Rural Setting Doesn’t Hamper Growth of Specialty Care at Door County Medical Center

3,500 patients received specialty services in past 11 months 

Rural America is a little bit older, a little bit poorer and a little bit sicker than its urban counterparts. These factors and decreasing populations cause many rural hospitals to struggle financially, according to the Rural Health Information Hub, an organization supported by the U.S. Department of Health and Human Services. 

Although “rural” is defined more by what it’s not – an “urbanized area” of 50,000 people or more, or an attached “urban cluster” of 2,500-50,000 – it’s exact enough to differentiate the data. Across the country, 500 rural hospitals are at immediate risk of closing because of inadequate revenues and very low financial reserves, according to a March 2022 report by the Center for Healthcare Quality and Payment Reform. More than 300 others are at high risk within five years. Fifty-nine percent of the hospitals that closed between 2015 and 2019 – more than 150 – were rural hospitals.

That’s not good news for the 46 million U.S. residents living in rural areas in 2020, or 14% of the U.S. population, according to the USDA Economic Research Service’s 2021 edition of Rural America at a Glance. Door County residents are among that population of people because of its functional classification as a “rural” county: a 2020 population of 30,066 and not a member of a metropolitan statistical area. 

Yet amenities and access to provisions and services that are typically exclusive to urban areas are available in Door County, whether they’re entertainment, dining or shopping options. Also in that atypical category is local access to health care services, including specialists – an area that Door County Medical Center (DCMC) has been improving.

Door County’s 79-year-old, critical-access hospital and outpatient medical center in Sturgeon Bay, with rural health and/or rehab clinics in Algoma, Fish Creek, Sister Bay and Washington Island, is by definition a rural hospital health care provider. But, in partnership with Prevea Health Services, DCMC began offering additional specialty services in 2016 that patients would previously have needed to travel to Green Bay to receive.

Since July 2022, Prevea specialists have seen 3,500 Door County patients. 

Brian Stephens, Door County Medical Center’s CEO, succeeded former president and CEO Jerry Worrick in January 2019. Prior to that, Stephens had worked at DCMC for 13 years as its chief financial officer and chief administrative officer.

“That’s 3,500 trips prevented from having to go to Green Bay,” said Brian Stephens, DCMC’s CEO. 

What straps rural areas is the lack of patient volume. That’s why long journeys to crowded urban areas for treatment are a given for rural populations across the nation, rather than being able to access conveniently reachable health services within their rural communities. 

“It takes a critical mass of patients to make specialty care work,” Stephens said. “That’s why it makes sense to partner with more urban specialists.”

The menu of specialty-care services is enabled through Hospital Sisters Health System (HSHS), which has owned a minority share of DCMC since 2016.

“We’re 60% locally owned and controlled, and 40% owned by [HSHS],” Stephens said. 

HSHS is a multi-institutional health care system based in Springfield, Illinois, that cares for patients in 14 communities in Illinois and Wisconsin. HSHS’s hospitals in Green Bay are St. Vincent’s and St. Mary’s, and its medical group is Prevea Health Centers. 

It’s providers from those entities who travel regularly to Sturgeon Bay. In 2020, DCMC dedicated space for the Prevea Specialty Clinic to house the Prevea specialists when they rotate up. The full menu of specialty services now includes asthma and allergy, audiology, ENT, endocrinology, heart and vascular care, weight management, neurology, rheumatology, physiatry and pain management, urology and vascular surgery. 

The specialty-care services amped up right when COVID-19 clamped down, which may have kept the full scope of services offered off the radar of the larger community. Still, those services are offered based on community demand.

“On a quarterly basis, we get together and talk about the specialist needs,” Stephens said. “We base that on our PCP [primary care physician] referral data.”

Some of the highest-demand specialty care has been for ENTs (ear, nose and throat specialists); endocrinologists, who treat hormonal issues; and neuromuscular specialists, who treat problems with the nerves in the body that cause problems with muscle function.

“A lot of that turns out to be pain medicine and back pain,” Stephens said.

Future plans call for improvements that would allow specialists to offer a wider range of local services.

“Over time, we want to buy the equipment they need and have the employees and do more procedures here,” Stephens said. 

DCMC will also increasingly employ telemedicine. Currently used largely for emergency-room services, such as immediate consultation with a neurologist when a stroke patient arrives, DCMC’s telemedicine offerings will expand when telepsychology services go online July 11.

“We see a lot of psych issues coming through the ER,” Stephens said. “We work with the county, but rarely do we have a psychiatrist right there in the room. Another thing that service will do, if a patient needs placement, that psychiatrist takes care of that referral.”

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