W hen hospital administrators and med-ical office managers in rural Kansas

need to give their physicians a little time off,they know they can turn to the Kansas LocumTenens Program.

“If there is one thing that impresses meabout the service, it’s dependability,” saidMichael Ryan, CEO and administrator atHillsboro Community Medical Center(HCMC). “If we have a contract for a certainweekend to be covered, we just know some-body’s going to be here. That’s what we need,and that’s what our physicians need, so thatthey’re assured time off. It’s kind of like a goodalarm clock – you just set it and forget it.”

Coordinated by Rural Health Education andServices at the University of Kansas MedicalCenter, the Kansas Locum Tenems Programprovides temporary practice coverage for physi-cians in rural areas of the state. Substitute doc-tors, who are KU faculty and residents, provideassistance for their rural colleagues in the areasof family medicine, general internal medicine,pediatrics and medicine pediatrics.

HCMC, a 15-bed Critical Access Hospital incentral Kansas, has used locum tenens over theyears to give its physicians regular time off andto fill in during staff changes.

“From January 2001 to September 2002,every fourth week we’d have a locum tenenscome in so our physicians could get out of townand do whatever,” said Kenneth Johnson, direc-tor of respiratory therapy and risk manager.“Then we had another physician join our staff,

so we discontinued the service. Now, one of ourphysicians is leaving, so we decided to go backto giving our physicians one weekend out ofevery four off again.”

To participate in the Kansas Locum TenensProgram, rural physicians or community repre-sentatives must complete a service order formsix weeks prior to the date service is needed.After a provider is located from among theUniversity of Kansas School of Medicine facultyand resident physicians, a contractual agree-ment is signed.

The contracting physician or medical facility isinvoiced upon completion of the locum tenensservice. While the rates vary depending on cir-cumstances, the Kansas Locum Tenens Programcurrently charges $525 for an 8-hour weekdayand $440 for a weekend 24-hour call rate.

What’s Inside . . .

Page 3Telemedicine, TelehealthReceive OAT Grant

Page 6AHECs Provide Continuing EducationTo All Parts of Kansas

Page 8Health Alliance AidsRural Hospitals

Page 10Kingman HospitalContinues Growth

Communities in Need of Doctors FindHelp Through Locum Tenens Program

Volume 11

Number 3

Winter 2004 RURAL HEALTH EDUCATION AND SERVICES

Dr. Shawn Conard examines Delores Johnson during his locumtenens weekend at Hillsboro Community Medical Center.

CONTINUED ON PAGE 4

2

Kansas CareerOpportunities

The Kansas Career Opportunities conferencesheld in Wichita and Kansas City last fall gavecurrent and future health-care professionals achance to meet with representatives from ruralcommunities across the state. The Wichita event,Oct. 9, drew 20 exhibitors and some 100 med-ical students, nursing students, medical residentsand allied health students.

The event included a panel discussion titled“Recruiting the Team,” which gave attendeesthe opportunity to ask questions and learnmore about finding a “good fit” in a practiceopportunity in rural areas of Kansas. Panelistsincluded Eileen Hawkins, coordinator ofWichita State University’s Family NursePractitioner Program; Jennifer Jackson, MD,

internist and Bridging Plan participant at PrattInternal Medicine; Jackie John, vice presidentof Resource Development at Great PlainsHealth Alliance; and Richard Ohmart, MD,Oakley. The discussion was moderated by RickKellerman, MD, chair of the Department ofFamily and Community Medicine, Universityof Kansas School of Medicine-Wichita.

The Kansas City event, Nov. 20 in the HixsonAtrium of the University of Kansas MedicalCenter, attracted 137 attendees who spoke with14 exhibitors about rural opportunities. Bothconferences included free lunch and prize draw-ings for participants who obtained the designat-ed number of signatures from exhibitors.

Kansas Recruitment Network Coming soon: Rural Health Education and

Services will be organizing the KansasRecruitment Network (KRN). The KRN willbe composed of agencies and organizations thatadminister recruitment programs for health-care professionals. The purpose of the networkwill be to link resources in order to coordinateservices, cross-market programs and enhancerecruitment efforts. Among the participants willbe the state and federal governments as well asKansas universities and community groups. Tofind out more about the network, contact me,Lorene Valentine, at 316-293-2649, or e-maillvalenti@kumc.edu.

New Federal Web Site for GrantsA new government Web site is helping to

streamline the grant process for health-careproviders. Launched in early December 2003,www.grants.gov contains information and appli-cation forms for a variety of federal grants. Thesite is easy to navigate and includes a wealth ofhelpful information such as: grant opportunitiesand the option to receive future notifications; asecure online application process; and links tofederal grant programs, grant-making agenciesand other resources. The site provides access tothe more than 900 grant opportunities availablethrough 26 federal agencies.

Publication ScheduleIf you have an idea for an article or would

like to contribute a news item to KansasConnections, we welcome your input. Pleasesend information to the KU School ofMedicine-Wichita, 1010 N. Kansas, Wichita,KS 67214-3199. Ideas are also welcomed bytelephone at 316-293-2649; fax, 316-293-2671; or e-mail, lvalenti@kumc.edu.

Deadline for submission of ideas or articlesfor the next issue is March 5, 2004.

If you know of someone who is not receivingthe newsletter but might enjoy reading it, pleaselet us know.

From The Director . . .Lorene R. Valentine

Kansas Connectionsis published four times ayear by the University ofKansas Medical Center,Rural Health Educationand Services, Kansas Cityand Wichita. KUMC is anAA/EO/Title IX Institution.

316-293-2649DIRECTOR

Lorene R. ValentineEDITOR

Regina Roths

http://ruralhealth.kumc.edu

Kansas Career Opportunities brings together potential candi-dates and prospective practice communities.

