Holding the Door Open for Healthcare Access in Rural North Dakota with Brock Sherva

Jeremiah Hodshire (Host): Our guest today is Brock Serva, the CEO of Northwood Deaconess Health Center in North Dakota. I’m excited to learn a little bit about North Dakota. A lot about your hospital, maybe even the weather, we’re going to talk about a lot of things today, probably things that are more pleasant than healthcare in rural America today, but a lot to talk about. First of all, it is great to have you on the podcast. I’ve been trying to get you here for at least six months. It is great to have you here. It’s great to get the recommendation. I’ve had a chance for the last several months to review a lot of the work that you’re doing. Man, you’re a go getter. Look forward to talking to you about that today. So first of all, Brock, welcome to the podcast. First time here. Let our listeners know a little bit about your background, your role there at Northwood and how long have you been there? What brought you to the organization and why in the world in 2025 and six? Did you ever choose to be a CEO in health care? So, a lot of those questions hopefully you can answer to identify with our listeners today.

Brock Sherva (Guest): Well appreciate it, JJ and thank you so much for having me on the show. Happy to happy to be a part of it. Hopefully can glean a little bit of information, but I learn a lot from your shows and your guests. You set a high bar, and so I don’t think we’re going to clear it today. As you said I’m located up here in Northwood, North Dakota. So, we are a little small town about 35 miles southwest of Grand Forks. Town of about 950 people. So, a little bit of background on me. I am a fourth-generation Northwood resident. So, my running joke that my wife rolls her eyes at is I never made it too far in life. I just stayed right here. So, Northwood High School graduate, class of 2013, and then Mayville State.

JJ: Brock, I got to stop you right there. So, if you’ve got a town of 900. How many students did you graduate with?

BS: So, my class was one of the larger classes. We had 26 in my graduating class. My wife’s from a neighboring community. It’s about half the size of Northwood and her graduating class was nine.

JJ: 26, that’s rule America. Let me ask you this. What is the geographical span of your community? It’s probably miles and miles, right?

BS: Yeah, absolutely. So, we’ll get into it a little bit into later into the podcast on our actual service area, but our service area covers about 5000 people, and we touch parts of three different counties here. So, we are we are rural. We are the definition of rural.

JJ: Now Brock, remind me because I, I’ve done the research a while ago, but critical access? And nearest tertiary center would be how far?

BS: Critical access hospital and that’s Grand Forks. So, we’re actually lucky there were about 35 miles away from our closest tertiary center. So out kind of west to Grand Forks is where you start to get real rural. Just for those that aren’t, you know, familiar with the geography of North Dakota. Grand forks is one of our metropolises. That’s right on the Red River there, which is on the shared North Dakota Minnesota border. That’s the urban areas.

JJ: So how long have you been in this role?

BS: So, I started with northward. I bring it back a little bit. So out of college I had zero interest in health care. I was going to be a banker. Agriculture is obviously huge around here. And so, I did my internship at a little local bank here and actually moved into a lending role there after college. And so, it was when I was serving on that as a lender there, trying to get some accounts in Northwood that I got asked to sit on north of Deaconesses Board. That was my first, first blush at North of Deaconess. Besides, you know, being a patient here my whole life. I did a little bit of board work. I was excited to be a part of that. Our former administrator and CEO, and was in the role for many years. He had a 40-year career that spanned all here at NDDC. And I kind of and I remember it. So, I had actually switched banks to the metropolis at Grand Forks. I was working for a bank there at the time, but still living in Northwood. And it was a it was a snow day. And Pete had called me and he said, hey, you know, we need some help in the business office. You know, we’re really growing. And I just I can’t be the CFO and CEO and manage it all. And so, we’re looking to kind of grow our bench there. And, you know, I thought he was coming to me as a board member. I’m like, yeah absolutely. What can I do to help. And he goes, well, I’m going to need you to apply. And I, I kind of it took me back and I’m like, well, Pete, I don’t know anything about health care besides what you’ve told me. He goes; you’ll figure it out. And I finally decided to take that leap of faith. And so, I took the leap of faith and started my new job in healthcare in February of 2020. And, you know, then then as we all know, the Covid pandemic started in March of 2020. And so, I got my baptism by fire and learned quick.

