As people try to visualize what a summer during a public health pandemic will look like, the Steele County Parks and Recreation Department is doing all they can to continue services as normal.
During the regular county Board of Commissioners meeting Tuesday, Parks and Rec Director Steve Schroht recommended that the county move forward with operating the park and beach at Beaver Lake near Ellendale as usual. Aside from the picnic pavilions, fishing pier, and hiking trails that have remained open to the public, the action will allow county parks and rec employees to maintain and operate the beach house into the month of August.
“Quite a few residents have said that with the warmer weather [Beaver Lake] is getting a lot of use,” Schroht said to the board. “Just this morning when I went out there I had to dump every single garbage can, so it is clearly getting a lot of use and I see it only getting more as we go on through the summer.”
The commissioners unanimously approved putting in the buoys at the beach and opening the beach house Saturday. Schroht said that the buoys serve as an important safety precaution both to alert swimmers of a drop off in the lake’s depth as well as to keep boats away from the swimming area. Schroht is also working with Steele County Public Health to create signs that encourage social distancing. Those will be posted throughout the park area and on the beach.
The beach house is available to the public Friday through Sunday during the summer months.
In addition to opening and operating Beaver Lake County Park and beach, the commissioners also approved the installation of the summer ice at the Four Seasons Centre with skating available beginning July 6. Summer ice has been a part of summer recreation options in Steele County since 2001, but Schroht explained that this summer provides a very unique opportunity for revenue.
“If I book just one hour of skate time in August, that will already be more revenue for that month than we have ever had,” Schroht said, explaining that with the cancelation of the Steele County Free Fair that the ice installed in July will be able to remain in place until March 2021. “This eliminates one time of putting in the ice and taking it out, and I believe that if we don’t do this it will be a missed opportunity for us.”
Schroht believes groups will jump at the chance to skate throughout the summer; especially in August when skating typically isn’t an option. He said that the youth hockey association is already talking about an earlier registration date and that it could provide their usual fall clinic earlier as well.
“I think there is going to be a lot of demand during the month of August simply because they have never had that opportunity before,” Schroht said. With the current social distancing guidelines from the Centers for Disease Control and Prevention, Schroht said that open skate will not be an option at this time, but that groups can make skating reservations. Reservations can be made by contacting the Four Seasons Centre at 507-451-1093.
In addition to operating Beaver Lake County Park and the summer ice, Schroht said that all furloughed workers for the county Parks and Rec Department will return to work, with the potential opportunity to bring back some part-time staff.
“It’s not just going to be what we’re doing with the summer ice and Beaver Lake, but it’s the stages and pavilion rentals and everything else,” Schroht said. “We’re trying to get back to operating as much as normal.”
Wendy Stephani could almost always tell when a book was right for one of her students.
Selecting from a library that lined the walls of her classroom, the longtime special education teacher had a knack for learning about teens’ interests and getting them excited to read by matching them up with a story they would enjoy. This was no small feat, considering that at the high school level, many still struggled with reading comprehension and had become disinterested in reading for fun.
Stephani, who’s retiring after 30 years with the district, first at the junior high and then at Owatonna High School, will be remembered by colleagues for her passion and talent for reading intervention.
Science teacher Emily Leckner, who worked with Stephani to help students transition to high school through the Ninth Grade Academy program, attributed participants’ increased reading comprehension scores in large part to Stephani’s ability to equate books with enjoyment.
“She was amazing at reaching these kids who hated reading, who had never picked up a book in their life or were apathetic,” said Leckner. “She got just the right book in these kids’ hands.”
While Stephani always knew she wanted to be a teacher, her career as a special education instructor at the middle and high school level wasn’t what she initially envisioned.
“I was always going to be an elementary school teacher, that’s what I always dreamed of,” she recalled. “Then, when I was in high school, I heard about this new licensure possibility.”
Entering a growing field
In the late 1970s, the special education field was just beginning to take off thanks to help from new legislation which required accommodations for students with disabilities. She learned that she was able to become licensed in the field, and decided to study special education in addition to elementary education during her time at Winona State University.
“Initially, I thought it would make me more marketable. It was a lot harder to find a job back then, I was competing against hundreds of people for each position when I graduated from college,” she said.