K U M E D I C A L C E N T E R RURAL H E A L T H 3

T he University of Kansas Medical CenterTelemedicine and Telehealth has received its

second three-year federal grant award from theOffice for the Advancement of Telehealth(OAT), a division of the Health Resources andServices Administration (HRSA). The grant of$749,460, awarded in the amount of $249,820per year for three years, will support andexpand Telemedicine and Telehealth’s existingtelehealth network.

“We feel fortunate to have received this awardas it is a very competitive grant program,” saidRyan Spaulding, associate director, Telemedicineand Telehealth. “They had 178 applicants, andwe were one of only 15 that received funding.”

Spaulding said Telemedicine and Telehealth’strack record was a possible factor in securingthe grant. “We have a pretty strong telemedicineprogram and, consequently, a good reputationnationwide. But I think most importantly is thatthe project we submitted focuses on evaluatingthe costs of telemedicine, which is a real impor-tant topic right now, and we have some experi-ence in providing that cost research.”

The first OAT grant, awarded in 1999, pro-vided for the delivery of specialty services viatelemedicine to nine rural communitiesthroughout the state. That original project,known as TeleHealth for Kansans, has broughta host of specialties to rural Kansas communi-ties, including dermatology, dietetics and nutri-tion, oncology and hematology, neurology,rheumatology, pediatric cardiology, psychiatryand psychology, and speech pathology.

The latest grant, titled “Sustainability andCost Benefit Evaluation of the Kansas TelehealthNetwork,” allots at least 50 percent of the fund-ing to rural areas of the state. The grant willprovide funding for additional equipment, tele-phone charges and staff at already establishedsites. It will also support continuing educationevents through video conferencing technology.In addition, it will help to establish a newInteractive Tele-Video (ITV) system for theUniversity of Kansas School of Medicine-Wichita Family Practice Residency Program at

Smoky Hill-Salina, and at a newly constructedhealth clinic on the Prairie Band PotawatomiNation Reservation north of Topeka.

The research component of the grant willhelp determine the cost benefit experienced byusing telemedicine.

“The idea of telemedicine is to get somespecialty care out to areas that normally do nothave access to it,” saidSpaulding. “But to dothat, you have to getequipment out therethat’s fairly expensive;you need access to thespecialists to providethe service, and thereare phone charges thatgo along with the callsthemselves when apatient is visiting witha physician. So thequestion is, are those costs offset by the savingsthat telemedicine realizes? While we’ve donesome cost studies that show that it is worth-while, we want to expand that across a numberof different specialties and a number of differentremote sites.”

Kansas has been effectively using telemedicinetechnology since the first connection was madeto a community in western Kansas in 1991.Since then, the Kansas telehealth network hasgrown to encompass in excess of 60 sitesstatewide. More than 10,000 clinical consulta-tions have taken place via Telemedicine andTelehealth’s technology, making it one of theworld’s most active programs.

Telemedicine and Telehealth is a division ofKU Medical Center Health and TechnologyOutreach, promoting educational programs,health care services, communication, collabora-tion and statewide partnerships in an effort toimprove the health of Kansas. For more infor-mation about KUMC’s Health and TechnologyOutreach, visit the department’s Web site athttp://kuhto.kumc.edu.

Telemedicine and TelehealthAwarded Second OAT Grant

We feel fortunate to havereceived this award as it is

a very competitive grant program.They had 178 applicants, and wewere one of only 15that received funding. Ryan Spaulding, associate director,Telemedicine and Telehealth

4

In addition to providing needed med-ical practice relief, locum tenens givesparticipants on both sides of the con-tract a chance to gain insight into otherpeople and operations in the medicalprofession.

“I think there are benefits for all ofus,” said Ryan. “I think the residentsget a more well-rounded aspect to theireducation. Plus, we get the opportunityto meet a lot of good residents andhopefully convince some of them topractice in rural settings. And then, forour staff, there is the exposure to other,more current practices.”

For instance, when HCMC firstbegan using locum tenens, the staffquickly discovered the differencesbetween urban and rural practice. Whilemetropolitan medical facilities are typi-cally equipped to provide onsite care fora majority of conditions, rural practicesoften work with more limited resourcesand are more accustomed to transferringpatients when needed.

“It was kind of a challenge when itcame to referring patients because thephysicians from Kansas City weren’tfamiliar with the doctors down there inWichita,” said Johnson. “But we wroteup a list and gave it to them, and itworked out well. Also, we transfersome of our lab tests out to a referencelab. So that was kind of interesting atfirst, seeing what they wanted to orderfor lab tests.”

Today, a list of referring doctorsand locally available tests is a standardpart of every new locum tenens intro-

duction at HCMC. Shawn Conard, MD, a third-year Via

Christi Family Practice resident inWichita, recently participated in locumtenens for the first time. Over a 60-hour weekend shift, Conard providedcoverage for HCMC’s 15-bed hospitaland emergency room and a local clinic.He said locum tenens was a goodopportunity for residents wanting a lit-tle extra income, but that the rewardsgo beyond financial gain.

“The facility is small but it’s well runbecause there’s a lot of good staff therethat really cares for patients,” he said.

“And they’re good to work with becausethey really enjoy their jobs.”

Emily Robb, MD, a fourth-yearInternal Medicine/Pediatrics resident atthe University of Kansas MedicalCenter in Kansas City, agreed that theincentives for participating in locumtenens go beyond money.

“If you can find the time, it’s a veryrewarding experience,” she said. “I liketalking to the staff and finding outwhat it is like living so far from anycity, what they do for fun, etc. It’s veryinteresting to me and they are alwaysglad to have me there. It’s almost like aweekend getaway, except for the factthat I’m working.”

While she enjoys filling in wheneverand wherever she can, Robb said she hasseen how access to equipment can dic-tate the scope of practice. “Dependingon the facility, I may have to sendpatients to a nearby city for additionaltesting, like CTs or MRIs, which aren’tavailable in the local hospital.”

Robb’s multiple locum tenens serviceincludes covering for the two-personmedical provider staff at the SheridanCounty Health Complex, whichencompasses an 18-bed acute-care hos-pital, a long-term care unit, an assisted-living unit and a health clinic.

