Sue Sitter/PCT Heart of America Medical Center CEO Erik Christenson stands at the site of a new hospital building on U.S. Highway 2 in Rugby.

In uncertain times for rural health care, keeping community connections strong makes a difference for Heart of America Medical Center in Rugby.

Erik Christenson, CEO of the non-profit health care organization said the center’s clinics, hospital and long-term care facilities have been changing over the years to stay in sync with the changes in the communities they serve.

Community-centered mission

“The basic mission is the health and well-being of our community,” Christenson said.

“We provide primary care medicine through our clinics and hospital ER services and emergency care services,” he said of the critical-access medical services provided by the rural facility.

Farms and tiny towns surround the facility, located in Rugby, population 2,517. It’s the only one of its type within about a 40-mile radius.

Established in 1904 as Good Samaritan Hospital by a group of Lutheran pastors in Rugby, HAMC has grown over nearly 120 years to receive support from 27 area churches today. Its governing board, Good Samaritan Hospital Association, still retains its original name.

The health care organization has its Johnson Clinic building adjacent to its main hospital to offer primary health services, plus satellite clinics in Dunseith and Maddock to reach patients in those communities.

The hospital’s location along Highway 3 near Rugby’s downtown will soon change.

A newer facility is under construction and slated to open on U.S. Highway 2 in fall 2024. The new, smaller design will maximize efficiency and better meet the Rugby area’s needs for quality health care in the 21st Century, according to HAMC directors.

Changing needs

Christenson said HAMC strives to meet the needs of a changing rural community.

“We do elder care services that we provide through our skilled nursing-based care in assisted living,” he said. “But besides those, we also do a lot of other services that promote well-being and wellness. We have rehab services, cardiac rehab and, of course, rehab through physical therapy in the wellness center there.”

“We also have pharmacy services, infusion services and hospice care services, so we have a wide range of services that can not only treat diseases; we also are very active in preventing diseases and educating our community about healthful living and taking care of yourself so you don’t have to use healthcare services,” he noted.

The facility’s focus on preventative care and wellness mirrors the shift in medicine toward prevention discussed widely in the United States, according to Christenson.

Providers ranging from doctors to nurse practitioners staff the facility, each one meeting basic health care needs and making referrals for any specialty care needed.

“We have service agreements with larger hospitals,” he said. “We work closely with larger hospitals, sometimes as basic as patient transfers, but we also work in concert with various specialists who come onsite, whether it’s oncology or telepsych, tele-endocrinology, services like that.”

Expanding reach

“Besides (its local reach), Heart of America has a reach out into the state,” Christenson said. “Many of our people from this facility serve on various state boards. I serve on the North Dakota Rural Health Association Board, the NDRHA.”

Wayne Trottier, chair of the Good Samaritan Hospital Association Board, said he learned of the current state of rural healthcare at the National Rural Healthcare Leadership Conference in San Antonio in February.

“It’s amazing to sit and listen where the Heart of America Medical Center falls by comparison to similar-size hospitals nationally,” he said. “I think we’re in the top 5 percent.”

“Small rural hospitals are struggling across the country,” Trottier added. “Rugby’s hospital, despite all the challenges, primarily COVID, has done quite well. And I think it reflects back on the vision and ultimately the mission in getting not just our executive team, but all staff included. And that includes the board of directors.”

Christenson said staying alert to changes in rural health care played a key role in HAMC’s success.

“You have to prepare yourself to weather the changes, and I think that’s what Heart of America is doing,” he said.

“You look at health care and it can be scary, because we see the escalating costs in what’s going on, but it’s not always bad news,” he added.

Christenson said connections between rural hospitals could mitigate costs and keep rural health care going strong.

“We do work in concert with other rural hospitals,” Christenson said.

“Through those connections, you share ideas of how things are being done — are we best serving our communities, things like that,” he added. “So, those kinds of networks are always being formed, so you don’t get a lot of hospitals doing things on their own.”

Trottier agreed, saying, “I think we’re in a position to spread out beyond our normal service area, that is, the communities that are represented on the board. I want to say it’s the wave of the future, but it’s happening now.”

Communities represented on the board and served by HAMC include Dunseith and Maddock, which each have HAMC clinics, and smaller areas such as Towner.

Christenson said, “I think the future of rural health care is going to have to be some sort of networking.”

“Just given (economic conditions), with smaller hospitals, it’s going to be harder and harder to survive, just given the regulatory burden, the staffing burden and the reimbursement burden to provide the services that are needed,” he said. “It’s expensive and given the small volume, sometimes, of those services, it just doesn’t pay your bills.”

The strength of networking

Christenson said as rural providers network more, “I think you’re going to find out which hospital is really good at (a certain service), and you’re going to be depending more on that service line.”

“I think Heart of America Medical Center’s surgery center is one of our unique things,” he noted. “Most rural hospitals don’t have a full-time surgery center. We do.”

“I think we’re starting to see the difference in where health care is going with what we call value-based reimbursement or value-added services,” he explained. “It’s more population health, and we’re seeing it go in that direction.

“I think it’s a wonderful thing for Heart of America,” he added. “We have a healthy community. It decreases the costs on Medicare and insurances then, and the way they’re hopefully moving it, it helps the reimbursement for Heart of America.”

Christenson said value-added services could not only keep Rugby area people healthier; they could keep rural health care thriving in central North Dakota.

He said to accomplish this goal, HAMC and area businesses might consider connecting with HAMC “to encourage healthful living.”

“That means getting your preventative tests done when you’re supposed to or seeing your doctor every year,” he said. “That means eating right, exercising and all those things they tell us to do, but I think are things we have to encourage as a community.”

Components of a network focused on healthy communities include schools as well as businesses, he said, noting Rugby schools employ a public health nurse part-time and offer mental health services for their students.

“In order to keep your health system viable, you have to create a healthy community,” Christenson said. “I think that all provides an opportunity.

“There’s a way through all this, and that’s good news for Heart of America as we head into the future of health care,” he said.