The good news — between initial funding from the Big Beautiful Bill, and the rushed state budget, Lafayette Hospital should see a boost in funding for services for the next three years.
The bad news — after those first three years, the Federal Government will be peeling back that funding, to the point it will be one-half what it was before the bill.
DARLINGTON — Having moved into their new building in April, staff at Lafayette Hospital and Clinic have been getting a feel for the new digs.
So have the public, as discussed last week during the County Hospital Board meeting, where it was said that more and more people are coming through the doors of the new facility, keeping up a trend that in the last months of the old facility.
And for many, they are not just coming for the food.
Lafayette Hospital CEO Marie Wamsley was very proud to announce that May — the first full month in the new facility — was the best month ever for people utilizing the hospital, as visits across various departments were up 10 percent from a year ago, some exceeding more than 15 percent jumps.
Part of the increases, which began in the final months of the previous facility, Wamsley admits were in anticipation of the new building going online, but in the new facility they have also continued to expand offerings.
For one, there is the new in-house MRI, which came in part with a $4 million grant from the state. No longer having a truck pull up next to the building, the new MRI allows services anytime.
Wamsley continued that their urologist and orthopedic surgeon on staff have continued to bring in increased numbers, as both continue to get referrals from around the region.
“That continues to grow as we moved into this new facility,” Wamsley continued.
One of the draws, outside of receiving medical attention, was the cafeteria, which is getting a fair amount of usage from the community, as it has both meals at breakfast and lunch, as well as the ability to grab items to go.
For those coming in and staying to eat, they get a view of the countryside that almost beats the taste of the food.
Wamsley quipped that the Darlington Police Department seems to visit every day, for the food, while board member Jed Gant noted that the parking lot seems to swell at noon.
“If you can please the local critics, its got to be good,” Gant remarked.
Wamsley added that people plan their appointments so they then can stay and eat.
This expanded service is new for the hospital, compared to what business the previous cafeteria handled, and they are reviewing the costs and the revenue of the service to see how well its doing.
County Board Chair Jack Sauer joked they may have to look into adding a bar, increasing revenue.
While the hospital held an open house before they opened in April, the ribbon cutting Aug. 21, starting at noon, will be another opportunity for the public to see the facility, although since it is open, there will not be so many detailed tours as in April.
What will be new will be several opportunities to acknowledge the supporters of the facility. During the event, the Donor Wall will be revealed, part of the $2 million capital campaign the hospital has been undertaking.
The event will also reveal the new name of the atrium in honor of a family who gave a large donation for the facility.
While open, there is still work going on as they move in. From the small — the board discussed additional way finding signage for visitors, pointing them to different entrances for the facility.
To the larger — the remote ICU will go live next month. The program will have an ‘easy’ button that will alert and bring online specialists from UW Hospital to diagnose and treat patients remotely.
Wamsley noted that while some critical care patients, for severe issues like burns, will still be transferred, this will allow greater critical care kept close to home.
The hospital is also looking at ways to increase its swing bed usage, so residents do not have to travel to get treatment.
To also help improve speed of diagnosis, the hospital switch providers for the lab work not handled internally, using Meriter, which means daily pickups.
Meeting with partners
The hospital board will be holding a joint board meeting next month, Aug. 5, with the board from Upland Hills in Darlington to discuss ways to maintain and improve their partnerships between the two medical centers.
Wamsley told the board that this meeting was on the request from Upland Hills, who is the hospital’s partner when it comes to birthing services, as, due to frequency, Lafayette Hospital had moved away from handling deliveries, unless it is an emergency.
“They want to build on that relationship,” Wamsley shared.
Upland Hills had some changes in leadership, and they want to have the meeting in Darlington as part meet and greet, part how they may work together in the future.
With that meeting brought up, and with a couple of months into the new facility, some members of the board wondered if they would someday bring back such services to Lafayette Hospital.
“That is not in our future at the moment,” Wamsley replied, noting that when the decision was made to give up that service, it was difficult, but when they average 24 or fewer births a year, having staff be certified and ready was increasingly difficult.
“Unfortunately, its hard to keep up those competencies,” Wamsley continued, noting they were down to having only one person who would take on cesarean section surgeries.
The emergency room is capable of handling deliveries. “To have that available 24-7 is difficult,” Wamsley shared.
Sauer noted that the trend in rural communities has been fewer small hospitals have been able to keep up birthing services.
Gant added even larger hospitals in places like surrounding Madison have a difficult time keeping up, as staffing becomes one of the hardest issues to deal with. “Even there they struggle,” Gant shared.
Regionally, surrounding hospitals offering birthing services include Upland Hills, Southwest Health, and the Monroe Clinic.
Lafayette Hospital is not alone in the region on working with other hospitals when it comes to birthing services. Boscobel Area Health in neighboring Grant County stopped having deliveries in their facility more than a decade ago, partnering with Grant Regional in Lancaster, a 30-minute drive away.
