Prairie Lakes Healthcare System

How has this small-town health system, which now includes a cancer center, a surgical center, and dialysis units, managed to achieve this level of success, continually expand its size and services, and remain independent while the population of Watertown has held steady? President and CEO Jill Fuller says it started more than 15 years ago with an intentional decision by the hospital board. At that time, Prairie Lakes employed only one specialty physician—a radiation oncologist.

South Dakota, a town of 22,000, was named among the Top 20 Rural Community Hospitals in the nation by iVantage Health Analytics. Prairie Lakes was the only independent hospital in our region to make the list, which was based on eight indices including inpatient and outpatient market share, quality, outcomes, patient perspectives, costs, charge and financial stability.

“Our board made a strategic decision in 2003 when I was Chief Nursing Officer that we were going to better serve the 90,000 people in our 10-county service area by expanding our services,” says Fuller, who took the helm of the organization in 2009. “We are 100 miles away from Sioux Falls. Some of our people are 100 or 150 miles away from specialty services. So we knew they needed better access.”

Architect's rendering of Prairie Lakes Healthcare System with the new Prairie Lakes Specialty Clinic addition Fuller says the decision to expand and small organizations in South services, along with a commitment Dakota and beyond, and continue to to a) maintain a substantial financial expand its campus and technology— cushion, b) diversify to keep up with all without the financial intervention changes in healthcare utilization, and of another health system. c) establish good relationships with “We knew that a lot of people critical access hospitals (including were going out ot town for the kinds helping them keep certain services of services we now offer here, but it in their own towns) set Prairie Lakes was so ‘out-of-the-box’ to imagine on its current course. that we could start, for instance, an

It is a course that has allowed this interventional cardiology program 81-bed hospital to now offer nine in Watertown, South Dakota,” says specialty service lines (including Fuller. “The startup costs alone were specialties like nephrology and interventional cardiology that are often As the hospital’s latest expansion,

unheard-of in small communities), a $32 million dollar, 68,000 square employ 23 physicians, maintain 21 foot specialty clinic, nears completion, it is clear that the gamble outreach clinics, collaborate with big has

Architect's rendering of a corridor in the new Prairie Lakes Specialty Clinic which opens this fall. paid off. “When I came here in 2000, our total patient revenue was 33 million,” says Fuller. “Today we are at 100 million. That came through adding services. Without doing that, we would have been on a totally different path.”

While many rural healthcare facilitiesstruggle to fill positions, Prairie Lakeshas managed to excel in this area, too.Fuller says many physicians, especiallythose in the latter part of theircareers, appreciate the slower pace oflife in this rural community, thenatural beauty of the area, and thewarmth and friendliness of patientshere. The hospital’s financial stabilityand its independent status are, formany, the icing on the cake.

Urologist Chris Adducci, MD, oneof two urologists in town, says he wason the brink of burnout when he lefthis multi-specialty clinic in Bismarcknine years ago to join Prairie Lakes.He was attracted not only to thepromise of a higher quality of life forhimself, but also to the high qualityof care the hospital was providing, asevidenced by its multiple service linesand top-of-the-line equipment.

“I don’t think many people understandhow unique this is,” says Dr.Adducci. “Any town this size wouldlove to have this many service linesavailable on the ground. But it is adifficult thing to carry off. Starting aservice line is a gamble. You have totool up and hope that the bodies arethere to make it successful. They havemanaged to figure out a way to attractphysicians who are good at what theydo and not grind them into the dirt.”

Not only has Prairie Lakes beeninnovative in finding alternatives toround-the-clock call—even for solospecialty providers like Adducci—butthey have demonstrated both the abilityand the willingness to invest innew technology. A few of the upgradesat Prairie Lakes this year include new cath lab equipment, phototherapy for dermatology, a therapy pool, and a new minimally option for benign prostatic hyperplasia called Rezum.

“You don’t have to go seven layers up the chain if you want to get something done,” says Adducci, who helped bring Rezum to Watertown. “With Rezum, I said ‘here’s what I think we need’ and we were able to get it up and going quickly. Communication has never been a problem here. If you want to say something to Jill, you can just walk down there and talk to her. They are very responsive.”

That responsiveness and the opportunity to help guide innovation were also big draws for California native Jeffrey Smith, MD, the only dermatologist for 100 miles around Watertown. Before he joined Prairie Lakes two years ago, Watertown hadn’t had a full-time dermatologist for at least a decade.

“I really liked that the hospital is small and independent because there is so much room for autonomy,” says Smith, who also provides monthly outreach services in Milbank. “We are in the business of taking care of people and we put our priorities where they need to be. I feel like I am able to make choices that are in the patients’ interests without anyone breathing down my neck.”

Dr. Smith’s clinic will relocate to the new building when it opens this Fall. Smith says the hospital not only welcomed but invited his direct input during the planning stages. “Itwas great to be able to work withadministration and the architects todetermine exactly what was goingto be best for our needs,” says Smith.“I have never done anything like thatbefore.”

• CARDIOLOGY

• DERMATOLOGY

• ENT

• GENERAL SURGERY

• HOSPICE & HOME CARE

• PT & REHABILITATION

• NEPHROLOGY

• PULMONOLOGY

• UROLOGY

• WOUND CARE

Along with dermatology, thetwo-story Prairie Lakes SpecialtyClinic will also house cardiology,general surgery, nephrology, pulmonologyand urology. Physicaltherapy, occupational therapy,speech therapy and Glacial LakesOrthopaedics will now be togetheron one floor in the new building anda new helipad on the roof will providedirect access to the radiologydepartment and Emergency Roombelow in the adjacent building.

“Things have been growing herelike crazy and this facility is beingbuilt with a view toward continuedgrowth,” says Smith, who will be ableto offer phototherapy services in thenew building. “Prairie Lakes has a lotof foresight. They have really helpedour clinic get up to par, including anEMR system which enables us to bevery efficient. They are setting it upfor long-term success.”

INNOVATION AND COLLABORATION

For Physical Therapist Dot McAreavey, Directorof Rehab and Wound Care Services, the hydrotherapypool in the Specialty Clinic is anotherexample of Prairie Lakes’ commitment to investwisely in the right technology. The new pool, witha treadmill floor that can be raised or lowered toadjust resistance, is expected to pay off big for painpatients—a special focus for her department.

“The thing I really appreciate about PrairieLakes is that they allow employees, from directorsall the way down the chain, to be innovative,” saysMcAreavey, who has been with the organizationsince 2004. “You can say, ‘I have a patient who hasthis problem. We don’t have an option for them.What can we do?’ We are able to think outside thebox without having to go through quite so muchred tape. We are more fluid in how we move, whichis more productive and better for patients.”

McAreavey gives a lot of the credit to collaboration,both within and outside of the organization.As an example, she cites last summer’s jointreplacement education program that was runthrough Prairie Lakes to support Glacial LakesOrthopedic patients. Prairie Lakes’ partnershipwith Lake Area Technical Institute for physicaltherapy education is another example.

“These kinds of partnerships are fun and keepyou thinking and staying innovative and creative,”says McAreavey. “That’s important in a small townwhere your patients are your friends and neighbors.PT is always personal, but it’s even more sohere.”

CEO Fuller says collaboration has also beenpivotal for Prairie Lakes Healthcare as a whole.

“Collaboration and partnership is an essentialpart of our success,” she says. “We collaborate withSanford and Avera and even providers in Minneapolis.We are able to pick and choose, which is toour advantage. I have also visited every hospitalin our services area. This is really what populationhealth should be about, where we all work collaboratively. That is a novel concept.” ❖

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