My wife and I still joke about the story is, you know, I would come back from work and just kind of like energized about this and like, man, I’m really contributing. I’m doing a lot. And so that was fun for about a month. And then after a month, it’s kind of like the it settles in and I had to take a step back. And I’m like, Pete’s been doing this for 40 years and doesn’t know the answer to some of these questions. Why do I think I know what I’m doing? So, then the imposter syndrome kicks in a little bit then. But we weathered the storm and worked through it. And then at the end of 2022, Pete announced his retirement. And so, the we opened it up or opened up the CEO position here. And I applied for it and was fortunate enough to be awarded it. And so, in serving in this role since January 2023.

JJ: Well, congratulations. And prior to that were either CFO then did you serve that role or.

BS: So, we let Pete retain the title of CFO. So, I was I was rev-cycle manager. It was my official title. And so, working behind the scenes more on the claims side of things.

JJ: So, then you’re doing that. You’re loving it. Life’s good. Pete’s job comes open. You take it and I, I would venture to say and we’re going to talk about some of the topics today. For me at least, it’s been the most dynamic job I’ve ever had in my life, because it’s no day is the same.

BS: Absolutely. I’ve been teasing Pete afterwards. You know, he’s still in the community. And so, I keep it clean, close contact with them. And I’ve been joking with him. I said, you know, you guys really hit a lot of things in that other duties as assigned section of the job posting.

JJ: There always is that isn’t there? Trust me, I felt for the same thing. Well, you know, sounds like you’ve obviously got a nice niche going there in your community. And having grown up there, you know, the, you know, the needs of it. We’re going to talk about that in a minute, which will mirror a lot of what our rural communities face in this country. But to connect with our listeners, I want to go a little bit more personal. Could you share with us maybe something that is unique to you, something that you know, can just really summarize and humanize you as a person? Fun fact, interesting facts, something of that nature.

BS: So, so kind of an interesting fact is we have a performing arts center that was just added on to our school back in around that 2020 timeline. And so, we have a performing arts council that tries to just bring the arts in. And one of our one of our first performances was from a gentleman named Tom Brousseau, who’s a local musician here, has roots in in North Dakota now, has gone national with his music. But he asked us when we scheduled them. He said, hey, is it okay if I bring a couple of friends to perform with me? And, you know, we said, yeah, absolutely. And so, we said, you know, send us their headshots and, you know, brief bios, we can include it in our programs. Well, we were all pretty surprised when the headshot came back, as John C Reilly from, you know, My Generation Stepbrothers, Talladega Nights and, you know, movies well before that as well. And so, it was exciting for Northwood to have, you know, what we did. Yeah, I initially googled John C Reilly and then, you know, I said musicians because we all know him as an actor. And, you know, this was obviously a musical act. And it just kept on popping up. And so, I learned that about John is that he he’s very musically talented. He does, you know, folk and blues and bluegrass and very interesting. And so, we brought him to Northwood, and I was fortunate enough to be able to emcee that event. And so, my claim to fame is, even though I have no artistic ability in my body, as I shared the stage with John C Reilly for a night.

JJ: That is amazing. Even if you would have sang by yourself without a microphone, you could say I sang with him, right? Probably tripled the size of your town with a number of people that came out right. Well, that’s a great way to humanize yourself to our listeners if you’re just tuning in. Today we’re going to be talking about how hospitals play a unique and vital role in their communities. And in this episode, Brock, the CEO of Northwood Deaconess Health Center in North Dakota, will be sharing with us how he’s leading the hospital to close the care gaps in their communities and to serve the rule patient population. When we talk about rural folks, we’re talking about significant areas where it’s hundreds of miles of vast openness and hospitals are hundreds of miles in between each other. And so obviously, that plays a significant role in the care that we give in rural community hospitals. And so, a very unique niche that their community is serving. But we’ll talk about, you know, nonprofit health care, unique service lines that they offer, and of course, what all of this has to do with rural health. So, let’s jump into it., in you know in we call it in NDHC. So, for folks that are listening that’s the Northwood Deaconess Health Center I’ll refer to it as Northwood moving forward. But let’s talk a little bit about Northwood itself. How long has it been in operation? You know, your last CEO was there 40 years, so had to be at least that long. How long has it been in the community? Has it always been a community hospital? And you know, what services does it provide right now? And I guess the greater question is what role does it play in the surrounding communities?

