Decatur County Memorial Hospital: Linda Simmons, Chief Executive Officer

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Rural hospitals provide a critical service in small communities throughout the United States, and most are finding that partnerships are vital to their survival. Decatur County Memorial Hospital in Greensburg, Ind., is an independent 25-bed critical-access hospital.

Greensburg is located less than an hour’s drive from Indianapolis and Cincinnati and is home to more than 11,000 people. Decatur County Memorial has been named one of the Top 20 Critical Access Hospitals in the Nation by the Health Strong Index.

Renovating for change

Despite its small size, Decatur County Memorial has managed to stay technologically advanced, with state-of-the-art imaging equipment, electronic medical records, and a telestroke program. The hospital has upgraded most of its facility and is beginning a construction project to enhance the med/surg department, which is the final renovation area of the existing hospital.

Decatur is adding two floors to the building, creating all private rooms, universal rooms, and an acute-care unit. The ACU will be plumbed for dialysis to allow for more patients to remain at Decatur rather than being transferred to a tertiary center.

The next construction project will be the construction of a medical-office building and the consolidation of outpatient services. Chief Executive Officer Linda Simmons said that this project is necessary as more hospitals are moving services to the outpatient environment. Younger patients coming in are also conscious of time and are looking for more of a “one-stop shop.” The office building will house oncology services, physical therapy, and physician specialists.

“Even if the facility has nicely renovated areas, but the services are scattered and inefficient, it’s hard for patients to come in for care and get back to work quickly,” Simmons said. “We want to get our outpatient services together and accommodate patients efficiently.”

A future of partnerships

As with many rural hospitals, Decatur’s goal is to remain independent as long as possible, but partnerships with larger organizations are necessary to continue providing services to the community.

“I want to make sure that what we do positions us to stay financially feasible,” Simmons said. “We are strengthening ourselves and making partnerships. If the landscape changes because of reform, we have leverage in who we can go to and how they handle us.”

Simmons is working to grow necessary service lines, including telemedicine links and diagnostic imaging, to prevent patient care from being delayed in transfers to a tertiary center. She said if Decatur becomes a partner with another organization that relegates it to being a triage center, then care is delayed for rural patients.

To help strengthen the hospital’s position, Simmons said Indiana has a strong network of hospitals, including a rural-hospital association that provides support to critical-access hospitals.

Decatur has also established a telestroke program with Indiana University Medical Center. The hospital has a 128-slice CT scanner, which, through PACS, allows a neurologist at the medical center to help diagnose and determine whether to bring the tissue plasminogen activator (tPA) to Decatur or to immediately transfer the patient.

Decatur is also looking to partner with a tertiary center for cardiology. With the diagnostic equipment available at the hospital combined with the expertise of specialists at a tertiary center, many patients can be treated close to home without being transferred.

Another unique partnership the hospital has is a shared-employment agreement with another critical-access hospital about 15 miles away for five physicians. One hospital employs the physicians, but half of the salary and benefits are underwritten by the other facility. Simmons said this poses unique challenges that the hospital is working through.

Rallying around rural care

Despite the success of partnerships, rural hospitals face particular threats related to funding, which affects the strategic plans for the coming years.

“When I look out three years, I think about what service lines it makes sense to grow, particularly in light of if we become affiliated with another hospital, what services they would see value in and allow us to maintain a strong presence within our community,” Simmons said.

Decatur County is a growing community and likely will be able to sustain the hospital for years to come. Honda has a plant in the county and is adding an Acura plant, bringing in many new jobs to the community. Simmons emphasized the importance of maintaining strong rural hospitals throughout the country.

“We need to rally around the rural healthcare that’s out there,” she said. “I understand politicians need to balance the budget, but not on the back of undermining and doing away with rural healthcare. Our patients shouldn’t be penalized or have delayed care because they choose to live in a rural community. We have elderly and others in our communities as well who struggle to find transportation and traveling 20 or 30 miles from home can be challenging.”

-by Patricia Chaney

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