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Building the Hospital of the Future...Now

Aug 23, 2021 07:00AM ● By Med Magazine

Earlier this year, Sanford Health rolled out a $300 million initiative it hopes will transform the way healthcare is delivered in rural areas and improve access to affordable, high-quality care for generations. 

In addition to a significant investment in community health through an expansion of the Sanford Sports Complex in Sioux Falls, the initiative will create eight new residencies and fellowships in critical specialty areas and help build a 60,000 square foot facility that will be the headquarters of a new virtual care center. 

We invited hospitalist Jeremy Cauwels, MD, chief physician at Sanford Health, and surgeon Luis Garcia, MD, president of Sanford Health’s clinic division, to tell us more about how Sanford plans to roll out its bold vision. 

MED: Why is it important to make this investment in rural healthcare now, when so many Americans are moving to larger cities?

JC: I think it's important to realize that while some towns are shrinking, other towns and other ways to earn a living in those areas are absolutely growing. We are always going to have smaller communities. We are always going to have farms. Part of our job, if we want to be the premier rural health provider in the US, is to find ways to reach out and deliver premium care to those patients, whether they live 7 miles away from a medical center or 70 miles. That is our mission.

LG: The reality is that about 20 percent of the US population still lives in rural areas. There are numerous studies that show a health gap between rural and urban situations. Rural Americans are more likely to die from the four leading causes of death in this country: heart disease, cancer, stroke, and injury. Most of these deaths are preventable with better access to care. While the attention tends to turn toward urban settings, one fifth of our population is still living in rural areas. 

MED: Why are new graduate programs such a big part of this initiative?

LG: The Association of American Medical Colleges predicts a nationwide shortage of 140,000 physicians by 2043. Some of those shortages are going to be in areas of high medical expertise because we have a deficit in training physicians in some of these areas. So that presents a recruitment issue. 

But we also know that people tend to stay close to where they receive their education. So, in addition to engaging in recruitment like everyone else, we are taking the next step and developing our own high-level training programs with the expectation that a portion of the people who train here are going to stay and practice in the rural setting. 

MED: The first two training programs will be a hematology/oncology fellowship and a neurology residency, both starting in Fargo next summer. How is Sanford deciding which specialty areas are most critical?

JC: We have done a wonderful job of building up our primary care base with the first eighteen training programs that we have developed here along with our education partners. We keep about 40 percent of those residents to maintain the primary care in our region. Now what we need to do is bring in people who can help the folks who need things like cancer specialty care, specialty care for strokes, etc. That's why we have picked these areas first to help round out the primary care. 

LG: The next ones we choose will be in other areas of high expertise that would otherwise go to an urban setting. These will be residencies and fellowships that are typically difficult to get into and hard to recruit for. From our perspective, this is also about impacting our communities by leaving a legacy. We deeply value the relationships we have with the academic institutions we work with. Creating new educational opportunities not only has an impact on direct patient care, but also on communities.

MED: What is a 'virtual care center'?

JC: The virtual care center concept is really about how you access and receive your care. In that sense, it is separate from a building. If a patient is having a stroke in a rural town, there is a good chance that the hospital will not have a neurologist present. But that hospital can connect to a center that does have a neurologist, allowing us to both diagnose the stroke and start treatment before we consider transporting them. 

Another great example is a provider whose child recently needed pediatric psychiatric care. The closest specialist was 4.5 hours away with a six week wait time. We were able to connect that family remotely and have that visit done in less than 72 hours. That, to me, is the power of a virtual care center. 

LG: For us it is about improving access to care, magnifying convenience for our patients, and enhancing efficiencies in situations of dire need or emergency situations. We have had the technology available for a number of years. But we have been held back by the business model of healthcare and the need for coding and reimbursement. 

One thing that COVID has taught us is that that needs to change and this initiative will allow us to not have to wait for those changes before we do something meaningful. In the past, we couldn't do a virtual visit because we didn't have a code for it. This allows us to say we are just going to do it. 

MED: If the care is virtual, how will the new building be used?

JC: The building will serve as a place to house all of the data, hardware, and people we need to implement this on a large scale. Along with Dakota State University, we are building a facility that will bring us to the forefront in terms of how we provide digital care. That facility will give us not only the ability to reach out to patients, but also to help train physicians to diagnose and treat patients in the virtual world. We expect to need a dozen or so physicians and support staff along with advanced practice providers, nurses, physical therapists, pharmacists, etc. Plus all of the IT and other professionals that are needed to run all of this. This building is going to come with a fleet of people.

The entire initiative brings us back to the promise that we will deliver the same quality of healthcare in a small South Dakota town that we would deliver if you were sitting in an office in Sioux Falls. The same services that you can get in one office should be the same as another.