MercyOne Elkader Medical Center continues to improve services

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By Willis Patenaude, Times-Register


It was around this time last year when MercyOne Elkader Medical Center put out a public survey in an effort to gather feedback on everything ranging from community health and wants and needs, to exploring potential new avenues for healthcare and opportunities to provide it. 


Preliminary results revealed several problems areas for Clayton County, including health behaviors, clinical care in terms of access and quality and general social and economic factors. It also highlighted a deficiency in insurance plans being accepted, a lack of mental health assistance and an obesity epidemic.


The finalized report, which summarized most of what is already known, showed that, while MercyOne scored favorably on areas like ambulance service, the emergency room, outpatient services, and more importantly, that the length and quality of life in the county are trending in the right direction, the above list presented room for improvement. That’s something CEO Brooke Kensinger was eagerly willing to discuss, while also addressing the results of the assessment itself and the positive outcomes that have come as a result. 


One of the biggest net positives that emerged after the assessment was the acquisition of the Medical Associates clinics in Elkader and Monona last year. This opened the door to numerous improvements and advantages. 


At the time of the transition, Kensinger stated, “We are excited for this opportunity to better support the Elkader and Monona communities long into the future.”


“You know, there’s obvious needs because they’re apparent. It’s the ones that aren’t right in your face that you might not be as aware of,” Kensinger said. 


One of the immediate benefits solved an issue Kensinger was already aware of, and that was access to insurance providers that weren’t accepted at the clinic, but were at the hospital. However, post-acquisition, both places now accept the same insurance providers. In the case of the clinic, that means it opened access to more providers. 


According to Kensinger, the impact was felt almost immediately, as the clinic started taking in 30 new patients each month from July to December 2022. 


The area that has seen the greatest benefit is in high needs and patients with Medicaid, who previously had to drive to Guttenberg, and this eliminated that transportation hardship.


Another benefit, which addresses a community need, is opening access to patient records. Previously, the hospital and clinic did not use the same patient record system, but now, as Kensinger noted, “they’re all under one…which is so much better for patients.” 


When it comes to the aforementioned areas of concern, health concerns over drinking, obesity, diabetes and the elderly were not unknown. Again, Kensinger noted the new clinic as a way these needs will be addressed in a way that wasn’t previously available through the hospital, giving MercyOne “more control and ability to hone in” on some of the factors causing the problematic health conditions. This allows the clinic to provide proper resources, medication management and the potential to get mental health counselors within the community. 


“Now that we have that medical home under our umbrella, we’re better able to help and attack those types of conditions,” Kensinger said. 


Currently, the clinic doesn’t offer outpatient services for mental health, forcing patients to travel outside the area, but Kensinger stated it is “on the agenda.” She noted the new space available in the clinic opens the door to that eventually, though there are still hurdles to clear, mostly related to funding and whether there would be enough patients to support that service. 


This unknown, and the fact the hospital is not-for-profit, means every decision regarding a new service has to not just fill a need, but also be financially viable so the hospital can continue investing in its future. This includes maintaining updated CT, MRI and ultrasound machines.


“There’s a lot of things I’d like to do, but I think some of the constraints are space and funding…one step at a time,” Kensinger said.


The one-step-at-a-time approach is also being applied to another known area of need at the hospital and clinic: access to specialists such as pediatricians, dermatologists and OBGYNs. Presently, MercyOne has several specialists who visit the community on varying schedules. The list includes a cardiologist who visits once a month, a podiatrist who comes every two weeks, a general surgeon who comes for minor procedures and an ophthalmologist who visits once a month, but Kensinger is aware of the lack of depth in terms of specialists. 


“I think we need to increase the number of specialists in the community,” Kensinger said. 


On this front, Kensinger again brought up the existence of the clinic now being under the MercyOne brand, as a way to potentially alleviate this need. 


One thing preventing specialists from coming to Elkader is the lack of space for multiple exam rooms. According to Kensinger, these specialists typically want three to four exam rooms for efficiency. The other holdup is the number of patients, an area Elkader would struggle to compete in with Dubuque or Waterloo, where a day’s worth of patients is almost guaranteed. 


“If they’re driving to Elkader, they want to be busy. You’ve got to have the volume and you also have to have the space, and right now, we’re a little bit struggling on the space side, but that would be an area I would want to pursue. You know, expansion to be able to kind of add a visiting specialist clinic,” Kensinger said. 


There have been ongoing efforts to improve the hospital, especially the emergency room and ambulance services, both of which received high marks on the assessment. Over the previous seven years, the ER has made a “strong effort” at “enhancing the care” the hospital provides, such as adding full-time paramedics who also respond to all 911 calls, provided multiple calls don’t come in at the same time. 


The hospital also did away with the on-call model for physicians, and they’re on site to respond to the ER. They’ve added another ambulance with more EMTs and upgraded the equipment and technology on the rigs. 


These two areas, according to Kensinger, represent “the two most fundamental services and most important services” the hospital provides, which explains the investment in those areas. 


“We need to be very good at those two things because that’s going to save people’s lives,” Kensinger said. 


While the assessment has resulted in several areas being impacted in a positive way, the hospital underwent some difficulties over the previous year. They were unrelated to the assessment and more to do with the array of construction projects. The impact of Carter Street went beyond parking lot inconveniences and resulted in the hospital being unable to provide MRI services for several months, which cost between $80,000 and $100,000. 


The Keystone Bridge highlighted an odd feature that, in the past might seem quirky. But there’s nothing quirky about the fact the ambulance garage and hospital are on opposite sides of a bridge that is out of service for an extended period, slightly delaying response times. 


More recently, however, it came out that MercyOne is experiencing financial trouble, which will result in layoffs. What that means for Clayton County and Elkader is still an unknown. In a video released to employees, MercyOne CEO Bob Ritz said, “As the leader of MercyOne, I take full responsibility for the current situation.”


“As we have provided in previous weekly memos, MercyOne, like other health systems across the country, has experienced financial losses from patient care services,” Ritz added. He blamed the pandemic, inflation and gaps in payer reimbursements for financial troubles.


The Times-Register reached out to Kensinger regarding this development, but was redirected to MercyOne’s Interim Public Relations Manager Marcy Peterson, who replied, “As a non-profit health system, MercyOne serves a mission established more than 150 years ago to serve the health care needs of our communities. To ensure we continue to meet the needs of our communities, we must take steps to develop a more sustainable model of health care delivery.” 


Peterson said this includes re-sizing the organization for an even greater focus on delivering high-quality patient care. 


“Sadly, this means we have to make difficult decisions to reduce some positions. Position reductions will primarily be in non-clinical areas; however, some clinics or service lines may be impacted,” she continued. “In those cases, we are working to ensure clinical colleagues are connected with other opportunities that their skill sets align with. Colleagues whose positions have been eliminated will be eligible for a severance package that includes pay, medical coverage and other benefits.”

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