MercyOne Newton Medical Center may receive American Rescue Plan Act funds from Jasper County to go towards facility improvements.
During the Sept. 27 county board of supervisors meeting, Chad Kelley, director of operations for MercyOne Newton, formally requested the hospital at least be considered to receive ARPA funding. Specifically, the hospital asked for a $2 million gift for a $6 million emergency room enhancement project.
The emergency room has been part of the hospital since 1921, and Kelley said it was last revised in 1971. It is an “old, archaic” structure that sometimes does not provide the best patient experience. Renovating the emergency room requires a substantial financial commitment, but the design work has been completed.
MercyOne Newton serves about 10,000 visits per year in the emergency department, and that number only continues to grow. Jasper County is one of the only rural counties in Iowa projected to grow. Other rural counties are shrinking. Kelley said market share data continues to show a 1 percent increase each year.
“Of that, most of the younger (population) is not growing. But the 65-plus crowd is growing at 10 percent. We’re seeing a lot of retirees come back,” Kelley said. “Many of them, whether they’re in assisted living or a nursing home, find their way, at some point, to our emergency room and to our hospital.”
Knowing it has been a long process with ARPA funds and that some allocations may already be finalized, Kelley said hospital administrators were encouraged and motivated to make their request because of Jasper County supervisors’ interest in improving the advanced life support (ALS) services.
“We know sometimes things change. So we just ask if things change or if budgets get revised down the road that, perhaps, we be considered,” Kelley said.
MercyOne Newton and the Jasper County Sheriff’s Office work together to serve patients, particularly mental health and behavioral health patients, Kelley added. In a three-month period 20 years ago, the hospital would hold behavioral health patients in its emergency department for up to 300 hours, or 12.5 days.
“It’s now up to over 1,000 hours that we see a large number of behavioral health patients, and, quite frankly, the structure is not safe,” Kelley said. “We had one patient recently for 21 days. We lose staff because they’re not comfortable with the environment.”
When four out of the six rooms in the emergency room are taken up by behavioral health or mental health patients, Kelley said you could imagine it is not a pleasant experience when families are trying to get their kids seen. Sometimes they’re listening to four language or experiencing bad behaviors.
“We feel stuck,” he said. “So the new emergency room would be six rooms that are twice the size and it would have an additional behavioral health suite towards the back of the department with a toilet so these individuals, while we’re trying to get them placed, can be comfortable. Hopefully (there are) less outbursts.”
MercyOne Newton has seen approximately 1,000 mental health patients over the past three fiscal years, which averages to more than 300 patients per year in that timeframe. Kelley said MercyOne Newton, formerly Skiff, is one of approximately five hospitals in the whole state that, rurally, is not considered critical access.
“We’re considered a rural demonstration hospital,” he said. “So under that designation, that decision was made over two decades ago when that program was open, and any of these rural hospitals were seeing declining in-patients. So they could essentially cut their beds down to 25.”
The caveat is they would get paid 101 percent by the government. So they get reimbursed for staffing the hospital. At that time, Maytag was still keeping Newton and its hospital afloat. Volumes were high at the hospital and it was decided to not cut beds, locking the facility in as rural demonstration.
“We get paid 28 cents on the dollar,” Kelley said. “Many of our rural competitors — Knoxville, Pella — they are critical access. They get paid $1.01 for every dollar they spend. Guaranteed … Our hospital staff, we consider ourselves a lean, mean machine, because we can’t staff like they do to make ends meet.”
Coupled with the high costs of capital equipment, it is difficult for the hospital to make the right infrastructure changes to address the needs of all patients.
“It’s hard to keep up on the infrastructure changes of our 1921 facility when we’re just trying to cover losses and keep the equipment so we can still do services,” Kelley said.
The new emergency room would have two different trauma bays. MercyOne Newton learned during the pandemic it was not well equipped for certain things with the infrastructure currently in place. There were negative pressure rooms and the hospital still has half its ambulance bay shut down for intubations.
“We can’t fit intubation equipment in the rooms for as many people as we were seeing,” Kelley said. “We can’t even fit stretchers in many of the rooms. So I think a local EMS emergency room would also support that. It just isn’t a great situation but we know communities, economically, need a hospital.”
To provide care for residents of Jasper County, all it takes is one large donor to kick off the process. One might ask why MercyOne doesn’t invest the capital. It is a fair question, Kelley said. But the reality is margins are razor thin for hospitals. The past several years the Newton-based hospital has not made money.
“In fact since this hospital was acquired in 2016, we’ve lost $14.5 million,” Kelley said. “And that all is covered by our parent company. They’ve additionally invested over $7 million in equipment, CT scanners, surgery equipment. So at some point when it comes to infrastructure changes, a lot of it is on us.”
The impact of the project — in conjunction with the enhanced ALS services — touches a lot of people. Even the community recognizes the impact of a new emergency room. Health needs assessments frequently rate the emergency room within the top five every year.
“It’s our job, our obligation to try and improve health care in the county. And we’ve done so,” Kelley said. “Urgent care has been an issue. We’ve done a joint venture to bring urgent care to town and we try to take actual steps toward improving what our residents are saying to us.”
In addition to the bigger rooms, the designs of new emergency room positions the behavioral health suite towards the end to allow staff adequate time to intervene in case patients elope. Right now it’s physically impossible to keep eyes on every patient. The new designs have a centralized nurse station.
Why ask for ARPA funds now? Kelley said the process to communicate with the county’s ARPA committee was a challenge. Supervisor Brandon Talsma took the blame and apologized to Kelley. He intended to share this information with the committee during their last meeting before it dissolved.
Kelley emphasized the need for a lead donor to start the process, which he later said would allow the hospital or foundation to apply for grant funding.
“That large of a gift would certainly create an opportunity to get a match either from donors in the community … This is something we’ve known as a need for a while, so we know we have certain donors we would reach out to for fundraising, campaigning, as well as our own capital,” Kelley said.
Jasper County Sheriff John Halferty said as a lifelong resident — five of the six Halferty kids were born at the Newton hospital — his family has a lot of close ties to the hospital. Halferty said Jasper County needs its health care facility and that it deserves, at least, a consideration from the board.
“COVID was definitely a challenge, but if we lose that facility and we can’t bring some partnerships together, as a personal, as a resident and as an EMS provider, I do not want to see that,” Halferty said. “That’s just my opinion. So I would ask the board to at least consider a way we can partner with them.”
Supervisor Doug Cupples suggested if there was a way for the county to partner with the hospital. The county’s financial consultant said he will look into it. Although no action was taken by supervisors, they were receptive to the idea but needed further discussion with staff before allocating ARPA funds.
Contact Christopher Braunschweig at 641-792-3121 ext 560 or at firstname.lastname@example.org