Brian Monsma, administrator of Hawarden Community Hospital, stands outside the facility, which has seen improvement in its financial condition within the past year but which still faces future challenges, as do many small, rural hospitals. (Photo by Hannah Wolfson)
...Brian Monsma, administrator of Hawarden Community Hospital, stands outside the facility, which has seen improvement in its financial condition within the past year but which still faces future challenges, as do many small, rural hospitals. (Photo by Hannah Wolfson)
"Right now we're relatively healthy," said Brian Monsma
, who runs Hawarden's hospital
."But understanding the volatility of health care, there's going to come a day when we're not again."
That's worrying to residents of this community of 2,500, who have been proud of their hospital since its founding in 1936.Many were born in the brick hospital on Eleventh Street; others have had family members rescued in the two-bed emergency room or recover in long-term care.
Young doctors trained on the latest technology don't want to take on a small hospital with older equipment, Monsma
says.The hospital is currently in talks with two candidates.
Meanwhile Sioux City's Mercy Health Network
, which is contracted by the town to manage the hospital, provides an emergency room doctor at a cost of up to $4,000 a weekend.A general surgeon visits every other week for scheduled procedures.
Keeping nurses hasn't been easy, either.
Small hospitals are at a disadvantage when it comes to federal reimbursements for Medicare payments, Monsma
explains, because they lack the economy of scale of larger, urban systems.
That means that a blood test that might cost a big city hospital $4 could cost Hawarden
$7 because the hospital can't spread around the cost of an on-site lab and technicians.If Medicare's payout for the test is set at $4, then Hawarden
is out $3 every time.Add in the fact that Iowa has the highest percentage of population more than 85 in the country –- and thus a high proportion of Medicare recipients -– and country hospitals are in a tight squeeze.
In fiscal year 2000, Hawarden Community
racked up losses of $321,000; in fiscal year 2001, the hospital lost $535,000 and owed its creditors more than $1.3 million.That's despite an outpouring of support from the town, which provided $800,000 for a recent building expansion and funnels money from property and sales taxes to the hospital.
"That has been an immense help," Monsma
said."But we see it as a short-term solution."
Others may be more promising, Monsma
said, citing the hospital's new Wellness Center, which is open to residents for a fee, and physical therapy unit.Also promising, although still uncertain, are ongoing talks among the four Sioux County hospitals about possible cooperation or consolidation.
Meanwhile, employees say they'll do what they can to keep the emergency room open.At least then, they say, they can give a patient enough time to be flown to Sioux City or Sioux Falls.