A high-tech advantage

Hospitals in rural areas are increasing their use of sophisticated medical technology when possible to meet the needs of the community and to prevent patients from going outside of the community for their care, experts say.

Though rural facilities typically are hampered by lower patient volumes and more limited access to funding, advanced equipment is becoming more commonly found outside of urban areas.

“The types of technology being adopted in rural areas are more complex than they have been,” says James Keller, vice president of health technology evaluation and safety for the ECRI Institute, a not-for-profit that evaluates medical technology. Rural facilities typically don't ride the first wave of implementation of a new or updated technology, but can be found buying second generations or later of the newest technologies, he says.

Among the technologies increasingly found among rural hospitals, including critical-access hospitals, are MRIs, CT scanners, digital mammography equipment and even robotic surgery equipment.

“We're seeing da Vinci robots being bought all over the place,” says Jennifer Myers, vice president of ECRI's Select Health Technology Services, a decision support technology service, referring to robotic surgical systems.

The equipment doesn't come cheap. ECRI data from clients indicate that a 1.5 Tesla MRI costs an average of $1.6 million, a 16-slice CT scanner costs $330,000 and digital mammography equipment costs about $322,000.

And like their urban counterparts, rural hospitals face different circumstances that lead them to come to a variety of decisions regarding what technology to invest in and what bells and whistles to include—but a desire to remain competitive is a recurring theme.

The following rural hospitals recently completed technology additions or upgrades, each taking a different tack for a different set of reasons.

Executives at 25-bed Community Hospital in McCook, Neb., recently made some big technology acquisitions and say that strict negotiating and detailed financial decisionmaking were important to getting the deals done.

The not-for-profit critical-access hospital recently acquired an MRI unit, a CT scanner and digital mammography equipment, executives say. Troy Bruntz, vice president of finance and chief financial officer for Community Hospital, says their equipment decisionmaking entails balancing the community's need, available capital and financing options.

Digital mammography was expected to lose money from the outset, “But if I can't do that here, I've got a problem,” Bruntz says. “If we're not (offering) that service here, it doesn't send a good message to the community.”

But Community Hospital officials decided that the latest and greatest CT scanner was not what it needed, and ordered a 40-slice scanner, as opposed to more powerful models, such as 128- and 256-slice scanners. “I don't need an image of a beating heart,” at least right now, Bruntz says.

Dealing with vendors for such expensive equipment plays a big role in the ultimate success of the acquisition, with a lot of posturing and back and forth between the two sides, Bruntz says. “They're going to charge the crap out of us if we don't push back with everything we have,” he says.

Community Hospital executives determined that it made financial sense to initially lease its CT scanner and MRI and now is in the process of purchasing the equipment outright. A shorter-term lease can be attractive when technology is advancing quickly and an upgrade might be needed, but that doesn't appear to be in the cards, so Community Hospital has decided to buy the equipment. Negotiation of those agreements also can be tricky.

“You've got to know what you're doing with leases or you can get taken,” Bruntz says.

Part of the reason the hospital could afford the new equipment is because it also has gotten more sophisticated with its supply purchasing, including among its department heads, says Jon Reiners, Community Hospital's director of materials management.

Officials at Northwest Healthcare, Kalispell, Mont., were responding to patient and physician needs with recent medical technology equipment investments, which included a da Vinci surgical robot, an interventional radiology lab and new surgical suites, says David Brabham, director of materials management. Northwest includes not-for-profit 163-bed Kalispell Regional Medical Center and the HealthCenter Northwest, a for-profit, physician joint venture hospital, also in Kalispell, which has 30 beds.

“The hospital up the street bought one so there was a competitive component to this,” Brabham says regarding its da Vinci robot purchase. “Up the street” has a slightly different meaning in Kalispell, though, as it refers to a hospital 120 miles away in Missoula, he says. The goal is to take “care of community members who have (medical) needs without forcing them to get care in faraway places,” Brabham says. He declined to say how much the robot cost.

The robotic surgery equipment also can help draw surgeons to work in the area, something many rural hospitals are working to do (March 26, p. 28).

Gunnison (Colo.) Valley Hospital undertook an expansion of its building and as part of that essentially replaced its diagnostic imaging department, says Randy Phelps, the hospital's CEO. The 24-bed county facility, a critical-access hospital, spent $2.2 million on equipment and $6.2 million on bricks and mortar, Phelps says.

“The technology we had was out of date,” he says.

The hospital's CT scanner was more than 6 years old, and with the change to a new one, Gunnison Valley upgraded to a 16-slice unit from a four-slice version, he says. The new CT scanner was placed right next to the emergency room, he adds.

A mobile MRI permanently placed in the parking lot was replaced with a unit installed inside the building, and the hospital upgraded to digital mammography from analog.

Gunnison Valley, whose nearest competitor is 65 miles away, undertook the project with the involvement of an oversight board appointed by county commissioners, Phelps says.

The construction was completed in May 2011, and so far utilization at the hospital is up, he says.

Clark Regional Medical Center, Winchester, Ky., took the opportunity to add new medical technology as part of a $60 million rebuild of its rural hospital.

A major change for 79-bed Clark Regional is that it installed technology that allows the hospital to perform surgeries in any of its operating rooms, giving it flexibility in scheduling surgeries and becoming more efficient in the process, says CEO Kathy Love. The ORs are designed to allow equipment to be easily moved in and out of the room to suit a given surgical procedure's requirements, Love says.

Another technological upgrade the hospital undertook was the installation of a wide-bore MRI, which is an MRI that is less daunting to claustrophobic patients, as well as larger patients.

“That's been an issue for us competitively,” Love says. “We really focused on reasons why our patients leave our hospital and drive to the city” for care, she says. Clark Regional serves two counties with a total population of about 60,000 people, she says. Attracting physicians and surgeons who want up-to-date technology also is an incentive to keep equipment current, Love says.

She adds that the technology and the rebuild likely would not have happened had the hospital not been acquired by a for-profit chain, LifePoint Hospitals, Brentwood, Tenn., which purchased Clark Regional in 2010. Love says before that there had been a years-long effort to build a new hospital; LifePoint went from design to opening the hospital in 18 months.