“We have one physician in the facili-ty, and a nurse practitioner, and we justneeded to give them a break,” explainedPam Popp, clinic manager. “I know alot of rural communities have this situa-tion where they’re very short staffed,but you can’t just keep on having thedoctor burn the candle at both ends.”

While locum tenens is a good way tofill a short-term practice need, it is agreat way to build confidence in resi-dents and in the communities theytemporarily call home.

“The program has been a really goodfit for us,” said Popp. “The physicianswe’ve had come out have been verycompetent. We’re very much leavingthe whole town in their hands and wefeel comfortable doing that with ourpatients and with our community.”

More information about the KansasLocum Tenens Program can be foundon Rural Health’s Web site at http://ruralhealth.kumc.edu. Communityrepresentatives and physicians interestedin additional details are encouraged tocall 913-588-1228.

Locum Tenens CONTINUED FROM PAGE 1

Dr. Emily Robb provided locum tenens over theholidays at New Frontiers Health Center in Oakley,allowing one physician time off when the otherwas called to active duty.

. . . it’s a very rewarding experience. I like talking tothe staff and finding out what it is like living so far from

any city, what they do for fun, etc. It’s almost like aweekend getaway, except for the fact that I’m working.Dr. Emily Robb

K U M E D I C A L C E N T E R RURAL H E A L T H 5

Rural Health WelcomesTwo New Staff MembersR ural Health Education and Services

(RHES) welcomed two new staff mem-bers last fall.

Andrea Cooper joined the staff asCoordinator for Rural Health Education andServices on the University of Kansas MedicalCenter-Kansas City campus. Cooper coordi-nates the Kansas Locum Tenens program,which provides temporary coverage for ruralKansas practices by filling requests from physi-cians and communities with resident physi-cians and faculty. In addition to her locumtenens responsibilities, Cooper helps marketand communicate information about RHES’sother programs.

A native of Missouri, and relocated for hernew position from Nebraska, Cooper saysKansas feels very much like home. “I am famil-iar with the area surrounding the Kansas Citycampus and have lived close by all my life. Andwhile I’m very comfortable here, I am also look-ing forward to learning more about the ruralcommunities throughout Kansas.”

Cooper graduated from Northwest MissouriState University with a degree in Marketing andCorporate Wellness, and has prior experience inmarketing with a community bank.

Cooper says she enjoys connecting people tothe state’s rural health opportunities and seesgreat promise for the RHES programs. “I liketrying to come up with ideas for generating alot of interest among communities and doctorsabout the locum tenens program. I am alsoenjoying marketing the RHES programs andwatching them grow and succeed.”

In addition, Cooper has found her workingenvironment to be one of friendship and stimu-lation. “I enjoy the coordinator position andworking at KUMC very much. I enjoy work-ing with the people including the KUMC staff,doctors and the communities that are involvedin the RHES programs as well as others.Through them, and through my activities, I amlearning a lot about the field and look forwardto learning more and more.”

In her spare time, Cooper runs, lifts weights,shops, watches sports, and visits with familyand friends.

Regina Roths joined the staff as editor forKansas Connections and senior coordinator forcommunications. As editor, she researches andwrites articles and coordinates the newsletter’sproduction. In her communications role, Rothsworks to forward the RHES message throughpromotional activities ranging from flyer cre-ation to media coordination.

In addition to a BA in English Language andLiterature, and several years as a promotionalrepresentative for an international corporation,Roths has worked as a freelance writer for news-papers, magazines, book publishers and corpo-rate clients. She enjoys using her experienceinterviewing people to make new connectionsfor stories of interest in rural health.

“In recent years, I have found myself especial-ly drawn to writing involving health-care top-ics,” she said. “I don’t know if it is the fascina-tion with healing, the complications of theindustry, or just the big words. Since I havebeen with RHES, I have met many friendly,dedicated people who have very interesting sto-ries to tell about health care in rural Kansas,and I can’t wait to share them all with the read-ers of the newsletter.”

A native of Wichita, Roths spent several yearsafter high school traveling before returninghome to obtain her college degree. She hasstayed since graduation in order to remain closeto family members.

Admittedly, Roths’s spare time is also con-sumed with writing, both non-fiction and fic-tion projects. She also enjoys a variety of mediaarts including photography, sculpture and met-alworking.

Andrea Cooper

Regina Roths

I n order to ensure licensure renewal, health-care professionals in Kansas are periodically

required to obtain continuing education creditsover the course of their careers. For the morethan 13,000 health care professionals in thestate’s rural areas, that once meant driving manyhours to one of a few larger cities where classeswere held. But since the implementation of theKU Area Health Education Center (AHEC)program, continuing education credits havebeen much easier to obtain.

The formation of AHECs across the nationcame about as a result of a report published bythe Carnegie Commission in 1970. Titled“Higher Education and the Nation’s Health:Policies for Medical and Dental Education,” thereport brought to light the need for better dis-tribution of health-care professionals through-out the nation’s medically underserved areas. Todevelop the needed improvements, the reportcalled for a concerted effort among governingbodies, health authorities and higher learninginstitutes.

Among its recommendations was the estab-lishment of area health education centers thatwould serve specified geographic areas, be affili-ated with a sponsoring health-care institutionand provide training for health-care personnel.By 1972, Congress had implemented legislationand appropriated seed money to assist states indealing with the issues addressed in the report.

In fact, it was a Kansas Congressman, BillRoy, who authored the legislation giving birthto the AHEC program, known as theComprehensive Health Manpower Training Actof 1971.

Although Roy had the wisdom to see the viabil-ity of the program, it took considerable discussionwith University of Kansas School of Medicine(KUSM) administrators and two grant attemptsto finally secure the federal monies needed toestablish AHECs across the state.

With KUSM serving as the sponsoringprovider, the state’s first AHEC was formed inHays to provide continuing education opportu-

nities and medical student training for a 27-county area of northwest Kansas.