However, as soon as she started in the classroom, she realized that it was also a career she was passionate about. Stephani joked that she just sort of fell into special education — and also ended up falling into secondary education, instead of her planned elementary route. After moving to the area with her husband, who had taken a job at Federated Insurance, her first job was at Waseca High School.
After five years as a Bluejay, Stephani planned to take some time away from the classroom to focus full-time on raising kids. However, the Owatonna Junior High principal knew about Stephani’s work and asked if she would be interested in a part-time role doing team teaching. She officially started with the district in 1989, continuing to work at the middle and high school level, where she said she enjoys the fact that learning feels like a partnership.
Team teaching, something she would do for a large part of her career, meant Stephani was partnered with a general education teacher to help supervise students’ learning. Ideally, this meant collaborating as closely as possible in and out of the classroom. And, although Stephani was a special education instructor, she ended up working with all students in the classrooms where she team taught so as not to single any child out.
Launching the ninth grade academy
Shortly after coming to the high school in 2005, Stephani helped start up the Ninth Grade Academy program. Working with a cohort of general education teachers, Stephani was responsible for helping oversee students’ freshman years and ensuring they were able to successfully make the transition and keep up their grades and test scores going into high school.
Students were initially selected for the academy based on their performance in eighth grade, and Stephani said one of the things that made that role so rewarding was the number of students she taught. “I was able to work with such a wide variety of kids,” she added.
In addition to helping teach students in the academy, Stephani volunteered with her colleagues to launch the program in Owatonna.
“I joke that we were the founding mothers, instead of the founding fathers, because really it was like we were creating a constitution for what we were going to do and how we were going to be,” said Leckner. “Wendy was truly the one that gave us the lens of, ‘OK, we have to make sure we bring this to the level of the kids and meet them where they are.’”
Leckner added that Stephani was always available for students who had questions, and often had a full supply of granola bars or other snacks at her desk for those who needed them.
“There is a softness to Wendy that the kids were drawn to. They could immediately sense that she was on their side and she was going be their advocate and get them what they needed,” said Leckner. “After school, before school, during lunch — there really wasn’t a time that was off limits for kids to come and ask for help.”
Fellow special education teacher Lori Peglow said Stephani’s dedication to connecting with students also extended to her relationships with colleagues. “She is always a good listener, and really cares about people beyond school,” she said. “She cares about what’s going on in their lives, and that makes people feel special.”
After the academy program disbanded, Stephani spent the last part of her career at Owatonna High School focused more directly on reading intervention. Reading more for pleasure, she said, helped give students the practice they needed to improve their reading comprehension and to decipher more difficult texts.
In her retirement, Stephani plans to stay in education to a certain extent — making trips to volunteer in her daughter’s classroom in the metro, and offering to help out colleagues closer to home, as well. In her free time, she said she is eager to travel more with her husband once he joins her in retirement — including frequent trips to the North Shore. And, of course, plenty of time for reading.
In recent years, rural health care systems have increasingly struggled to make ends meet — and the COVID-19 pandemic has only increased those challenges, hospital leaders say.
As part of the state’s COVID-19 lockdown, Gov. Tim Walz’s restricted non-essential hospital services to help hospitals prepare for a potential surge in cases. With the case “curve” largely flattened, restrictions have since been relaxed.
Local hospitals are finding that not only has the region not seen a notable surge in COVID-19 hospitalizations, but many patients are now so concerned about contracting the virus that they aren’t coming in for regular care.
David Albrecht, President of District One Hospital in Faribault and Owatonna Hospital, said that even as hospital revenue has taken a nosedive, many costs have remained stubbornly high, putting a strain even on a large network like Allina Health. While the company’s losses due to COVID-19 have been partially blunted by funding received through the $2 trillion CARES Act passed by Congress earlier this year, Albrecht says the losses have continued, and more funding may be needed for struggling hospitals.
Northfield Hospital and Clinics CEO Steve Underdahl said that the city-owned hospital has lost as much as $1 million per week during the pandemic. Fortunately, he says the hospital has been able to fall back on significant financial reserves.
"We expect that 2020 will be a bad year financially, but we will make it through this situation intact," he shared.
