Prairie Lakes Healthcare System

By Alex Strauss

Architect's rendering of Prairie Lakes Healthcare System Entryway.

This Spring, Prairie Lakes Healthcare System in Watertown, South Dakota, a town of 22,000, was named among the Top 20 Rural Community Hospitals in the nation by iVantage Health Analytics. Prairie Lakes was the only independent hospital in our region to make the list, which was based on eight indices including inpatient and outpatient market share, quality, outcomes, patient perspectives, costs, charge and financial stability.

How has this small-town health system, which now includes a cancer center, a surgical center, and dialysis units, managed to achieve this level of success, continually expand its size and services, and remain independent while the population of Watertown has held steady? President and CEO Jill Fuller says it started more than 15 years ago with an intentional decision by the hospital board. At that time, Prairie Lakes employed only one specialty physician—a radiation oncologist.

Jeffrey Smith, MD, CEO Jill Fuller, Dot McAreavey, PT and Chris Adducci, MD.

 “Our board made a strategic decision in 2003 when I was Chief Nursing Officer that we were going to better serve the 90,000 people in our 10-county service area by expanding our services,” says Fuller, who took the helm of the organization in 2009. “We are 100 miles away from Sioux Falls. Some of our people are 100 or 150 miles away from specialty services. So we knew they needed better access.”

Fuller says the decision to expand services, along with a commitment to a) maintain a substantial financial cushion, b) diversify to keep up with changes in healthcare utilization, and c) establish good relationships with critical access hospitals (including helping them keep certain services in their own towns) set Prairie Lakes on its current course.

 It is a course that has allowed this 81-bed hospital to now offer nine specialty service lines (including specialties like nephrology and interventional cardiology that are often unheard-of in small communities), employ 23 physicians, maintain 21 outreach clinics, collaborate with big and small organizations in South Dakota and beyond, and continue to expand its campus and technology—all without the financial intervention of another health system.

“We knew that a lot of people were going out ot town for the kinds of services we now offer here, but it was so ‘out-of-the-box’ to imagine that we could start, for instance, an interventional cardiology program in Watertown, South Dakota,” says Fuller. “The startup costs alone were huge.”

As the hospital’s latest expansion, a $32 million dollar, 68,000 square foot specialty clinic, nears completion, it is clear that the gamble has paid off. “When I came here in 2000, our total patient revenue was 33 million,” says Fuller. “Today we are at 100 million. That came through adding services. Without doing that, we would have been on a totally different path.”

Attracting Quality Providers

While many rural healthcare facilities struggle to fill positions, Prairie Lakes has managed to excel in this area, too. Fuller says many physicians, especially those in the latter part of their careers, appreciate the slower pace of life in this rural community, the natural beauty of the area, and the warmth and friendliness of patients here. The hospital’s financial stability and its independent status are, for many, the icing on the cake.  

Urologist Chris Adducci, MD

 Urologist Chris Adducci, MD, one of two urologists in town, says he was on the brink of burnout when he left his multi-specialty clinic in Bismarck nine years ago to join Prairie Lakes. He was attracted not only to the promise of a higher quality of life for himself, but also to the high quality of care the hospital was providing, as evidenced by its multiple service lines and top-of-the-line equipment.

“I don’t think many people understand how unique this is,” says Dr. Adducci. “Any town this size would love to have this many service lines available on the ground. But it is a difficult thing to carry off. Starting a service line is a gamble. You have to tool up and hope that the bodies are there to make it successful. They have managed to figure out a way to attract physicians who are good at what they do and not grind them into the dirt.”

Not only has Prairie Lakes been innovative in finding alternatives to round-the-clock call—even for solo specialty providers like Adducci—but they have demonstrated both the ability and the willingness to invest in new technology. A few of the upgrades at Prairie Lakes this year include new cath lab equipment, phototherapy for dermatology, a therapy pool, and a new minimally option for benign prostatic hyperplasia called Rezum.

“You don’t have to go seven layers up the chain if you want to get something done,” says Adducci, who helped bring Rezum to Watertown. “With Rezum, I said ‘here’s what I think we need’ and we were able to get it up and going quickly. Communication has never been a problem here. If you want to say something to Jill, you can just walk down there and talk to her. They are very responsive.”

Inviting Input

That responsiveness and the opportunity to help guide innovation were also big draws for California native Jeffrey Smith, MD, the only dermatologist for 100 miles around Watertown. Before he joined Prairie Lakes two years ago, Watertown hadn’t had a full-time dermatologist for at least a decade.

Jeffrey Smith, MD

 “I really liked that the hospital is small and independent because there is so much room for autonomy,” says Smith, who also provides monthly outreach services in Milbank. “We are in the business of taking care of people and we put our priorities where they need to be. I feel like I am able to make choices that are in the patients’ interests without anyone breathing down my neck.”

Dr. Smith’s clinic will relocate to the new building when it opens this Fall. Smith says the hospital not only welcomed but invited his direct input during the planning stages. “It was great to be able to work with administration and the architects to determine exactly what was going to be best for our needs,” says Smith. “I have never done anything like that before.”

Along with dermatology, the two-story Prairie Lakes Specialty Clinic will also house cardiology, general surgery, nephrology, pulmonology and urology. Physical therapy, occupational therapy, speech therapy and Glacial Lakes Orthopaedics will now be together on one floor in the new building and a new helipad on the roof will provide direct access to the radiology department and Emergency Room below in the adjacent building.

“Things have been growing here like crazy and this facility is being built with a view toward continued growth,” says Smith, who will be able to offer phototherapy services in the new building. “Prairie Lakes has a lot of foresight. They have really helped our clinic get up to par, including an EMR system which enables us to be very efficient. They are setting it up for long-term success.”

Innovation and Collaboration

For Physical Therapist Dot McAreavey, Director of Rehab and Wound Care Services, the hydrotherapy pool in the Specialty Clinic is another example of Prairie Lakes’ commitment to invest wisely in the right technology. The new pool, with a treadmill floor that can be raised or lowered to adjust resistance, is expected to pay off big for pain patients—a special focus for her department.

Physical Therapist Dot McAreavey, Director of Rehab and Wound Care Services.

 “The thing I really appreciate about Prairie Lakes is that they allow employees, from directors all the way down the chain, to be innovative,” says McAreavey, who has been with the organization since 2004. “You can say, ‘I have a patient who has this problem. We don’t have an option for them. What can we do?’ We are able to think outside the box without having to go through quite so much red tape. We are more fluid in how we move, which is more productive and better for patients.”

McAreavey gives a lot of the credit to collaboration, both within and outside of the organization. As an example, she cites last summer’s joint replacement education program that was run through Prairie Lakes to support Glacial Lakes Orthopedic patients. Prairie Lakes’ partnership with Lake Area Technical Institute for physical therapy education is another example.

“These kinds of partnerships are fun and keep you thinking and staying innovative and creative,” says McAreavey. “That’s important in a small town where your patients are your friends and neighbors. PT is always personal, but it’s even more so here.”

CEO Fuller says collaboration has also been pivotal for Prairie Lakes Healthcare as a whole.

CEO Jill Fuller

 “Collaboration and partnership is an essential part of our success,” she says. “We collaborate with Sanford and Avera and even providers in Minneapolis. We are able to pick and choose, which is to our advantage. I have also visited every hospital in our services area. This is really what population health should be about, where we all work collaboratively. That is a novel concept.”

Services at PLHS:

Cardiology

Dermatology

ENT

General Surgery

Hospice & Home Care

PT & Rehabilitation

Nephrology

Pulmonology

Urology

Wound Care