This Northwest AHEC was still in its firstyear of operation when an appeal was made bylegislators for state funding to continue the pro-gram. KUSM had found itself in opposition toessential elements of the federal program, andwith state allocated funds, proceeded to craft itsown version of the AHEC program.

In essence, the Kansas AHEC programbecame one that emphasized continuing educa-tion supported by a learning resource centerand a telehealth network. The program’s intentalso focused on offering limited specialty clinicsserviced by KUSM physicians and residents.

With state funding firmly secured, the KansasAHEC program expanded. Today, threeAHECs each serve approximately one-third ofKansas counties. Located in Pittsburg, Haysand Garden City, these AHECs are known,respectively, as the East, Northwest andSouthwest sites, corresponding to their desig-nated areas of the state.

State funds through KUSM allocation, alongwith service fees, continue to support the KUAHEC program. In FY03, that funding helpedthe AHECs conduct 568 programs totalingmore than 1,775 instructional hours.Enrollment of more than 8,150 attendeesresulted in the awarding of 5,893 ContinuingMedical Education credits and 22,840Continuing Nursing Education credits.

AHECs fulfill the program’s mission of mak-ing continuing education more rurally accessiblethrough both center- and community-basedcourses. To identify continuing education needs,and the best methods of delivery, each AHECperforms an annual assessment. Informationgathered from this assessment is then used todetermine the most appropriate courses.

Mary Beth Warren, AHEC East director, saidthat level of personalization is where theAHEC’s strength lies.

“Programs are based upon what your organi-zation wants,” she said. “It is not a canned

KU Area Health Education CentersAHECs Bring Kansans Access to Continuing Education

6

Mary Beth Warren, MS, RN,CPHQ, Director, AHEC East

Robert Smoot, MS, Director,AHEC Southwest

Ruby Jane Davis, Director,AHEC Northwest

program that we thrust upon you.” According to Ruby Jane Davis,

Northwest AHEC director, input alsocomes, informally, from a variety ofsources.

“If the hospital suddenly needs some-thing on infection control, then webring somebody in for that. Sometimeswe also look at the hospital dismissaldiagnosis to see where the education isneeded, or there might be somethinggoing on in the area with influenza orAIDS, or maybe just an individualhealth professional will call and say theyneed something.”

Since programs can take place in awide range of places, at times thataccommodate an organization’s needs,flexibility is a key trait for each of theKU AHECs.

“From contacting the speaker andfinding the right place to have the pro-gram to picking the speaker up fromoutreach aircraft, if needed, to settingup refreshments, we set up the entireprogram,” said Robert Smoot,Southwest AHEC director.

Beyond continuing education courses,each AHEC also offers clinical experienceand consultations. The degree of empha-sis in each of these areas varies slightlydepending on demographic needs.

For instance, AHEC Northwest pro-vides pediatric services in cardiology,orthopedics, rheumatology, behavioralhealth and endocrinology. These ser-

vices, delivered by visiting KUMCphysicians and residents, bring care tothe community while providing ruralrotation experience. AHEC Northwestalso offers pediatric behavioral healthvia Interactive Tele-Video (ITV).

In addition to telemedicine, AHECSouthwest’s ITV assists nursing studentsin completing their degrees through theUniversity of Kansas School of Nursingin Kansas City.

“Out here, we do not have a majoruniversity, so that changes how we dothings just a little bit,” said Smoot. “Butwe see ourselves as an extension of KU,and I think that’s our role: to be theliaison between southwest Kansas andthe main university campus.”

Clinical experience also takes an inter-disciplinary approach, bringing togetherdifferent health professions to provideinsight into the roles of constituents.

“Frequently, the formal education

occurs in a silo where studentsdon’t interrelate or have experi-ences with other students,”Warren said. “Our programs are

trying to change that bit by bit, andwhat we’re finding is that participants’attitudes toward each other are changedforever.”

Each AHEC also offers a variety ofprograms for area organizations toaddress specific topics of concern. FromAlzheimer’s support to packing plantsafety, AHEC personnel learn aboutsuch needs by building relationshipswithin their respective communities.

“We take part in things that are ofinterest to us personally, but we’revery much involved and have a verystrong presence in all health-relatedmatters and community partnerships,”said Davis.

Promoting health care to future gen-erations is one emphasis AHECs areaddressing with greater frequency.

“In the rural communities, we haveto grow our own because we know thatthe people who will come back to prac-tice are the ones who grew up there,”said Warren, whose AHEC currentlyworks with middle and high schoolstudents to promote careers in thehealth-care field.

In the future, the KU AHECs willcontinue to evolve alongside the needs oftheir community’s health-care personnel.

“There’s never going to be a timewhen we can sit still and not expandinto our respective roles as continuingeducation providers,” said Smoot. “Inthe process, we also have to remainaware that part of our mission willalways be to bring new and developingthings to our community where med-ical education is concerned.”

More information about KU AHECsand the programs offered in variouslocations can be found on the Web athttp://kuahec.kumc.edu.

Left: Participants registerat the 17th Annual Four-State Nurses’ Conferencein Pittsburg, which wasorganized by AHEC East.

K U M E D I C A L C E N T E R RURAL H E A L T H 7

Missy Wilson, Pharm. D., speaks at the 17thAnnual Four-State Nurses’ Conference in Pittsburg,which was organized by AHEC East.

8

F or more than half a century, the GreatPlains Health Alliance (GPHA) has helped

rural Kansas hospitals operate efficiently andremain competitive.

“There are a lot of very small communitiesthat, in order to continue providing services,would spend vast amounts of money to try toget the advice that we give them, and in manycases, it would be too expensive for them tocontinue on,” said Roger John, president andchief executive officer. “Our services provide anavenue for their continuance.”

