MPCA News

RURAL HEALTH CLINIC (RHC) HIGHLIGHT

Liberty County Hospital and Nursing Home in Chester, Montana

Liberty County Hospital and Nursing Home

Chester, Montana is noted for its agricultural history, relaxed lifestyle, and the success of its medical facility, the Liberty County Hospital and Nursing Home (LCHNH). LCHNH is located along Highway 2 on Montana’s highline, about halfway between Shelby and Havre. Chester’s population is 900, but its medical facility, LCHNH, provides medical care to a service area of 2200, and includes an 11-bed hospital, 47-bed nursing home, a 17-bed assisted living facility (Wheat Country Estates), and a certified rural health clinic (Triangle Healthcare).

At the root of Chester’s modern health care facility is Dr. Richard Buker, Jr., a private physician and surgeon who maintained a private medical/surgical practice in Chester for over 50 years. Dr. Buker is renowned for his skill and dedication as Chester’s “country doctor” for the past five decades, and is still on staff in an administrative and advisory role. In 2000, the clinic merged with the hospital facility. This was done to combat declining reimbursement from Medicare/Medicaid programs and to promote clinician retention by strengthening the overall employment package for medical providers.

Five years later, Chester boasts strong provider retention in spite of the challenges of providing care in rural Montana. The facility currently has two full-time and one part-time physician, and one physician assistant (PA) on staff. Three of the providers have practiced there for at least five years. “It’s important to find the right mix of skills and experience when recruiting providers,” comments CEO Walter Busch. Dr. Anna Earl grew up in Fort Benton and did a rotation in Chester with Dr. Buker during her medical school training. This fostered a desire to return to the area. Dr. Gladys Young, a former Air Force physician, had filled in as a locum tenens in Chester and knew and liked the area and the facility prior to accepting her part-time position. Dr. Kozakiewicz had a strong liking for rural medicine. Born and educated in Poland, he taught medicine in Canada and practiced in rural Washington State prior to moving to Chester. Physician Assistant Jeff Chelmo has been at LCHNH for over five years. He did a rotation with Dr. Buker and Dr. Earl during his PA training and liked Chester so well, he chose to come back to start his practice.

Busch also believes the nature of the practice and its overall fit with the medical providers’ interests is important for provider retention. LCHNH clinicians provide obstetrical care, delivering approximately 12-18 babies in Chester annually. Both Dr. Earl and Dr. Kozakiewicz are certified in OB and C-section and enjoy this aspect of their practice. The facility purchased a Computerized Tomography (CT) unit from Benefis Hospital in Great Falls in 2003. CT capability has allowed for faster evaluation and treatment of conditions such as stroke and trauma. It has also “increased the comfort level of the clinicians practicing in this remote setting,” says Busch. Use of teleradiology further enhances prompt patient treatment and provider satisfaction. Digital images can be transmitted and read by a radiologist in 15 minutes, if required.

In 2003, like many smaller Montana medical facilities, LCHNH was designated as a Critical Access Hospital (CAH). “With CAH status, we benefit from cost-based reimbursement, which works out better for our facility than traditional payments at a set rate per case. The CAH program is designed to more fairly reimburse smaller, low-volume facilities.” Busch explained.

For a smaller facility, LCHNH provides a surprising array of specialty services. Two surgeons, one from Shelby and one from Great Falls, visit weekly and monthly, respectively, and perform general surgery, including laparoscopic surgery, in the hospital operating room. Other specialty services include Ear/Nose/Throat, Urology, and Oncology. In addition to laboratory and radiology diagnostic capabilities, “we have just about every kind of scope,” Busch comments. Available diagnostic testing includes endoscopy, sigmoidoscopy, colonoscopy and colposcopy. 3-D ultrasound, mammography, and DEXA-scanning (for osteoporosis) are also available. LCHNH also provides mobile mammography services to several neighboring hospitals. LCHNH has a contract with Liberty County to provide Public Health and WIC services.

“Participation in the Northcentral Montana Healthcare Alliance (NMHA) has been a good partnership for us,” Busch says. Composed of nine rural facilities located along Montana’s highline and with Benefis Healthcare in Great Falls as the hub, NMHA’s goal is to increase access to medical services in rural areas through shared partnerships and resources. An example of such shared services is the mobile DEXA-Scan equipment that travels among the member hospitals.

Busch is regenerating a Home Health program that was closed several years ago due to inability to staff enough nurses for the program. “We now have 21 nurses on staff, a mix of RN’s and LPN’s, but staffing the hospital and nursing home services took priority over Home Health, and we had to close the program.”

Busch expresses concern regarding continued recruitment and retention of nursing staff. “We have highly qualified, experienced nurses right now,” he says, and he anticipates future recruitment challenges in the next decade. “Many nurses are choosing to specialize in more urban areas,” he observes, and emphasizes the facility’s openness to nursing student rotations in the facility. “We certainly have the nursing leadership, high quality medical staff, and a wide variety of clinical services to give students a good rotation,” he says.

For more information about Lincoln County Hospital and Nursing Home, contact Walter Busch, CEO, 406-759-5181.

Montana Primary Care Association 1805 Euclid Avenue Helena, MT 59601 Phone: (406) 442-2750 Fax: (406) 449-2460