Not all hospitals have that kind of financial cushion. Rick Ash, who serves as CEO of United Hospital District, a small, independent group with several clinics in southern Minnesota, said that even before the pandemic, UHD was struggling to balance the books. Now, the the hospital's financial forecasts are even more worrisome.
"COVID has been like a gut punch, it's taken the wind right out of us," Ash said. "Not only have we not had too many COVID patients, but our patients have largely gone away."
Last month, Rep. Jim Hagedorn, R-Blue Earth joined a bipartisan group of 32 colleagues in asking Health and Human Services Secretary Alex Azar to set aside at least 20% of the funding allocated for health care institutions in Congress’s latest COVID-19 relief bill to rural providers.
Hagedorn followed that up by introducing the Save Our Rural Health Providers Act along with Rep. Xochitl Torres Small, a New Mexico Democrat. Hagedorn and Torres Small’s bill would add that 20% benchmark to the CARES Act’s Provider Relief Fund. Priority would be granted to facilities which have been particularly affected by COVID-19 preparations, which serve a high number of Medicare or Medicaid patients, and/or which serve areas with limited access to healthcare infrastructure or high numbers of uninsured patients.
“This bill makes it clear that whenever we have a situation where rural health providers have gone out of their way (to prepare for COVID-19), that they be fully compensated for that,” Hagedorn said.
Hagedorn has long touted his support for the region’s network of rural hospitals. While the Mayo Clinic is the largest employer in the region, he noted that other, smaller hospital groups also do much to boost the economy and provide convenient and timely care
“It just goes back to our rural way of life,” Hagedorn said. “In some of our small towns, local hospitals are the biggest employer and drive the economy, in addition to making sure that people get the treatment they need.”
With an eye to the upcoming election, Hagedorn criticized “Medicare for All” and the “public option,” both of which have been proposed by Democrats to expand access to health care. Hagedorn warned that moving away from private insurance could actually reduce access to health care in rural areas.
Hagedorn said that half of rural hospitals could be at risk of closure if a public option reimbursing providers at current Medicare rates is placed on the health insurance exchange created by the Affordable Care Act, apparently referring to a recent study conducted by a group called Navigant Consulting.
Navigant, which has since been purchased by Chicago-based Guidehouse, was supported in its research endeavor by the Partnership for America's Health Care Future, a coalition of provider, insurance and pharmaceutical lobbyists and organizations created to oppose “Medicare for All” and the public option.
As opposed to what it characterizes as a "one size fits all approach," Partnership for America's Future has instead called for tweaks to the Affordable Care Act, which passed with the support of the American Medical Association, Pharmaceutical Research & Manufacturers of America and other industry groups after significant concessions.
The challenges faced by rural hospitals trace back to issues with the funding model adopted by health insurers in the 1980s, and continued even during a decade of relative prosperity, according to a new report from the Center for Rural Policy and Development.
That’s when the federal government began to move away from its traditional “fee for service” model for Medicare and Medicaid reimbursements and towards a “prospective patient” model, which was designed to incentivize quality and efficiency of care rather than quantity.
The CRPD, a Mankato-based policy research organization which receives funding from the state of Minnesota, noted that the policy has had other effects, exacerbated by the efforts of the federal and state governments to hold the line on health care expenses.
In order to maximize their reimbursement under the “prospective patient model,” hospitals have adopted a number of strategies. Those include finding new administrative efficiencies, embracing new technology and offering an increasingly coordinated model of care.
However, those strategies are often far less accessible to rural health care institutions with a limited number of locations and care providers. A smaller patient pool also means more financial risk and instability.
Larger hospitals and hospital groups, like Allina Health or Mayo, have far more leverage than smaller hospitals on the private market. That enables them to negotiate favorable reimbursement rates from private insurers and lower supply costs. As a result of those factors, many small, independent hospitals have sought out buyers in recent years, according to CRPD Research Associate Kelly Ashe. Once part of the larger group, consolidation often forces rural residents to travel further and further for essential care.