GPHA is a not-for-profit, private managementcompany that leases and manages two dozen hos-pitals in Kansas as well as one in Nebraska.Started in 1950, at a time when the Kansascounty hospital system was in its infancy, theGPHA has grown to become one of the oldestand largest health-management systems in theMidwest. It was built on the desire to fulfill theneed for quality care in the rural areas of Kansas.

The alliance was formed by the Rev. C.F.Schaffnit, a Lutheran minister whose back-ground included working in social services andwith one of the nation’s early organizers of ruralhospitals. Schaffnit initiated the formation of

the alliance when he recognized the need formanagement services for rural hospitals con-structed as a result of the Hospital Survey andConstruction Act of 1946, more popularlyknown as the Hill-Burton Act.

Schaffnit’s resolution to attendees of theAmerican Lutheran Church Central DistrictConvention in April 1950 led to the formationof a committee that began work on developingthe corporation. By mid-June, the group hadcontacted potential hospitals, resolved the arti-cles of incorporation and selected a name forthe newly formed management group. Thus,The Great Plains Lutheran Health and HospitalAssociation was born.

For the first two years of its existence, Schaffnitwas the organization’s sole employee, workingout of an office on the second floor of his homein Alma, Neb. By 1953, the staff had increasedto three, overseeing an organization of seven hos-pitals. Today, a staff of 20 provides services fromthe alliance’s corporate office in Phillipsburg,Kan., and a second office in Wichita.

Curtis Erickson, who joined the organizationin 1955, ultimately rose to the title of presidentand chief executive officer before retiring in1991. In a speech at the organization’s annualmeeting in 1996, Erickson attributed several“firsts” to the alliance, including the state’s firstlong-term care unit, the nation’s first hospitalmanagement contract and one of the area’s firstemployee life insurance programs. Erickson alsonoted a considerable difference in the cost ofdoing business over time, comparing a first yeartotal operating cost of $13,400 to a current dayannual telephone bill of $60,000.

In addition, Erickson noted his 1.2 millionmiles in travel over time with the alliance, a tra-dition of relationship building that remains tothis day. Among the alliance’s personnel areregional vice presidents, who work with admin-istrators, boards and medical staffs in their cor-responding hospitals. This personalized atten-tion to understanding the needs of its con-stituents is one reason the alliance has gained

Great Plains Health Alliance HelpsEnsure Success of Rural Hospitals

GPHA Board of Directors in 1987, during Curtis Erickson’s tenure as president. Front row, leftto right: Robert Hamilton, Irwin Jacobs, Walt Seidel. Middle row, left to right: John Chittenden,Ervin Helm, G. Donald Larson, Vergil Wright, and Curtis Erickson. Back row, left to right: BethMeyeres, Tom Keller, A.B. Davis, and Ferd Dietz.

K U M E D I C A L C E N T E R RURAL H E A L T H 9

strength over time. “Our staff is oriented toward rural

hospitals,” said John. “Most of them arefrom small communities, and theyknow the value of health care in thoserural areas. They live the rural hospitalstory so they know the problems thatare there and are able to speak very wellto what would improve their situation.”

Dr. Willard Werner, a practitioner atGreeley County Hospital since 1954,first heard about GPHA in 1972 whenthe hospital board decided to join thealliance. As a recipient of GPHA’s ser-vices, Werner quickly grew to appreci-ate the organization’s commitment.

“The thing that impresses me aboutGPHA is their dedication,” he said.“They are dedicated to establishing anoverall insight into what hospitals needto know. They’re not trying to pull a

fast one on anyone; they’re justhonestly trying to make things go.”

Since becoming a member of theGPHA board of directors in the mid-1980s, Werner has also seen consider-able change, which GPHA hasremained dedicated to accommodating.

“Hospital work has become extremelycomplex, so complex that these littlehospitals just cannot keep up,” he said.“But over the years, when GHPAnotices a need, they send out their spe-cialists to get everyone up to date. Andit harmonizes things when everyone’stalking on the same level. It makesthem stay in compliance and keepsthem out of hot water with the differentgovernment agencies.”

That evolution with the health-careindustry is another one of GPHA’sstrengths.

“Over the years, we have developedexpertise in all areas of rural healthcare,” said John, “and we have retainedour commitment as an organizationtowards making sure that we continueto provide care to our communities.”

In addition to administrative services,Great Plains’ financial expertise hasgrown beyond pencil and paper book-keeping ledgers to encompass comput-erized standards of accountability.

“We use the same uniform chart ofaccounts in each of our hospitals tomake comparative studies to see howhospitals differ,” John said. “If one hos-pital is very good in an area, then we cantake that as a model and use it on other

hospitals. We also have a reportthat helps us determine, by

department, how muchtime is spent in compari-son to the volume ofservices provided. Weare then able to com-pare the performance ofany one department

over the range of hospi-tals.”

The long list of other ser-vices offered by GPHA

includes reimbursement, health infor-mation management and qualityimprovement. Through additional con-tracts with Midwest Health Systems,GPHA also provides physician verifica-tion, coding and information systemsservices.

Since the 1980s, GPHA has been amember of the Voluntary Hospitals ofAmerica, Inc. Through its associationwith this network, GPHA maintainsthe purchasing power to bring a wealthof resources to its hospitals. The net-work association also provides GPHAfacilities with a forum for sharing infor-mation and ideas to keep the doors ofopportunity – and rural hospitals –open for future generations.

An early photo of the original Alma Memorial Hospital, the second hospital to join GPHA. Opened in 1951,the hospital operated out of a donated, two-story home until a new hospital was built in 1969.

There are a lot of very small communitiesthat, in order to continue providing services,

would spend vast amounts of money to try to getthe advice that we give them, and in many cases,it would be too expensivefor them to continue on.

Roger John, GPHAPresident and CEO

10

Kingman Community Hospital: Growing in an Era of Shrinking Reimbursements

I n an era when simply keeping the doorsopen is one of the greatest challenges facing

rural hospitals, Kingman Community Hospitalfound a way to widen its doors – and more – toaccommodate growth and improvements.

