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Providing critical care at a price: maintaining Wisconsin’s Critical Access Hospitals

FRIENDSHIP (WKOW) — For 80-year-old Nancy Livingston, a trip down the halls of Gundersen Moundview Hospital in Friendship comes with a degree of familiarity, and in late June she once again found herself in need of critical care.

“This morning my neighbor brought me in after we decided maybe we oughta maybe get to the ER,” she said.

That morning, her knees couldn’t bear any weight so Livingston said her nurse practitioner admitted her to the hospital for observation.

“I’m very grateful this emergency room was here saved me a couple times,” Livingston said.

To do that, Gunderson Moundview keeps its emergency room open 24/7, though it’s rarely full. According to the CEO, Frank Perez-Guerra, the hospital sees two to three inpatient visits a week.

“If we weren’t able to do that then people would have to drive to Madison or other bigger cities to have major services taken care of,” he said.

That’s the case for the roughly 25 percent of Wisconsinites living in rural communities, who rely on Critical Access Hospitals.

They’re small 25-bed facilities with 24/7 emergency rooms located about 35 miles away from hospitals.  Wisconsin has 58, including Gundersen Moundview.

In a field where minutes matter, Perez-Guerra said Moundview’s mission is to provide that care close to home but that comes with the same challenges facing rural hospitals across the country, starting with staffing.

“Especially with family medicine they really have their choice to go anywhere they want in the country honestly,” he said.

On top of that, transportation barriers make it difficult for a lot of patients to get to their care or fill their prescriptions on time.

“Either you have your own form of transportation or, like you would guess in a small community, you rely on your neighbors and friends and that’s what gets you from place to place,” Perez-Guerra said.

While managing these challenges, Perez-Guerra said the hospital, like all businesses, has to meet a bottom line.

“The primary mission is to take care of our patients and take care of our communities but in order to do that we need to be financially viable and its difficult to do that,” Perez-Guerra said.

According to the National Rural Health Association nearly half of rural hospitals across the country lose money and in the past 10 years, 106 hospitals in 29 states have closed their doors, including one in Arcadia, Wisconsin.

“Challenges that healthcare has in general are that much more magnified in rural health,” Perez-Guerra said.

Still, for those like Livingston, who rely on these services, interruptions to that care could be fatal, as she learned when she stopped breathing a few years ago.

“They had to call an ambulance and they got me here to Moundview and there was a nurse here that put in a central line and that’s what got me going,” she said. “They actually got me breathing again and then stabilized me enough to transport me.”

Because even in a town of couple hundred, Livingston said a hospital like Moundview is essential to keeping her community alive.

“It’s made a lot of difference to me because it allows me to live independently in my home,” she said.

To help the hospitals stay alive, Perez-Guerra said an increase in Medicaid reimbursements would go a long way, allowing them to make hospital improvements or pay their staff competitively.

According to the Wisconsin Rural Health Cooperative, the new state budget will provide some help with $9.9 million in additional funding for rural hospitals over the next two years.

Watch an extended interview with Livingston here:

Michelle Alfini

Reporter, WKOW

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