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What's the future of health care in Fillmore County?

The politicians in Washington, D.C., aren't the only ones who have been talking about the future of health care.

The Fillmore County Hospital (FCH) Advisory Board has been discussing the direction health care has taken on the local scene with FCH CEO Paul Utemark the past several months. The next step for the board, according to Utemark, is to review proposals for the creation of a facility Master Plan and hire a firm to conduct the research. He said the cost for a Master Plan, which will include both remodeling and replacement options, should be about $25,000.

"We're looking at what the health care needs for the future will be in Fillmore County," Utemark said. "We're one of the last (critical access) hospitals in Nebraska who hasn't looked at completing a Master Plan."

Utemark went over a power-point presentation with the Fillmore County Board at the supervisor's regularly-scheduled meeting last week. He said while keeping patient rooms filled was the focus for the local hospital for many years, the main revenue stream for FCH now is in the area of out-patient services.

"Out-patient services is the future for us," Utemark said. "We're having more and more specialists coming in. We need to grow this area. Right now, 70 percent of the revenue coming in at the hospital is through out-patient services. In-patient numbers are declining rapidly, but, total revenue is on the upswing."

According to numbers provided to the county board, the in-patient numbers at FCH have fallen in half during the past four years—from 5,258 in 2005 to 2,446 in 2009. That's a current average of 6.7 in-patients per day.

Despite this dip, Utemark notes that service areas including out-patient surgeries, physical therapy, speech therapy and other skilled-therapy services present potential big-growth opportunities.

"The one thing we know for sure is health care changes rapidly," Utemark said. "We're looking at what needs to be done at the hospital to keep it competitive in today's health-care market."

And, FCH has been adapting to these ongoing changes. The hospital in Geneva has spent over $400,000 so far to meet the 2013 federally-mandated deadline for moving all patient files to Electronic Health Records. FCH is also in the process of installing a digital mammography unit.

Unfortunately, there are also physical issues that are arising at the local hospital, which was built in 1961. FCH's middle wing was added in 1965 and the south wing was built in 1970. The hospital's nurse's station was renovated in 1990 and the clinic building was added in 1998. A highly-successful fund-raiser helped make the hospital's Surgery, Scope and LDR renovations possible in 2005.

With a nearly 50-year old building, needs are popping up in the areas of patient-room updating, emergency-room updates and expansion and HVAC updating. Other potential priority areas include parking needs, outpatient services growth, work-flow concerns and improvements for patient drop-off areas.

"To get 50 years out of a building is a very positive thing," Utemark said.

The supervisors and the hospital's CEO also noted the economic importance of the local hospital to the county. FCH has over 100 people on its payroll, which is over $3.5 million annually. There are also five physicians and one physician's assistant who live in Geneva.

"It is really a hub of economic activity," Utemark said. "There's, no doubt, it's beneficial to the county. We need to also continue to factor this in."

Utemark said after the architecture/construction-management firm is chosen to create the Master Plan, it will take the company about three months to complete. Then, a county-wide focus group will be formed to review the plan and match it with the needs of the local area. Input will also be sought from the county board and other community leaders.

"It's important to note that there is nothing in concrete," Utemark said. "Nobody knows where this will lead. The (advisory) board wants to gather some solid information. This needs to be a community solution—not just a county board, hospital board one. The numbers also have to be right, too."

Utemark said hospital auditors will also look at the financial side of potential construction/renovation work. He also said funding for the construction would probably come from Revenue Bonds, which would require a vote of the people.

"Of course, we'll have to look at the numbers and see if any potential solution is economically feasible," Utemark said. "Whether this will be a viable option for financing will have to be determined."

Utemark said that a private option will also be talked about in the next several months. He told the county board that some rural, critical-access hospitals are being bought up by private companies. He said, in some cases, critical-access hospitals can present an attractive return on investment to private entities.

For now, Utemark said the main emphasis is to hire a company to complete the Master Plan. Then, a highly-visible, county-wide focus group will look at the plan's results and present them to the public.

"It's inevitable that we have to do something at the hospital," Fillmore County Supervisor Larry Cerny said. "We need the hospital to keep attracting the specialists that it does."

And, the best way to do this locally is to be proactive.

"These are uncertain and risky times," Utemark said. "The message is...what should we be doing?

"What do we need to do to make the future of health care viable in Fillmore County?"