BS: So Northwood Deaconess Health Center actually was incorporated in the state of North Dakota in March of 1902. So, we’ve been around for a few years here. Here in Northwood, we operate our 25-bed critical access hospital. And so that’s split up into two wings. So, we have 16 of what we consider non skilled swing bed. And that looks and feels more kind of like long term care. We don’t have a nursing home within our community. And so, we’re kind of feeling that gap by having a space for you know those people that want to stay in the community but need that 16 beds. In that extended care unit. So we used to own and operate a nursing home, a skilled nursing facility with within our community in our heydays would have been like late 90s, early 2000. That was a 60-bed facility. And really, you know, we’ve seen that drop as our communities, you know, kind of shrunk or right sized. And so, we really still needed to fill that gap. But based on reimbursements within North Dakota, within that long term care space, it just wasn’t feasible to operate it. We couldn’t hit our 90% occupancy rates, and we were really just struggling. It was really hemorrhaging red ink, as Pete used to say, from the facility. And so, when we started our building project, we kicked off a building project in 2024 to update our facility, update those rooms.

We were in 1971, hospital build, 1965 long term care build. And so, we were an old building that needed to be revamped. And so, when we when we transitioned into that new building space, that’s when we formally let our licensure lapse for the long-term care and move to what we call the swing bed model. And yeah, the beds have been staying full. You know, it’s we’re still after Covid. I think the industry as a whole or the long-term care industry as a whole is still trying to find, you know, find its place between home-based services and assisted living and independent living, you know, where does it fit in. And so, we just decided that, you know, we need to be, first and foremost a hospital to serve our community. And it was great that we could still offer 16 beds for those residents that needed that care.

JJ: That’s incredible. So, I’m assuming you’re the largest employer in your community?

BS: Yeah. So, we have about 165 employees in our facility. And so, when you have a town of 950, we’re the largest employer by far. So, and you know, with that we have to pull from, from neighboring communities. You know, we have a lot of our staff that commute from, from neighboring towns to, to work here. And so, we’re kind of a cornerstone, really, of this portion of Grand Forks County as far as economic development and economic sustainability.

JJ: So, for services, Brock, talk to us a little bit about maybe some of those core services that you offer outside of, you know, that skilled or SNF.

BS: So, the other the other side of our building then is a nine bed and that’s more your acute carrier traditional swing bed. Coming in to do some rehab type services. We own and operate our E.R. as well. So, 24/7 E.R. coverage. We have two rural health clinics, a one here in Northwood and one in a neighboring community of Larimore that we’re happy to offer. We have six providers, so one physician and five apps on our provider team. We kind of do it all. We create a degree of, I guess, as a maybe a way to describe what we do, but primarily family, practice, care and we don’t have any, you know, ologists on our team, but we work closely with, like I said, Ultra and Grand Forks to get some specialty services out here and then also with within the Sanford system or get some specialty services. A unique thing about us is we do own and operate our own ambulance service as well. So, it’s you know, it’s not a great business proposition, but it’s something that we’re happy to be able to offer to our community. We just like every other critical access hospital I think that owns and operates an ambulance service, did it out of community necessity. You know, it was the community-based service that could no longer staff it and make it work. And so, they lay the keys on the administrator’s desk and say, if you guys want ambulance service, you’re going to have to run it. And that’s how we acquired ours.

JJ: Oh yeah, we know what that challenge is. Significant challenge it is. And so, in your community, let me go back a little bit because obstetrical care that’s being delivered where?

BS: So, we do have OB services in our clinic.

JJ: That’s what I thought you said. But I needed to clarify that because not too many small hospitals even have OB care. And those that have OBGYN are historically not going to be critical access. So that’s incredible. That’s definitely a community benefit.

BS: Yeah, absolutely. So, we don’t deliver babies here. So, we’ll have a provider. We contract with ultra for that service. Order Grand Forks and they’ll send a provider here once a month for that. You know full spectrum OBGYN care. And then when the delivery needs to happen or if there’s any, you know, complications that happen along the way, we’ll send them to Grand Forks, which, like I said earlier, is about a 35-minute drive from here.

JJ: Well, let’s talk a little bit about this idea of independently owned and operated, not for profits, not for profit hospitals. Right now, we’re getting a lot of attention at the federal level, you know, being told that we’re waste, fraud and abuse. And, you know, we’re using our tax status to divert money, of course, all faults. But let’s dive into a little bit that’s, you know, you’re much like Hillsdale in terms of your community outreach and the fact that you’re independently owned and operated. But for our listeners today who may say, you know, what does that mean? What is a nonprofit health care and how do they function differently, and how does it impact leadership? And what difference does being independent and being a conglomerate hospital make in your community? I want your perspective because you’re the only hospital in your community. But talk to us about the nature you know of non for profit, independently owned hospitals as you see it from your lens.