As the cost of care has increased, driven by a larger than ever number of elderly Americans, reimbursement rates for Medicare, Medicaid and other public health insurance programs haven’t kept up with the cost of care. In other words, hospitals are losing money on each public insurance patient they see, forcing them to charge more to patients with private insurance or no insurance. That hits rural hospitals hard because Medicare and Medicaid enrollment is especially high in rural areas.
According to the American Hospital Association, Medicare covered only 87 cents for every dollar spent caring for Medicare patients in 2017. For several forms of insurance provided by the state of Minnesota, Ash reported that the reimbursement figure drops below 80%.
“Year after year of reductions in reimbursement have impacted rural areas greatly,” Ash said. “They take away a little bit here, a little bit there and it starts to add up.”
Those challenges have hit health care institutions across the state hard. While 9% of the state’s health care institutions are located in the state’s most rural areas, where just 5% of Minnesotans live, the average profit margin of such institutions was just 0.1% in 2018.
Kelly Asche, a CRPD Research Associate who helped to put together the report, said that Minnesota is doing better than many other states in retaining rural health care services but warned that unless state leaders act fast, that could change in a hurry.
Asche noted that from 2009 to 2018, the number of Minnesota counties without a health care institution providing birth services jumped from 20 to 29. Over that time period, a wide range of other services became increasingly difficult for rural residents to come by.
Asche said that given market pressures, it’s likely that independent hospital groups will continue to be bought up by larger outfits. In order to ensure that rural residents have access to care, he argued that a multifaceted approach is needed.
Improved transportation and additional investment in telehealth is one part of that strategy, Asche said. Investment in telehealth lagged for years, but that has changed rapidly in the face of the global pandemic.
While the technology enabling the significant shift to telemedicine has been in place for years, most providers have preferred to stick with face-to-face appointments. In addition, Medicare and other health insurance often haven’t reimbursed care providers for virtual appointments.
On March 30, the Centers for Medicare and Medicaid Services announced that it would reimburse physicians for telehealth visits at the same rate as for in-person visits. Effective March 1, the change covers checkups and medical care provided for any reason.
Medicare also expanded access by scrapping a rule that required all telehealth visits to take place on devices meeting federal online privacy and security standards. At the state level, additional restrictions on telemedicine reimbursement have been lifted.
Asche also said that legislators should consider requiring a public interest review whenever a health care system wants to consolidate or cut services at a facility. Under state law, such a review is only required when a hospital system wants to expand services. That’s a relic from a law which placed a moratorium on adding hospital beds anywhere in the state in order to reduce duplication of services and limit increasing costs. The moratorium was ultimately repealed, but the review requirement has remained.
Under such a review, the healthcare provider would be required to give its reasoning and provide for an accounting of the likely impact on the community in terms of health care access and jobs, giving communities time to react and prepare.
The report notes that such a requirement could help communities like Albert Lea to retain their health care services. The southern Minnesota city of roughly 20,000 became a flashpoint in the health care debate when Mayo Clinic Health System announced that it would consolidate services between its Albert Lea and Austin clinics.
Mayo's regional Vice President, Dr. Annie Sadosty, said that the rationale for the decision was both financial and staffing. In the two years before the consolidation, the two care facilities had lost a combined total of more than $13 million.
In response, residents of the town organized the "Save our Hospital" campaign, which then transformed into the "Save our Healthcare" campaign to find alternatives. Campaign organizer Brad Arends expressed particular frustration with Mayo's failure to consult local residents before making its decision.
"They did this without any feedback from local citizens or leaders," Arends is quoted as saying in the study. "No economic impact study or health impact study. Even though they have all this money in profits, they said Albert Lea isn’t worth it.”
In the end, Albert Lea's campaign was largely successful. While they didn't succeed in stopping Mayo's consolidation of services, the city's residents managed to bring a different care provider to town - MercyOne, Iowa's largest hospital group.
The new care facility, located in what had been retail space, will open as a primary care clinic before expanding to offer outpatient surgery and eventually birthing services as part of a five-phase plan.
Asche noted that like too many communities throughout greater Minnesota, Albert Lea was in a position to lose its health care services even as its community and health care needs continued to grow. While Albert Lea's story may have had a happy ending, he warned that its success may be difficult to replicate.
"No one has ill intent," he said. "Hospitals are simply reacting to the market, but we need to keep a better eye on this trend."