Wamsley said they will be conducting an update to their community health needs assessment study this year, and continue to see how operations are in the new building. “If we continue to grow, and there is an opportunity, we will look into it,” she said.
Working with the Amish community
During the discussion about health needs assessment, board member Arnie Miehe wondered about reaching out to the Amish.
Wamsley stated that talking with the members of the Amish community continues to be an ongoing dialogue that started at the beginning of this year.
Hospital staff and elders of the Amish community in Lafayette County met to discuss services that individuals may need, and how they wanted to pay for them.
“They want to pay their fair share,” Wamsley stated, noting that they signed an agreement that is available to any resident who would qualify for the financial assistance program, which they waive to get services at a discounted rate.
“This would be available to any patient,” Wamsley said.
One of the areas they are focusing on in upcoming conversations is about babies delivered at home.
Many utilize midwives to deliver babies at home, and a lack of communication has led to times when EMS have been called when complications have gotten severe.
“They are almost called in too late,” Wamsley remarked, noting that at a recent Shullsburg EMS meeting, the emergency responders talked about coming into difficult situations on calls in recent years.
Wamsley continued, noting that one of the issues when there is a complication, and EMS is called in, is that the midwife often still looks to be in control, which can lead to issues on how to respond when mother and baby are having complications.
Wamsley stated that future meetings will be going over scenarios so that there is a better understanding on both sides, and more open dialogue, so that when there is that next call, everyone will be on the same page.
Wamsley pointed to new staff, like Renee Edge, returning to work Lafayette County after being in Lancaster, who had forged a strong working relationship with Amish communities there in her position.
Also, a hitching post is being installed in the new parking lot of the new hospital.
Problems with Medical Associates
You are the head of the community hospital, but you can’t get your medical services there — that is a problem Wamsley said she had, as many employees of Lafayette County are seeing with their insurance provider, Medical Associates, trying to have more authorized procedures in their own facility in Dubuque, rather than have them handled in Darlington.
“It is really unfortunate,” Wamsley shared with the board. “I cannot have my own services done here.”
The issue has becoming more of a problem in the past six months.
“Medical Associates had been a great partner in the past,” Wamsley said, but as they see changes in revenue, this is one thing they are doing to increase revenue, which impacts the local patients.
Medical Associates is part of the state plans of insurance the county gives employees, and on the review of their offerings, shows many of the service providers in Lafayette County. When it comes to prior authorized procedures, they are denying the service in Lafayette County, and channeling patients to their own facility.
“Its deceiving,” Wamsley said, as hospital providers are listed as covered, but for those employees or residents living in the eastern side of the county, it means a long drive to Dubuque.
“Have you looked at a map?” board member Larry Ludlum asked, concerning the inconvenience of travel that people face.
Wamsley said that she shared information with State Sen. Howard Marklein’s office about the current situation, since it is under the state offerings.
Feast, then famine with Big Beautiful Bill
It was good news, bad news, when discussing the impact of federal and state budget bills, when it came to rural healthcare.
The good news — between initial funding from the Big Beautiful Bill, and the rushed state budget, Lafayette Hospital should see a boost in funding for services for the next three years.
The bad news — after those first three years, the Federal Government will be peeling back that funding, to the point it will be one-half what it was before the bill.
In the state budget bill, the Republican Legislature and Democratic Governor Tony Evers rushed to work together to increase hospital assessments for the two-year budget.
That increase then allowed the state to tap into additional Medicaid funds, which will mean increased coverage of services for rural hospitals.
“That was critical for all of our hospitals,” Wamsley said of the state budget. She noted that the Wisconsin Hospital Association worked closely with lawmakers to make sure the changes were made to increase the funding.
“It was absolutely appreciated,” Wamsley shared.
She noted the increased assessments mean the hospital will be paying more, but even more funding will come back for services. “We will be one of the winners.”
That is for the initial years, but the Federal Budget will then begin to pull money away from programs. “They will go down to a pretty low level,” Wamsley continued. “That will impact every facility across the nation.”
With that impending loss of funding, Wamsley knows the result will be some people will not get the care they need to try and prevent issues from getting worse, and when they get worse, they will end up in the emergency room, which will cost the hospital more.
“Their medical condition will be worse than if they had been getting proper coverage,” Wamsley shared.
They won’t be able to afford the bill, so we will just have to write it off,” Wamsley continued, noting that for an emergency room visit goes into thousands of dollars.
Seeing this, and wanting to serve the community better, staff and Carly Winslow, who is a nurse in the Lafayette County Jail and works for Upland Hills, are working on a free clinic one to help serve the needs of people who do not have coverage.
While not connected to the hospital directly, Wamsley said the positive impact on the quality of health for the community will be good.
Some of the board hope that once the issues show up, there will be changes by elected officials.
“The need of healthcare will always be there,” Gant stated. “There will be a knowledge that this will not work in rural areas,” of the cuts.