BS: So, NDHC when we incorporated back in 1902 as our nonprofit independently owned hospital, we were actually supported by the area Lutheran churches. And so, at that time, there was nine area Lutheran churches that kind of came together to be the support or the start of NDHC. NDHC is operated independent from those churches. And so, you know, we might get some year-end contributions from them, but there’s no financial profit sharing or anything like that by all means. NDHC is its own standalone facility. But what our affiliation with those member churches do is they’re who comprises our board of directors. And so, we have we have each member church gets a board of director, a board position. It makes a unique dynamic for, for our facility, you know, I have everything, but from, you know, farmers to retired school teachers to former accountants to entrepreneurs on my board. We’ve seen the full gamut of everything, which is great. I think we get a really diverse background on that. And, you know, everybody wants to see their small hospital do well, I think. And so that’s kind of a unique thing.

The other really unique thing about I think being truly independent like this and standalone is every decision truly is made locally here. There’s no going to the mothership, if you will, to ask for money or to do anything. You know, the decisions we make here directly impact us, which is which is good and bad, right? If you make a bad decision, it impacts the viability of your facility a long term. Because again, there’s no there’s no bailout for that. But I think that allows us to operate really uniquely here. We were able to move nimbly on decisions. We’re able to get into building projects. You know, like I said, that benefit us and benefit our community. And we don’t have to worry about other stakeholders outside of our own community, which is great.

One unique thing kind of going on here in North Dakota is we have what’s called the Rough Rider High Value Network, and I’m not sure if you’re familiar with it at all. But what it is, is it’s a clinically integrated network that was started back in 2023 and 23, critical, independent or independent critical access hospitals banded together to form this network. And so, you know, the goal of this network, kind of our slogan, if you will, is independence through interdependence. And so, when you have a single critical access hospital, it’s independently owned, doesn’t have resources, is in, you know, struggling communities. It’s easy for those hospitals to, you know, fall under that risk of closure and risk of not being able to serve their communities at all. And so, the goal of this network is, you know, we all work together to we’re in an ACL together. We do some group purchasing together. We’re able to really kind of spread that risk, if you will, across 23 independents as opposed to NDHC itself taking on all of that risk. And so, when the rural health transformation, I’m sure we’ll get into that later. But when the rural health transformation funds slowly started coming out, this network was actually called out by HHS to be kind of a model that other states could look at for areas where these dollars could be spent and some ideas that could be floated around. So, we’re really proud of the work that’s being done there. And it does allow us a little bit of breathing room, if you will, being a, you know, independent critical access hospital to be able to do some of that work still and take some of those risks that we maybe normally wouldn’t have taken otherwise.

JJ: You know, independent but interdependent. And I think that relationship is so important. And I would guess that your tertiary hospitals in your surrounding area would equally appraise that relationship as highly valuable, because they probably lack capacity or ambulance services to take care of that population.

BS: And really, it’s open some doors for us that probably wouldn’t have been open to NDHC by itself. You know, another it’s kind of a goofy analogy, but another analogy, if you will, that that’s been said about our Rough Rider network is that, you know, instead of being it gives us a spot at the table instead of being on the menu. When 23 of us are aggregating our lives, we’re about as big as the smallest tertiary center if you aggregate those lives in North Dakota. it really makes the state look at you and say, if we have to treat us as an independent system if you will, but give us a voice.

JJ: Great way to do it. So, if you’re listening today man and you want additional information from Brock, we’re going to drop his information in the show notes. If you want to create a system like that, I think that’s a great idea, especially as we look at the rural health transformation funds that probably aren’t going to get where they need to go, but we’re going to talk about that in a minute. I want to go back to your ambulance, okay. Because it is a significant gap right now in our care delivery model in this country. We are not engaging our EMTs. And many times, you can’t find first responders. And part of that is, you know, they’re low the low wage that they’re paid, the 24-hour shifts. There’s a lot of reasons. And we see rural communities even like mine, with very limited resources for EMTs. And so, you have patients boarded in the emergency department for long periods of times waiting to get out, especially as it relates to juvenile if there’s psychiatric juvenile needs or whatever the need may be that every second counts in in critical incidents. And when you don’t have the transport services, it will create deficits. So, understanding that premise that we’re all facing those challenges, you’ve tackled that. It is not a moneymaker, unless you can have any golden secrets. You can tell me EMS is usually a lost leader, and I want to hear more about your perspective of community paramedics, EMS, what you’re doing, how that feed your system, what that growth looks like.

