Burda: Why dont we take some last comments on issues facing rural providers. Phil, any comments on where your facility will be a year from now?
Stuart: A year from now well probably be the same. I think more like five or six years down the road I think there are going to be challenges. I think the primary-care (physicians)which we rely very heavily on with our providers ... for the first time are recording that there are actually openings, that people arent even applying for some internal (medicine) residency slots. I think thats going to create a fundamental shift in rural healthcare.
The other thing that I find somewhat troubling is weve gone to where pharmacists now are Ph.D.s, our physical therapists are going to be Ph.D.s, and nursing is going to make the nurse practitioners be Ph.D.s. Weve got a lot of creep in that, which creates a shortage because of the longer education. Its going to drive up costs. I have yet to see too many studies that actually show the outcome is better, but we certainly have seen a lot of changes that way.
Sexton: Well be better and stronger than we are today in the future, at least in the near term, primarily because weve been able to add capacity. The key for us is having the capacity with physicians. I tell my staff that its very simple. Nothing happens on our campus without a physicians order. If you dont have the physicians, you dont have the orders, you dont have the care being provided to the patients, you dont have the reimbursementsso thats kind of a vicious cycle.
The one issue we didnt talk enough about is EMS. One of the things that our emergency medical services struggle with is that most of that is provided by volunteers and the support and the structure for our emergency medical systems are very difficult at best. One of the things that were challenged with in the rural areas is its not a few blocks for us, its several miles. And its the time from injury until the EMS staff arrives and theyre able to transport them to the rural facility. Were able to really provide that first level of significant care, so I think EMS is going to continue to be a challenge for us, too.
Bullock: I am very optimistic about the future. Ive watched the health system in this country adapt to so many things over a 30-year career that Im very optimistic about our ability to continue to adapt.
Weve just entered into a collaborative relationship with Eastern Maine Healthcare, which is a large system based (near) Bangor and MaineHealth, which is a large system based in Portland, so all of the systems in Maine are trying very hard to collaborate on connecting our disparate information systems. We have electronic ICUs now; were working on 24-hour pharmacies that can be used to help the pharmacy shortage throughout the state of Maine, so we seem to be headed in a more collaborative direction than we have in the past.
I guess one final thing I would just suggest is we need to keep aligning, if you will, the payment system with the actual needs of the population so where we talk about needing to prevent illness more in the future.
We have a huge issue with behavioral health, substance abuse and issues like that. We just need to constantly look at how our payment system funds the things that the people need so that we keep working on how to best deliver the care that the people of our country need.
Schou: I would like to think that after the next couple of years that well be able to really put innovation back into patient-care delivery. Right now information technology and all these diagnostics are driving us. Instead of the providers and the care being driven, its the technology. I have to learn how to do electronic medical records rather than thinking how can I make that work better for us. And I think once we get a lot of our IT equipment and other diagnostics installed that will allow us to think better how we can deliver the care, how we can be safer and how we can even move to the direction of better chronic-disease management.