Rosebud Health Care Center: Ryan Tooke, Chief Executive Officer

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Ryan-Tooke-thumbThere are many reasons to respect rural healthcare. Not only does it provide services within sparsely populated regions, but it also provides these services under increasingly tenuous regulatory conditions and depleted financial resources. Rural healthcare often survives because of the combined passion its providers hold for healthcare and community.

This is the kind of passion that has carried Rosebud Health Care Center of Forsyth, Mont., through some difficult times. An 11-bed critical-access hospital, Rosebud also has a rural health clinic and a 44-bed nursing home; it draws approximately 3,500 patients from its catchment area.

Rosebud’s patient population is a growing mix of aging retirees and younger payers who work on the Burlington Northern and Santa Fe Railway and in the generation plants and coal mines 25 miles south of Rosebud.

While predominantly Medicare, roughly 30 percent are commercial payers, 10 percent are self-pay, and nearly six percent are Medicaid. Being located next to an Interstate, Rosebud also attracts 79 percent of the people who are traveling through.

Ryan Tooke has been chief executive officer for two years, inheriting the position in the middle of a worsening financial crisis for the hospital.

“For the last 10 years, it’s just been a financial albatross, because in the late nineties, we found ourselves in extreme financial strain, and then in 2002, we converted to critical access,” he said. “But this last year we’ve been able to get the financing and start construction on a new clinic as well as get our EHR. We were also able to assure the community that we’re here.”

He explained that this last component is especially important. In smaller communities, residents are prone to assume that the hospital may go away at any time. Tooke said it’s vital for an organization to show growth and optimism if it’s going to secure the lasting support of its community.

Securing its role in the community

In December of 2011, one of Rosebud’s lead providers moved on, leaving a service-line hole that needed to be filled. Tooke’s first instinct was to panic and hire the first provider who became available. However, he and the organization decided they would take things more slowly, not just hiring a provider for the sake of hiring one, but going out of their way to find someone who would be the right fit.

It took them until September of 2012 to secure a new hire, but taking their time was beneficial. The new provider is skilled and talented and brings a wealth of experience not always afforded to rural healthcare organizations.

Tooke also said the organization is delving full-force into EHRs. Although Rosebud had previously had a platform, it wasn’t certified. On Dec. 7, 2012, the organization converted all of its data into the new platform by Healthland. He said that Rosebud is fortunate to have two very young mid-level providers who are computer savvy, along with an older provider who is aggressive about going forward with technology.

Although satisfied with the direction of these projects, Tooke continues to worry about the changing CMS regulations for critical-access hospitals. With many of the smaller PPS hospitals achieving this designation, Tooke is concerned that CMS might require all critical-access hospitals to abide by the same rules, regardless of size.

“We’re not big enough,” he stated. “If they say we have to have a hospitalist, we don’t have that kind of coverage. If they say that we have to have 24-hour ER with a provider on site at all times, I can’t do that, because I can’t hire enough people.”

He added, “I guess my biggest fear is, how controlled are we going to be with our payer sources, because you have to be competent and you have to be within the scope of practice of everything? With that comes cost. If you don’t get paid to stay current with everything, then you fall behind and then you mess up and get sued and it’s just a vicious circle.”

To guard against this, Rosebud has joined the Frontier Community Health Integration Demonstration Program or F-CHIP, a pilot project that seeks to attain a new designation for extremely rural facilities, establishing a buffer zone between them and the larger critical-access hospitals. The F-CHIP would also change the reimbursement system for smaller critical-access hospitals.

“The quality and expectations would be all the same,” Tooke explained. “It’s just that we would be able to provide more home health and more extended care in the hospital. Right now, the nursing home is basically losing money, but if you can provide additional beds, you can break even a little bit.”

Top priorities for 2013

In 2013, Tooke would like to see Rosebud complete construction on its clinic and finalize integration of its EHR. Beyond that, he wants to see his organization confront the two biggest issues in its region: a growing elderly population and the mental-health needs of its patient population.

Unfortunately, he explained, “we don’t have enough providers, but we have a lot of demand for mental-health services.”

As the organization continues to innovate within its region, he urges providers around the country to advocate for rural health.

“We are very vibrant,” he said. “We’re competent people who choose to live in smaller areas. We know what our limitations are and we do very well at the services we provide.”

-by Pete Fernbaugh

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{ 1 comment… read it below or add one }

Larry Putnam September 6, 2013 at 10:13 pm

Nice article on Rosebud Health Care Center, Forsyth, Mont. and CEO Ryan Tooke. If anyone would like more info on the Frontier Community Health Integration Project (F-CHIP) discussed in this article, please see my LinkedIn profile for a more-detailed framework document and one of the six F-CHIP white papers describing the proposed frontier community healthcare service delivery model or contact me.

Larry Putnam, ex-Project Director
Frontier Community Health Integration Project (F-CHIP)
406-390-0666 (M)


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