“We were just out of space and we had to dosomething with the roof,” said Gary Tiller, chiefexecutive officer and administrator. “We hadjammed stuff into every corner and the roof wasover twenty years old. So, since we needed abond issue to replace that, we thought we mightas well build some space, too.”

A 501(c)3 non-profit hospital, KingmanCommunity Hospital is the cornerstone ofNinnescah Valley Health Systems Inc., a health-care provider whose entities also include a homehealth agency and three clinics in SouthcentralKansas. Located roughly 30 minutes west ofWichita, the state’s largest city, KingmanCommunity Hospital has enjoyed the uniqueposition of being well situated for rural livingwith metropolitan opportunities within reach.

But while the big city connection has been aplus for Kingman residents in need of advancedlevels of medical attention, over time it has alsoproduced a steady draw of patients away fromthe hospital.

“What happens with rural hospitals is itbecomes easier to transfer patients than to justtake care of them,” said Tiller, “and these placesjust become glorified nursing homes. Well, youcan’t support a hospital on nursing home pay-ments, so you have to do something.”

Tiller already had a record for producingchange when he joined the hospital in 1996,making Kingman Community Hospital thefourth facility to benefit from his expertise as

CEO and administrator. “This has kind of been my specialty,” he said.

“I go in and I fix broken hospitals. And when Ifirst came in here, I told the board, this is theonly $15 million a year hospital I ever sawdoing $5 million.”

To “fix” Kingman Community Hospital,Tiller went about using his standard procedureof looking at every aspect of operations.

“What I do is I just go in and look underevery rock,” he said. “What I have found in theprocess is that you get people to have faith inthemselves and what they can do; then you cantake on things that are a bit more complex interms of patient care. We have a really good,solid crew. We just had to get the right peoplein the right places and away we went. Ourboard has been very supportive and helpful inthat process.”

At a time when other hospitals were strugglingin the face of shrinking reimbursements, thehospital was able to secure funds from its com-munity for the changes needed. Through a com-

Dr. Stephen Grillot, specializing in obstetrics, examines youngBrandon Siemens in one of the hospital’s new examinationrooms. Grillot’s newly relocated practice is providing youngfamilies with quality care at home.

We got everything we wanted out of it. Itcame in within budget, and within time, and

the best part is, it’s functioning just exactly the waywe designed it.

Gary Tiller, chief executive officerand administrator

K U M E D I C A L C E N T E R RURAL H E A L T H 11

munity vision project, city leaders had alreadyidentified needed infrastructure changes.

“One of the ideas from our visioning processwas the expansion of the hospital so that wecould have health-care issues addressed for theseniors and the community members that wantto stay in Kingman,” said Cheryl Beatty,Kingman city manager.

“The main goal was to have good health careaccess come to Kingman, and what the hospitalneeded was a place where they could bring doc-tors in so that our people wouldn’t have to trav-el all the time for their special needs.”

Under state statute, the city and hospital wereable to enter into a joint venture that allowed alower interest, general obligation bond to besecured in order to finance the project.

“We acted as a partner to make the bondingprocess happen,” said Beatty, “and we werepleased to do that because it was part of theoverall infrastructure goals for the City ofKingman and the community.”

To make the most of the community’s gen-erosity, hospital leaders and personnel provid-ed the inspiration for much of the design,drawing their own layout and choosing thefinishes for the property’s decor. The design isclean and simple and perfectly befitting a ruralhospital setting.

“We told them no marble in the foyer, nostatues in the fountain,” Tiller said. “We didn’twant it to look like a hotel. This is small townAmerica, square is good. We went with a veryneutral color and punched it up with accentsand donated artwork.”

A groundbreaking ceremony in July 2002marked the beginning of a building project thatincreased the facility’s size from 46,000 toapproximately 58,000 square feet. The project,completed in 2003 at a cost of just under $2million dollars, includes the addition of a for-mal oncology department, five examinationrooms, a procedure room and a physician work-room. Administrative offices and the admissionsdepartment were relocated to the addition,making possible the expansions of cardiac reha-bilitation, nuclear medicine, dietary and emer-gency departments.

“They did a great job for the amount ofmoney that they spent,” said Beatty.

Tiller agreed. “We got everything we wantedout of it,” he said. “It came in within budget,and within time, and the best part is, it’s func-tioning just exactly the way we designed it.”

Now licensed for 49 beds, the newly con-structed and rearranged space has allowed vis-iting physicians to see more patients in lesstime. While Dr. Hussam Farhoud, cardiolo-gist, has reported needing one hour less timeto see patients when he visits from Wichita,the expanded and rearranged areas have alsobrought the town’s newest residents back tothe fold.

“We’ve been out of obstetrics now for threeyears and are jumping back into that,” saidTiller. “I like that; I like having those babiesaround.”

In fact, Dr. Stephen Grillot, specializing inobstetrics, recently moved to Kingman anddelivered the community’s first baby in fouryears. For Grillot, the hospital’s improvementshave only enhanced what he views as a perfectpractice.

“I’m in the best of both worlds,” he said. “Ilike being close to a big city, and I like Wichita.I was born and raised there and my dad was adoctor there, but at the same time I can have

The new entrance to Kingman Community Hospital demonstrates a conservative and functionaldesign that was inspired by input from hospital personnel.

CONTINUED ON BACK PAGE

The University of KansasSchool of Medicine – Wichita1010 N. KansasWichita, KS 67214-3199

RETURN SERVICE REQUESTED

Non-ProfitOrganizationU.S. Postage

PAIDWichita, KSPermit #864

the flavor and the fun and the indepen-dence of being a rural physician.”

But perhaps nothing speaks to thehospital’s rebirth as loudly as the num-bers. “We’ve pretty much recaptured alot of the flow that was going intoWichita or Pratt or Hutchinson,” saidTiller. “We’re up to about $18 million ayear now and our patient census hasgone from an average of four or fivewhen I came here up to about 15 today.In just about every area we’ve growndramatically in service and numbers. Insome, we’re probably up 500 percent; inothers, we’re probably up 200 percent.”

