News From Terre Haute, Indiana

March 1, 2014

Rural health

Medical services vacuum in outlying regions creates need for outreach groups, centers

Howard Greninger
The Tribune-Star

TERRE HAUTE — Medical facilities in small towns scattered throughout Indiana face unique challenges, navigating changes in the health care industry.

A local group, however, is making some of those challenges less arduous.

Organized in 1997, the Linton-based Indiana Rural Health Association, which has its largest satellite office in Terre Haute, has become an education and advocacy support to small hospitals and health centers, including the Valley Professionals Community Health Center.

“My staff has attended their leadership training that is offered annually, and my middle management team has been very happy about that training,” said Elizabeth Burrows, CEO of Valley Professionals, formerly known as the Vermillion Parke Community Health Center. The name change was the result of being designated a federally qualified health center.

Valley Professionals has health centers in Clinton, Cayuga and Bloomingdale, as well as a mobile school-based health center, according to its website.

Burrows said it is difficult to evaluate a return on investment “when you are empowering employees and giving them additional training, but I can tell you our employees have given great evaluations of those experiences, and I believe one way to retain employees is always to provide additional training and learning opportunities for them,” Burrows said.

A federally qualified health center, Burrows explained, receives federal funding and, in exchange, provides primary and behavioral health care to everyone based on the ability to pay. “We take private insurance, Medicaid, Medicare, and then we offer a sliding fee scale where fees are based on family size and income.

“In our first year in 2008, we completed 3,500 patient visits ,and this past year, we completed just under 30,000 patient visits in all of our sites combined,” she said, adding that 20,000 of those visits were to the Clinton facility. “We meet a big need in the community and are in medically under-served areas.”

In addition, the center has created 58 jobs in Vermillion and Parke counties, “which is an economic development driver with job creation,” Burrows said.

Valley Professionals also uses the IRHA’s website for recruitment, and has been able to make connections with other resource providers at the rural health association’s annual conference, which attracts hundreds of people each year.

The non-profit IRHA has a nine-person staff and is the largest statewide rural health association in the nation, with more than 2,700 members, said Don Kelso, IRHA executive director. Of the nine staff members, five are based in Terre Haute.

The IRHA in late December created and launched a “business partner network” to help rural facilities meet health care challenges.

“We have vetted companies, consultants and firms that we have experience with and we know have a good track record and focus on rural facilities, which are different than urban facilities in needs and have different resources,” Kelso said.

The network — at — offers free management and operational advice through blogs and white papers. The network partners can also provide discounted services to hospitals and clinics, Kelso said. Examples of members in the network include CliftonLarsonAllen, an accounting and capital management firm, Barnes & Thornburg, for legal services, and insurer Gregory & Appel.

The IRHA is also an advocate on health care issues for its members.

Deena Dodd, statewide rural health network director for the association, said the organization advocates at the federal and state levels so legislators “better understand what kind of economic engine rural hospitals provide” to communities.

“Every day, we are seeing where certain entities are opting to either embrace or challenge Obamacare, thus it is very difficult for hospitals to navigate something so new and is still in the process of unveiling itself,” Dodd said.

In addition, across-the-board sequester budget cuts, including a 2-percent cut in Medicare payments, are costing hospitals millions of dollars annually. “Most rural hospitals operate on a very, very lean margin,” Dodd said. “It can be anywhere from a half to a 2-percent margin in the positive,” creating a challenge in how to make up a reduced revenue stream.

Hospitals have turned to using a lean health care concept, she said, similar to lean manufacturing practices, to improve processes and reduce costs.

“The last thing a rural hospital wants to do is trim staff. They look at everything that they do,” Dodd said. “They are very lean in how they buy supplies and expenditures for employees. It is how do we continue to provide for our employees … and how do we maintain the health and wellness of our community.”

One way the IRHA helps hospitals and its members is in the pooling of resources.

For example, the Rural Health Innovation Collaborative, part of the Terre Haute-based Richard G. Lugar Center for Rural Health, has shared hands-on training information, including the use of simulated mannequins, which when attached to a computer, can mimic symptoms of a heart attack or other health issue, Dodd said.

“We really try to bring folks together in group efforts as often as possible because there is where they stand to gain the most,” she said. “We try to take the isolation out of rural by providing roundtables to various members of their staff, and we do that all virtually, so they can come together and share. We facilitate peer-to-peer learning and mentoring.”

Virtual training, including webinars, has helped to educate the 149 nurses at the Sullivan County Hospital, said Lori Resler, the hospital’s director of nursing.

“It is an educational resource that we would not otherwise get to participate in just because of our unique size, as we are a smaller facility,” Resler said. “The [IRHA] has been able to get rural hospitals educational resources and has worked to get hospitals high-speed Internet and integrate technologies.”

Dodd said the IRHA’s continuing goal is to positively impact rural health care providers and the communities they serve.

“We like to think we have helped organizations be more collaborative and have helped them in strengthening and diversifying the way they approach health care, especially in an independent facility,” Dodd said.

Reporter Howard Greninger can be reached at 812-231-4204 or