BS: So, like I alluded to it a little bit earlier, we are ambulance services, parts of three different counties. And so, we have quite a big footprint for it. Our ambulance service today looks a whole lot different than it did when we took it over in 1960. And so, we have two rigs that that we staff and run. When we first started our ambulance service all the way up until fairly recently, we really relied on volunteers, just like you do, a volunteer fire department in our rural communities. You know, we have these are your people that are working in town and have other jobs, but out of the goodness of their heart, you know, carry around to pager and are willing to hop in a rig and go on a call when needed. And that’s been great. And so, we still have 16 of those people on our on our staff. So, you know, we pay them a nominal wage to be on call and per run. But, it’s out of the goodness of their heart. None of them are doing this for the money. But that’s a harder and harder thing to recruit for.

As our town’s population, you know, as a whole ages I have I have five of them over the age of 60 on my squad right now. And so, it’s a challenge to recruit for that. And so last year we moved a little bit to add two paramedics, two full time paramedics to help cover. We were really having difficulties covering daytime call, you know, because just for reasons I alluded to, people work. People do other things that aren’t ambulance for their day jobs. And so those paramedics have really allowed us to still continue to have coverage without hopefully burning out our volunteers. And so, our volunteers are still doing a great job of picking up, you know, nights and weekends for us. But I think that’s a model that that we’re going to need to continue to push as, as the volunteerism dwindles. And luckily it hasn’t hit Northwood quite yet. But, you know, national averages show that, you know, volunteerism is down. And so, in order to sustain that and make sure that we always have an ambulance service to respond to those three counties, we’re going to need to add paramedics. And it’s easy to say we’re going to add them. But like you alluded to, where do you find them that it’s a harder and harder field to fill as well. So, we navigate those challenges on the financial side of things.

You know, as I said, it’s obviously not a moneymaker for us. But Grand Forks County has been really supportive of ambulance services. And really, the state as a whole has done a lot of work over the last couple of legislative sessions to set up ambulance taxing districts and making sure that there is some financial infrastructure there to make sure that these services are funded. So, I mean, throwing money at it doesn’t necessarily, you know, find people for it. You know, there’s still staffing struggles. But financial services in North Dakota by and large have done a good job of at least getting the floor set underneath them. You know, again, none of them are making a bunch of money, but they’re also not, you know, hopefully losing a bunch of money and able to still operate.

JJ: Well, I congratulate you. That’s incredible to take that task. It is truly mission-minded work. And it sounds like that’s exactly what you do every day. From what a what could have been a faith-based approach with the churches. I mean, there’s a mission here and I and I’m starting to get that theme. And so, bless you man, for taking care of that population and having a service line like ambulance, which is very, very challenging. Well, let’s talk about something not so pleasant, at least from my perspective. You know, there was $1 trillion taken away from us under H.R. one, affectionately known as the One Big Beautiful Bill, basically stripped Medicaid as we know it, how we get paid under commercial rates. You know the shtick. End of the day, we get 1 trillion taken away. The government gives us a token by throwing 50 billion into this fund that’s not divided equally among the states. And then when the states do get those funds, they can distribute them according to an algorithm they choose. In Michigan, you’ve all heard me talk on this podcast. I will not preach it any longer, but it is not a good system. Very concerned that we were the seventh from the last to be funded dollar wise in this program. But the application process was highly secretive at the state of Michigan level. I’m on the board of the Michigan Hospital Association, and we had a task force of CEOs that put together our recommendation, not one taken; very concerning, because what we’re seeing come out of that application isn’t necessarily the most encouraging.

We do know that from President Trump to Director Oz, they’ve made it very clear that the funding cannot be used to supplant or supplement the cuts to Medicaid, Medicare, any programs creating really an opportunity for hospitals and supposedly rural hospitals that comes into play with the definition to utilize these funds for program creation. Problem with program creation as it creates a legacy cost, and you have to continue those well after the funding is gone. So, all of that to say you were involved in reviewing the RHTP, sounds like you have that clinically integrated network that is working together. I’m interested to hear North Dakota’s, at least from your lens perspective on RTP, how you’re leveraging it, what your state is doing to get those dollars to rural, and are they getting to rural? Give me your perspective, because I want to hear beyond just Michigan and others that we’ve interviewed.