Employee morale is reportedly up aswell. “They love what we have now,” saidTiller. “It’s something they can have pridein, yet it’s not so overblown. I see people

bending over to pick up a piece of linthere or there or polish some scuff markson the floor. They really have taken a lotof pride in keeping the thing nice.”

While Tiller also envisions additionalgrowth in the years to come, the bot-tom line is about more than dollars andcents. “We’re looking to have at leastone more family physician in here, andwe can always take on more specialists.What I’d like to see is more rural physi-cian rotations come through here, and Ithink the best way to do it is to developit over a five or ten year period of time.If we just do our best and keep improv-ing all the time, the bottom line willtake care of itself. That’s our only goal,to become one of the most respectedhealth-care systems in the state.”

Kingman Community Hospital CONTINUED FROM PAGE 11

Left to right: Shane Alexander, DO, with GaryTiller, CEO and Administrator, in the hospital’snew admissions area.

K U M E D I C A L C E N T E R RURAL H E A L T H

The mission of the Kansas Recruitment Center is

to assist Kansas’ rural communities in recruiting and

retaining physicians and other health care providers.

The Center works with hospitals, private physician practices, community health

centers, and other organizations that are recruiting for physicians, nurses, physician

assistants or other health care professionals. An organization can participate by

annually registering with the Kansas Recruitment Center.

The Center is also a health care career service for physicians, physician assistants,

nurses, nurse practitioners and other allied health professionals. The Center assists

candidates in finding a community and practice or career opportunity that meets their

requirements. Services are provided to candidates at no charge. Candidates should refer to a position by number when they are calling about a specific opening.

For more information, contact Kathryn Stone at the University of Kansas Medical Center, Rural Health Education and Services at 316-293-3456 or 1-888-503-4221 or visit the

web site at http://ruralhealth.kumc.edu.

NORTH CENTRALKRC0603.0101.01Internist – hospital-based (49 beds), multi-specialtygroup, recreational activities, great housing options,acres of parks

KRC0603.0101.02Internist or Family Physician – hospital-employed (24 bed), group of 2 providers, affordablehousing, excellent public and parochial schools,recreational activities

KRC0603.1901.01Internist – 8-physician multi-specialty group, cul-tural events, zoo, winery, 385-bed hospital locatednear practice

KRC0729.0701.01Family Physician w/OB – group practice, goodschool system, community college, park/zoo, strongcommunity pride

NORTHEASTKRC0603.0101.03Family Physician w/OB – hospital-employed,must be willing to do OB and special procedures, 24-bed hospital, affordable housing, great schools, locatednear large community

KRC0603.1302.01Diagnostic Radiologist – 4-physician practice,90-bed hospital, inpatient and outpatient

KRC1103.1101.01Family Physician w/OB – will serve as MedicalDirector at federally-qualified health care center, J-1Visa opportunity

NORTHWESTKRC0603.0101.04Family Physician w/OB – hospital-employed,stand-alone clinic, progressive educational, medical,cultural, and commercial facilities, great schools,junior college, excellent housing, National HealthService Corps site

KRC0603.0101.05Family Physician or Internist – hospital-employed, multi-specialty clinic, located one hourfrom metropolis of 30,000, touted as one of the besthunting areas in midwest and Kansas, family orient-ed community, National Health Service Corps site

KRC0603.0801.01Orthopedic Surgeon – group practice, excellentpublic and private schools, university, vo-tech, muse-ums, performing arts center, recreation commission,aquatic park, National Health Service Corps site

KRC0603.0801.02Orthopedic Surgeon – group practice, excellentpublic and private schools, university, vo-tech, muse-ums, performing arts center, recreation commission,aquatic park, National Health Service Corps site

KRC0603.0801.03Medical Oncologist – hospital-employed, excel-lent school systems, university, museums, perform-ing arts, aquatic park, 160-bed hospital, NationalHealth Service Corps site

KRC0603.0801.04General Surgeon – hospital-employed (160bed), excellent public and parochial schools, univer-sity, vo-tech, aquatic park, museums, performing artscenter, recreation commission, National HealthService Corps site

KRC0603.0801.05Plastic Surgeon – new position, hospital-employed, excellent public and parochial schools,university, vo-tech, museums, recreation commis-sion, aquatic park, performing arts center, NationalHealth Service Corps site

KRC0603.0801.06Obstetrician/Gynecologist – hospital-employed (160 bed), excellent public and parochialschools, university, vo-tech, aquatic park, museums,performing arts center, recreation commission,National Health Service Corps site

KRC0603.0801.12CRNA – group practice, excellent public andparochial schools, university, vo-tech, museums,aquatic parks, performing arts center, recreationcommission, National Health Service Corps site

KRC0603.0801.13CRNA – group practice, excellent public andparochial schools, university, vo-tech, museums,aquatic parks, performing arts center, recreationcommission, National Health Service Corps site

KRC0603.1902.01Family Physician – hospital-based rural healthclinic (15 bed with 40 bed LTCU), 9-hole golfcourse, museum, state historical park, small townatmosphere, J-1 Visa opportunity, National HealthService Corps site

KRC0603.1902.02Physician Assistant in Family Practice –hospital-based rural health clinic (15 bed with 40bed LTCU), 9-hole golf course, museum, state his-torical park, small town atmosphere, NationalHealth Service Corps site

K A N S A S R E C R U I T M E N T C E N T E R

CONTINUED ON BACK

January 2004

KRC0603.1902.03Nurse Practitioner – hospital-based rural healthclinic attached to a 15-bed acute care critical accesshospital, National Health Service Corps site

KRC0714.0301.01Lab/X-ray Supervisor – hospital-employed, newfacility within 1 1/2 hours, hunting, fishing, sports, 3hours from major metropolis, good schools, vo-techwithin one half hour drive

