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Medically Challenged

A new model to bring health care to rural Idaho

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Idaho's budget writers apparently don't want to make a house call. Instead, they're asking citizens to make their way to Boise if they want to have any say in the Health and Welfare budget.

In fact, the process on Friday, Jan. 28, won't be terribly unlike a doctor's visit--take time off from work or school, negotiate a parking spot near the Capitol, take a number and wait your turn. When and if you get the opportunity to speak, you get no more than three minutes. That's it. There will be no on-the-record dialogue with lawmakers, and in a surreal beat-the-clock parade of speakers, no more than three hours will be allowed for public input into a Health and Human Services budget that could approach $500 million.

Staff from the Adams County Health Center won't be there. They're too busy providing care in what could be ground zero of Idaho's anemic economy.

Once upon a time (only three years ago), Adams County unemployment rate was 4.9 percent. Since then, things have pretty much collapsed. For the better part of two years, Adams has been saddled with the burden of the highest jobless rate in the state, at or near the 20-percent mark (more than twice the Idaho average). Equally painful is Adams' uninsured rate of 50 percent (compared to a statewide average of 15 percent, according to the Kaiser Family Foundation).

Yet against those odds, the Adams County Health Center in Council has grown as a beacon of medical hope and, ironically, as one of the region's largest employers.

"Doctors, nurses, technicians, dentists, hygienists, counselors," listed Denise Langston-Groves, executive director/CFO of the center. "We're significantly larger than we were just a decade ago."

In 2000, the center, formally named the Council Community Hospital, was hemorrhaging money. It closed in 2002, leaving a bare-bones rural health clinic.

"The clinic had little to no future," said Langston-Groves. "There were five of us."

All that changed in 2004, when Langston-Groves played "midwife," securing funds through something called a Section 330 operating grant from the U.S. Health Resources and Services Administration.

"We don't get any money from Adams County," said Langston-Groves. "And we get no money from the state of Idaho."

That's not to say that state funds don't have a direct impact at the center. Medicaid represents about 19 percent of billable revenue. Even more (23 percent) comes from Medicare, more still (32 percent) from private insurance. A full 26 percent is paid by clients on a sliding scale.

Patients represent a cross-section of the region, with needs from pre-natal care to near-death emergencies.

"There was a terrible accident up in the mountains," said Langston-Groves. "A chainsaw hit a snag, flipped backwards through the air, and landed down on a man's leg. Blood everywhere. It went right to the bone. But we stabilized him. He's doing fine now."

The center offers a menu of services: checkups, lab work, radiology, dental care, physical and occupational therapy, mental-health counseling and psychosocial rehabilitation.

But when you visit the center, tucked on a side street in the blink-or-you'll-miss-it town, the most impressive elements are Beatrice and Norman. They aren't staff members. Those are the nicknames for two cabinet-sized devices that are Idaho's first and only rural tele-pharmacy units.

Imagine a vending machine that dispenses your meds (even though the operators hate it when you call them vending machines). Simply put, a patient can bring a prescription into the tele-pharmacy office at the Adams County Health Center and get their meds in a day, two days at the latest.

Here's how it works: a pharmacist from Ontario, Ore., confirms the prescription, via Skype, and then Beatrice or Norman drop a bottle, print a label and dispense the meds. If a client wants a consultation, they step into a side room where they can have a private Skype conversation with the pharmacist.

"You can't believe how thrilled our providers are," said Langston-Groves. "We had this installed here after obtaining a special order from Gov. Otter."

The success in Council has led Langston-Groves to consider duplicating their effort to nearby Valley County where, by all accounts, the need is as great. Last month, Valley's jobless rate hit 18.5 percent, and much like their Adams neighbors, half of the residents are uninsured.

"When I started doing data analysis of Valley County, I was shocked. It was a mirror of Adams County. And the concentration of need seems to be focused in Donnelly,"said Langston-Groves.

Brad Backus agrees and he ought to know. He's the mayor of Donnelly and was one of the scores of residents laid off when the Tamarack Resort landed in a financial snowdrift.

"As far as Donnelly goes, we're in desperate need," he said. "There's a free clinic over in McCall, but it's only open one night a week, and I understand that there's usually a 15 to 20 person waiting list. That's pretty tough."

But administration at McCall Memorial, which just three months ago joined the St. Luke's network of hospitals, isn't so sure they want to see a low-cost clinic near their turf. Two weeks ago, hospital administrators told the McCall Star News that "adding more medical providers could damage our long-term financial viability." But officials back-pedaled a bit when BW asked about the proposal.

"We're going to do a formal assessment to determine the need," said Lee Rhodes, CEO of St. Luke's McCall.

"I really hope the hospital doesn't try to shut this effort down," said Backus. "With these hard times and people struggling as much as they are, I don't know why folks aren't jumping at this. There's no way that a low-cost clinic in Donnelly is going to be, in any way, competition toward a large medical facility in McCall."

Langston-Groves just wants to provide service.

"Large hospitals and health-care centers have similar missions to provide different levels of care," she said. "So, the best scenario would be to develop partnerships for continuity of care in a community. It's all about collaboration."

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