It's not a good time to be trying to build a new hospital in rural Minnesota. Things didn't look so bad when the effort began in Cass County a few years ago.
Then came the recession. It hit the health care industry hard and funding options dried up.
Cass is one of only seven counties in Minnesota that doesn't have a hospital. A task force worked for years to get one built on a site near Walker, Minn., but the effort has lost a key supporter. Duluth-based Essentia Health pulled back as lead provider for the project.
On top of that, efforts for national health care reform began to build momentum. The changes have been frustrating for John Warren, who chairs the hospital task force in Walker. Warren says it's created a cloud of uncertainty.
"In a sense I'm discouraged, because the economy is enough to discourage anybody," Warren said. "And health care reform, it just couldn't have come at a worse time.
Supporters of the hospital effort say there's a lot at stake. The population in Cass County is projected to double in the next 20 years, with the growth spurred mostly by elderly retirees.
An older population means more people need convenient access to health care. Yet some county residents have to travel long distances for hospital care. Warren said in an emergency, that's critical.
Many services that state government, federal government provide, need to have reasonable proximity to a hospital.Cass County Administrator Bob Yochum
"For many folks in north-central Cass County, they're well over an hour away from the nearest hospital, whether it be Brainerd or Grand Rapids or Park Rapids or Bemidji," he said. "They call that the golden hour, and that could be a life and death time for somebody who's had a heart attack or stroke, or has been in a severe car accident. That's just unacceptable."
The task force has already cleared some big obstacles. Cass County purchased the 175-acre site from the state for $1. The state-owned psychiatric nursing home on the property was closed years ago and has been demolished.
The task force got a waiver from the state's longstanding moratorium on new hospital beds. The federal government also granted a waiver, giving the proposed facility critical access status, which means the hospital can expect higher reimbursement rates from some government programs.
Essentia's withdrawal from the effort is a step backward. As lead provider, the non-profit company would have likely provided start-up capital and possibly part ownership.
But, Warren said, the relationship between the task force and Essentia got complicated when the company went through a series of acquisitions and mergers.
"We selected the Benedictine Health Systems, which subsequently morphed into Essentia," said Warren. "They subsequently merged with Brainerd Medical Group, and then Dakota Clinic out of Fargo, which became Innovis [Health]. A lot has happened over the last four years. This thing keeps changing."
Officials with Essentia declined to comment for this story. In a letter to Cass County commissioners, the company said the decision to pull out was in response to an upheaval in capital markets and an evolving health care industry.
The Cass County task force is now looking for a new partner to move forward when the economy improves.
A few years ago, County Administrator Bob Yochum saw the need for a hospital firsthand. Yochum's mother needed to be taken by ambulance to a hospital in Crosby, Minn. He says it was nerve-wracking when, halfway there, she had to be transferred to another ambulance on the side of the road during a snowstorm.
Yochum said a new hospital is not just about health, it's about economics. The facility was expected to help replace some of the 100 jobs lost when the state nursing home closed.
Yochum said the lack of a hospital close by hurts efforts to bring other services to the region, such as treatment centers or increased services to veterans.
"Many services that state government, federal government provide, need to have reasonable proximity to a hospital," he said. "And so the absence of a hospital, I think, has a longer term economic development impact on the area."
Members of the Cass County hospital task force say they'll be closely watching health care reform as a final bill emerges from Congress. Right now, it's unclear how reform will impact the effort.