KRC0714.0301.02Family Physician – small 2 MD, 2 PA, hospital-based rural health community

KRC0714.0301.03Registered Nurse – 16-bed Critical AccessHospital with ER

KRC0903.0101.10General Surgeon – hospital-employed, golfcourse, swimming pool, festivals and events, greathunting, technical college, museums

KRC0903.0303.01Family Physician – multi-specialty clinic withadditional specialists on a rotating basis, must haveOB experience, J-1 Visa opportunity

KRC0903.0303.02Internist – multi-specialty clinic with additionalspecialists on a rotating basis

KRC0903.0303.03Pediatrician – multi-specialty clinic with addi-tional specialists on a rotating basis

KRC0903.0303.04Obstetrician/Gynecologist – multi-specialtyclinic with additional specialists on a rotating basis

KRC0903.0303.05General Surgeon – multi-specialty clinic withadditional specialists on a rotating basis

KRC0903.0303.06CRNA – multi-specialty clinic with additional spe-cialists on a rotating basis

KRC1013.1801.01Family Physician – hospital-employed, clinicattached to hospital, lake activities located nearby,near university

KRC1013.1801.02Physical Therapist – hospital-employed, clinicattached to hospital, lake activities located nearby,near university

KRC1103.1802.01Family Physician – medical surgery, outpatientsurgery, PT, Speech, OT, J-1 Visa opportunity

KRC1103.1802.02Internist – medical surgery, outpatient surgery, PT,Speech, OT, J-1 Visa opportunity

KRC1103.1802.03ARNP – medical, surgical, outpatient surgery, PT,Speech, OT

SOUTH CENTRALKRC0603.0101.06Family Physician w/OB – located near large

metropolis, strong diversified community, excellenteducation, many churches, friendly people

KRC0603.0101.07Family Physician or Internist – strong com-munity and family values, outstanding school sys-tem, many churches, located near wildlife refuge

KRC0603.0802.01Family Physician – hunting, fishing, manychurches, excellent school system, very activeChamber of Commerce, Balloonfest, drive-in the-ater, craft shows

SOUTHEAST KRC0603.0102.01Family Physician – 49-bed hospital, strongindustrial base, community college, numerous busi-ness opportunities, recreational opportunities, reli-gious affiliations, fine arts cultural center, public andprivate school system, 2 hours to large metropolis

KRC0603.0102.03Obstetrician/Gynecologist – 49-bed hospital,strong industrial base, community college, numerousbusiness opportunities, recreational opportunities,religious affiliations, fine arts cultural center, publicand private school system, 2 hours to large metropolis

KRC0603.0102.05Urologist – 49-bed hospital, strong industrial base,community college, numerous business opportuni-ties, recreational opportunities, religious affiliations,fine arts cultural center, public and private schoolsystem, 2 hours to large metropolis

KRC0603.1301.01Orthopedic Surgeon – group practice, lakesideliving, community college, full range of outsiderecreational opportunities, national park service site

KRC0603.1301.02Med/Peds – multi-specialty practice, lakeside liv-ing, community college, full range of outside recre-ational opportunities

KRC0603.1301.03Urologist – multi-specialty practice, near largemetropolis, excellent schools, community college,excellent recreational opportunities

KRC0603.1301.04General Surgeon – multi-specialty practice, lake-side living, community college, full range of outsiderecreational opportunities

KRC0603.1301.05General Surgeon – integrated multi-specialtygroup practice with 27 members in two locations,lakeside living, community college, full range of out-side recreational activities

KRC0709.1903.01Family Physician – hospital employed or grouppractice, 50 minute drive to the city, good schools,lakes, excellent practice opportunity, J-1 Visaopportunity

KRC0901.0103.01Family Physician w/OB – 11-physician multi-specialty group, quality safe schools, friendly people,low cost of living, honest hard working people, verylittle crime, clean neighborhoods, several large metro-politan areas nearby

KRC0901.0103.02Urologist – 11-physician multi-specialty group,quality schools, friendly people, low cost of living,very clean, hardworking people, near large metropo-lis

KRC0901.1201.01Internist – Internal medicine and general surgeongroup looking for a partner, brand new office inhospital, culturally active community, minimaltraffic, low crime rate, superb schools, quick accessto large metropolitan areas, lakes with water activitiesavailable

KRC0901.1201.02Obstetrician/Gynecologist – solo practice orassociate practice, office located in hospital, cultural-ly active community, minimal traffic, low crime rate,superb schools, quick access to metropolitan areas,beautiful lakes with activities available

KRC0901.1201.03Orthopedic Surgeon – two orthopedic surgeonslooking for a partner, office in hospital, culturally-active community, minimal traffic, low crime rate,superb schools, quick access to metropolitan areas,beautiful lakes with water activities available

KRC0903.0302.01Family Physician – federally-qualified healthcenter with mission to provide comprehensive pri-mary mental and dental health care to the under-served population, J-1 Visa opportunity

KRC0903.0302.02Family Physician – federally-qualified healthcenter with mission to provide comprehensive pri-mary mental and dental health care to the under-served population, J-1 Visa opportunity

KRC0924.1304.01Certified Coder (RHIT or RHIA) – hospital-employed

KRC0924.1304.02Nurse Practitioner – women’s health/oncology,hospital-employed, excellent benefits

SOUTHWESTKRC0603.0201.01Family Physician w/OB – economically strongcommunity, attractive, excellent schools

KRC0603.0501.01Family Physician – good school system, 9-holegolf course, community swimming pool, theater,National Health Service Corps site

KRC0603.0501.02Family Physician – good school system, 9-holegolf course, community swimming pool, theater,National Health Service Corps site

KRC0717.0401.01Internist – multi-specialty group practice, commu-nity college, J-1 Visa Opportunity

KRC0903.1303.01General Surgeon – group practice

KRC0903.1303.02Obstetrician/Gynecologist – group practice

KRC0903.1303.03Pediatrician – group practice