-of-the-art medical care previously offered in metropolitan areas only.

Such labors helped the medium-sized hospital rebound from years of financial turmoil into a facility recognized nationally for its care.

But smaller cities face an ongoing challenge to provide the type of care that keeps local residents from driving to specialists in nearby cities.

Networking

Operating small hospitals in Kansas is a little like being the smallest child on the school playground. Survival means banding together with others similar in size or finding a bigger, stronger friend for protection against bullies.

Many small- and medium-sized hospitals, especially in rural areas, join together in health networks. The Kansas Medicare Rural Hospital Flexibility Program matches small rural hospitals, or critical access hospitals, with larger, full-service hospitals. A federal grant program promotes network development.

The resulting networks can be one-on-one partnerships, like the pairing of St. Luke's-Shawnee Mission Health System with the much-smaller Anderson County Hospital in Garnett in eastern Kansas.

But the networks also can be quite extensive, such as the Northwest Kansas Health Alliance, which serves more than 20 county hospitals with a larger, secondary care hospital in Hays.

Hospitals in larger Kansas cities, like Salina, also establish specialty programs, such as a new cardiac care unit, to lure patients from major metropolitan areas, like Wichita and Kansas City.

Still, many hospitals face the challenge of convincing residents they can receive quality care within their own communities.

Across the state, 11 counties - mostly rural and within an hour's commute of larger health care centers - retain less than 25 percent of their residents' hospital care, according to an annual report from the Kansas Hospital Association.

In 57 of the state's 105 counties, fewer than 50 percent of residents remain in their home county for hospital care.

Measuring quality

Ransom Memorial Hospital, like many across the state, struggled financially during the 1980s and 1990s. But voters in 1994 approved a half-cent sales tax increase to support the hospital's new leadership and its focus on improving the center's quality of care.

The hospital experienced a dramatic turnaround.

It was recognized by Solucient, a company that measures hospital performance, as one of 100 top hospitals across the nation in performance improvement. Salina Regional Health Center and Shawnee Mission Medical Center received similar recognition last year.

"Everyone claims quality care," said Larry Felix, Ransom Memorial Hospital's chief executive officer. "Not everyone made ... the top 100. Quality and size of a hospital are not a direct relationship."

Ransom Memorial Hospital has operated in the black for much of the last few years. In addition to adding the rehabilitation center, hospital officials oversaw a $2.5 million renovation project and helped establish full-time practices for specialists.

Still, there remains a perception among some rural residents that bigger means better.

That's something Ottawa ophthalmologist Kenneth Frank discovered when he set up his practice in 1996. Frank grew up near Franklin County and wanted to practice in a small community.

Most residents were grateful for a full-time, local medical doctor who specialized in eye disease, Frank said. However, some still believe physicians in small towns are in some ways inferior to physicians in larger cities, he said.

"I've been very fortunate to have been really busy from the start, but it is a source of frustration when I run into that mindset that you have to go to a bigger area to get quality care," Frank said.

"This is where I want to be. I could have been in the city, but from my standpoint this is a far better place to practice. I love doing what I do and where I do it."

Dedication to the community is what motivated Pat Mourning and her husband, Jeff, to seek their medical care, when possible, in Ottawa. They understand the challenges their local hospital has overcome, Pat Mourning said.

Her family practice doctor in Ottawa treated Mourning when her knees started going bad about five years ago. But when prescription drugs and cortisone shots no longer proved effective, Mourning was forced to consider surgery.

She chose to have the procedure in Kansas City, Mo., because she knew the surgeon personally and could have both knees replaced at once. But even her Kansas City-based surgeon recommended Ottawa's Gollier Center for post-operative physical therapy.

"He bragged on the Gollier Center," Mourning said.

"Riding (in a vehicle) causes swelling. If I had to ride that long three times a week for five months, I would have been exhausted. It takes a lot out of you."

Battling perception

Even with Ransom Memorial Hospital's recent improvements, more than half of Franklin County residents still seek hospital care outside their own community.

Changing the perception that residents can receive the best health care in their own backyard takes time, said Felix, the hospital's CEO.

"How do we increase market share?" he asked. "By doing the things we do well and encouraging the community to tell our good story and use the local services if they need them."

And, Mourning said, it helps to have a personal touch.

Though she has completed physical therapy, Mourning occasionally runs into her therapist in Ottawa.

"She'll say, 'I've seen you walking around town and you look really good' or 'there's something about your gait we need to work on.' There's moral support."

It's a small detail, Mourning said, but it's a quality difficult to measure.