Avera Health may replicate e-medicine, hub-and-spoke model
Just over a year after Kennebec, S.D. — population 280 — lost its only health care site, the new Avera Medical Group Kennebec Area Clinic has opened in its place. The town's residents made the clinic possible by donating more than $112,000 to purchase the building to house the clinic, which Avera is leasing and operates.
"We're very fortunate to live where we live — this is a ‘get-it-done' community" that was committed to having a local health care provider, said Rod Bowar, a Kennebec resident and a supporter of the clinic.
Resident Herb Sundall said, "Kennebec, while small, has always had health care on Main Street — we were spoiled, and we liked it. So the thought of not having a facility just wasn't acceptable."
In the 1970s, a physician practiced in Kennebec, and then a nurse practitioner. Beginning in 1981, Sioux Falls, S.D.-based Sanford Health began operating a mobile clinic in the south-central South Dakotan farming community — that clinic operated as a satellite of a health care facility 30 miles away in Chamberlain, S.D. In September 2012, Sanford decided to consolidate that clinic into the Chamberlain site.
Sundall said, "When we found out Sanford was closing the clinic, we talked to them, and asked them to reconsider, but they said no."
Through some personal networking, Sundall, Bowar and other town leaders connected with David Flicek, chief administrative officer for Avera Medical Group, part of Sioux Falls, S.D.-based Avera Health. The system owns or is affiliated with 32 hospitals and hundreds of other care locations in five Midwestern states. South Dakota is one of the states where Avera Health operates.
During early conversations, Flicek explained that because of financial constraints, only a limited health care model would be feasible. "I asked about the possibility of telemedicine, about operating five days a week. (Town leaders) were open and receptive to this. If I'd had the sense that they wanted to have a full-time nurse practitioner, we would have struggled. But they were not stuck in the old paradigm."
Flicek said, "I told them, your engagement is great, but we can't bear all the risks, we need a partner."
After talking with Flicek, the town leaders convened a community meeting in the fall of 2012 to discuss whether they had the financial resources and backing to do something. They asked the meeting attendees to write down what they were willing to pledge toward the clinic, and the 27 residents said they would donate $65,000 (more pledges followed, bringing the pledge drive to the current $112,000-plus).
Sundall said the town leaders were shocked at the level of commitment.
The donations enabled the city to purchase a "governor's home" — a facility built by inmates through a program initiated by the governor — and to erect it as a clinic on Kennebec's Main Street.
The facility, which opened Nov. 4, has two exam rooms, a waiting room, reception area and office space for the providers. A local emergency medical technician staffs the clinic five days a week; a nurse practitioner visits for partial days twice a week.
Most of the care at the ambulatory clinic is delivered by telemedicine. Community members make an appointment, and the emergency medical technician arranges for a remote health care provider to meet with the patient via a teleconferencing-type connection. The Kennebec clinic is considered a satellite of an Avera Medical Group facility in Chamberlain, but practitioners from throughout Avera Health can see the patients through the telemedicine connection.
Sundall said there are many older community members in Kennebec who find it difficult to travel outside of the town for care. Now, for many common medical needs, they can receive care locally. Also, in the past, when Kennebec residents received treatment from a specialist in Sioux Falls, they often had to travel the two hours back to that city later for brief follow-up appointments. Now, they can schedule many such appointments over the telemedicine connection.
Avera Medical Group has a five-year lease agreement for the clinic with the town. The town will use the lease payments to retire the clinic's debt and to fund equipment.
Flicek said Avera Medical Group is evaluating the Kennebec approach to see if it would work for other rural towns. He said the group likely would use a "hub-and-spoke" design for the service, with a larger city being the hub, and towns about the size of Kennebec being on the spokes.
Flicek said rural communities are trying to figure out how to stay viable, including with some type of health care services.
"We are seeing whether telemedicine can help them do this," he said.
Serving rural communities is central to Avera Health's mission to help people in need, Flicek said, and the telemedicine approach "has definite potential to serve as a model to further this mission."
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