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WNC Business

Unique offerings and challenges of operating a rural hospital

Feb 14, 2024 07:29AM ● By Randee Brown

St. Luke’s Hospital is a locally- and independently-owned Critical Access Hospital, which CEO Michelle Fortune said is crucial for the many rural residents in Polk County. There are numerous specialty practices including those focused on cancer, orthopedics, behavioral health for seniors, and two rural health clinics for family health that operate on a sliding scale.

“St. Luke’s consists of a lot of things outside of the main hospital,” Fortune said. “About 65% to 70% of our business is outpatient work, so we take care of a lot of people outside of the hospital.”

Within the rural health clinics, there are embedded specialty care practitioners like a surgeon and a cardiologist that work in the clinic two days per week, which Fortune said is crucial for patients of lower income that often see barriers to specialty care.

As a nonprofit, revenues go back into the organization to fund facility updates and to help others afford certain services. St. Luke’s does a lot of work with philanthropic organizations to gain grants, and the NC Office of Rural Health helped to identify a grant allowing the cardiology program launch. Other funding comes from fundraisers and donations from generous community members.

The Critical Access Hospital designation is a federal government designation that gives some funds back to St. Luke’s on their annual cost report for the Medicare patients cared for in their facilities. 

“That’s what keeps hospitals like ours able to care for the community,” Fortune said. “It’s probably the biggest help for us to stay open.”

Unique services are provided due to the CAH designation. There are “swing beds” - 25 inpatient beds can be used for skilled nursing care or inpatient admission. This allows for all-hours services and stronger outcomes, resulting in shorter stays for many patients.

Not only does the CAH designation assist with funding and allow for flexibility within the facility, it really highlights how important this location is to the community. With mountainous terrain in a rural county, it can take some residents 25 to 30 minutes or more to get to the next available hospital, and that could take much longer in the winter, according to Fortune. “This can mean the difference in life and death for those folks,” she said.

Because of the rural location, Fortune said there is a common misconception that the providers are not as good as those in metropolitan areas. Providers at St. Luke’s have trained at esteemed universities like Johns Hopkins and served on presidential panels for research and other nationally-led programs, and are now serving the rural communities in Polk County.

Staffing for entry-level positions can be challenging outside of metropolitan areas, according to Fortune. Housing prices are still costly like the rest of the WNC region, and there are no apartment complexes, so affordable options are limited for younger professionals. The retention level is high at St. Lukes, and Fortune believes programs with local high schools will get people interested in serving their own community and encourage them to stay local instead of relocating to urban areas.

Telehealth visits can be challenging due to limited Wi-Fi availability in the county. Some local clinics allow patients to use space to conduct Telehealth visits with other providers, and St. Luke’s has to design these offerings to work on all types of devices to accommodate patients’ needs.

“We have to have creativity,” Fortune said. “There’s nothing ‘cookie-cutter’ about trying to serve patients in a rural area.”

One creative solution has been to host a men’s health clinic combined with a car show. There are offerings including lab draws, skin cancer screenings, and blood pressure checks, and Fortune said this helps encourage people to actually show up for the preventative and diagnostic services that are important for their wellbeing.

“We are also investing time, money, and resources to do more preventative work to keep people healthy,” Fortune said. “There is a high rate of prevention related to things like cancer screenings and coronary tests. I know that sounds strange because some wonder how we’ll stay open as a hospital if we keep people well — if we ended up working ourselves to not needing inpatient beds, then great. We’ll have a whole different focus. Our goal is to keep people healthy."