Fosston officials remain committed to local control over hospital

FOSSTON — The city of Fosston remains resolute in restoring local control over its hospital after arbitrators ruled earlier this year that Essentia Health did not end core services when redirecting labor and delivery to St. Mary’s in Detroit Lakes.

In its September meeting, the City Council passed a resolution directing Administrator Cassie Heide to explore other legal avenues for a transition of the Fosston hospital and clinic back under the administration of First Care Medical Services.

The city of Fosston is a significant stakeholder in the hospital currently operated by Essentia Health. First Care Medical Services is a local nonprofit organization the City Council selected to own its hospital, with Essentia Health operating it since its 2009 affiliation agreement.

Heide explained in an interview with KAXE that local control doesn’t mean the City Council, but a local board of directors guided by local medical staff.

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City of Fosston

“The doctors that work here, the medical staff that works here, that treat the patients locally,” Heide said. “Not medical providers who never serve patients in Fosston, and not a board of directors who never come to Fosston and don't know what this community needs.”

Despite the arbiters ruling 2-1 that the end of labor and delivery in Fosston did not constitute a breach of its contract, Fosston leaders believe there have been other violations of its affiliation agreement with Essentia Health.

Essentia Health’s interim president for the west market, Dr. Stefanie Gefroh, said staffing challenges remain a top issue in delivering rural health care, and it’s no different in communities like Fosston.

“We have almost 13% vacancies across health systems in the state of Minnesota,” Gefroh said. “And when you're looking at rural health sites, it can be even more difficult to recruit and retain staff.”

Gefroh explained that offering competitive salaries for staff is just one of the financial challenges in providing rural health care, with Medicare not reimbursing at the rate it costs to provide care. Nationwide, Medicare reimburses hospitals an average of 80% of billed costs, but some health systems report even lower reimbursement rates.

More on Fosston-Essentia dispute

Fired-up Fosston pushes back on Essentia Health's planned OB closure

Several area residents gathered in City Hall on Jan. 30 to share passionate testimony on the loss of labor and delivery services at Essentia Health’s Fosston hospital.

Essentia Health to permanently nix Fosston labor, delivery services

These services have been diverted to St. Mary’s Regional Health Center, an Essentia facility in Detroit Lakes. A public hearing on the change will be 6 p.m. Jan. 30.

Fosston administrator testifies on hospital closure notification bill

Cassie Heide, the city administrator for Fosston, testified in support of HF3700, which would require hospitals to provide more notice of unit closures.

Fosston leaders announce new hire as Essentia Health dispute nears end

While Fosston and Essentia Health wait for an arbitrator's decision on terminating the affiliation agreement, local leaders are looking to operate the hospital with a 501(c)3.

Arbitrators rule in favor of Essentia in Fosston OB care dispute

In a split decision, arbitrators ruled in favor of Essentia Health, finding no breach of contract for shuttering labor and delivery services at the Fosston hospital.

"When you couple that with revenue going down due to reimbursement challenges, it's kind of a perfect storm of negative impact, especially to our rural sites,” Gefroh said.

Heide said in the last 10 years, access to care has declined, with more Fosston patients traveling for their health care needs. She cited fewer services offered in Fosston and long waiting lists for specialty care.

“We hear a lot about all this access to specialty care, but you know Essentia is really not painting an accurate picture of how accessible that specialty care is,” Heide said.

In a document issued with a press release, Fosston leaders are citing a 50% decrease in surgery volume, a 40% decline in provider staffing, a 25% decrease in staff, plus the loss of dermatology, urology and ear, nose and throat specialty services.

Heide said she and other members of the task force have heard from community members waiting up to a year for an appointment in Fosston for specialty care like cardiology.

"If you have to wait that long for an appointment, most people are just going to go out of town anyways, and that's what's happening. And it's just really unfortunate, and these are the things that we're seeing,” Heide said. “This is why we have the resolve we do to continue to work to secure our health care future.”

Despite challenges, Gefroh said Essentia remains committed to delivering quality rural health care.

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Essentia Health

“Given the challenges of rural health care, I understand the concern, but we have remained committed in our outreach that we do in the Fosston community so that patients don't have to travel,” Gefroh said.

"Occasionally there are changes in staffing, so if we have a clinician that leaves, there may be a bit of a pivot to find a new physician that will provide that outreach. But we continue to do it and will remain committed to that.”

Gefroh said advocating to improve the Medicare reimbursement rates is just one part of the puzzle for balancing budgets in rural health.

“It's important to remember that this isn't a unique situation to Fosston. As an example, two-thirds of our rural facilities across the country have a negative margin, so this is very broad brush,” Gefroh said.

"The way that we can try to solve these problems are committing to medical education ... identifying local residents that want to go down the medical path and supporting their education so that we can bring them back to serve in their communities.”