BS: I think, you know, like any other state where we’re learning as we go with this. And I say we as the hospitals and we as the state. But I think one thing North Dakota has done very well to this point is they have kept that rural definition in mind of a few of the funding opportunities that have come out. Most of them are specific to RCS cause or FQCS, which is encouraging to us. That being said, you know, the rollout, as within any other state, has had its hiccups in North Dakota. They’re kind of unveiling these funding applications, you know, a couple at a time and with very tight deadlines, you know, you’ll probably have 30 days to put together an application for $2 million. And so we’re struggling with that, you know, being 165 employees. We don’t have a grant writer on staff. You know, it’s tying up a lot of our time to do this. And as you’re well aware, we can’t claim any administrative costs on the back end of this to try to offset the work that we’re missing out on. So I think, you know, the governor’s office, our state representatives, our local legislators, they seem to be very ears to the ground and wanting to know what we have, you know, what we think of things. But that being said, there’s still a lot of work that needs to get done to get these funds allocated by September. I think that’s in our state anyway. That’s I think, on everybody’s mind is to make sure we spend these dollars or have them allocated by that September, October 1st deadline to make sure we don’t handcuff ourselves for future funding opportunities for years two through five. And so, you know, I’m still optimistic that the money is going to go where it needs to go in the state of North Dakota anyway. But there’s a lot of work that needs to be done at our level and at the state level.

JJ: So, application process you’re in, in the midst of it right now. May I ask what your focus is going to be for your community?

BS: So that’s been the challenging thing of navigating. We weren’t necessarily included in North Dakota’s grant application writing process. And so, you know, obviously that was written at the state HHS level and wasn’t written by our local hospitals. And so now we’re trying to navigate what that looks like and how that comes about. So, a couple of the funding opportunities that have come out are employee retention. That was one that came out on dollars to be able to retain employees. However, we couldn’t use those dollars to recruit employees. And those dollars were specific to those offering direct clinical care. And so, you know, where we struggled is, you know, some of our hardest to fill positions are your housekeepers, your EVS crew, your dietary staff. And none of those dollars could really be used to help retain them. And so that was kind of a challenge the state’s also doing.

They came up with an application called Right-sizing Rural Healthcare Delivery, which I think we’re all a little bit concerned on what that means. And so, in this particular round of funding, there’s a consultant that will be working with the state to do feasibility studies on all of the hospitals in the state. And then we’re told that years two through five, they’ll be funding opportunities that’ll come out based on your specific results of that feasibility study. And so, I think there’s a lot of good that could come from that. But, you know, the concern is right. Right sizing usually means downsizing. Right. And so, some of those services, you know, that that all preach to anybody who will listen to me is I have to keep my E.R. open 24/7, 365 whether I see one person or whether I see 60 people. And so, there’s some of these that until you start looking at hospitals for what they really are, which is infrastructure and not private businesses, I think we’re always going to have that gap there where I will absolutely agree that that could hospitals be run more efficiently? But then we’re going to have to cut services that people need more than those, you know, ortho type services that are your money makers. And so, if they want us to continue operating ambulances, if they want us to continue operating any sort of inpatient care, if they want us to continue operating ER’s at all, they need to realize we’re inefficient by creation. We’re small, we’re 950 people. We service an area of 5000 people. I can’t predict what our E.R. volume is going to be, and nor can I make money off of that. I mean, and nor should we. I mean, we’re all out here serving a mission, right? We’re in the nonprofit realm for a reason.

JJ: Yeah, but, I mean, you’ve got to have a margin or there’s no mission, you know? So, you got to create the margin. Brock, what would you say is your percentage of payer mix? So, are you heavy Medicaid? Are you low Medicaid?

BS: I would say compared to North Dakota, we’re probably relatively low Medicaid. And North Dakota is an expanded state. And so, we lump Medicaid expansion into there as well. And so that’s probably about 12% of our population between Medicaid and Medicaid expansion, heavy, heavy Medicare utilization, just about 50% of our patient population. And then everything else is your commercial payers.

JJ: Do you have populations that you negotiate with for private based special pay? Any specialty groups that you work with?

We don’t have a lot. I’d say our truly uninsured population is going to be less than 5% around here. So that hasn’t been a factor yet. But that being said, with the ACA, you know, cuts and with these with these Medicaid changes coming down and, you know, it’s always a challenge for us with the state of North Dakota is, you know, every two years we have to go to bat for Medicaid expansion. And, you know, keep on beating the drum that, you know, these patients need this service. These aren’t your you know, it was listening to your podcast earlier on the fraud, waste and abuse and how that gets thrown around. And these aren’t these aren’t abusers. These are your people that without Medicaid expansion would fall between the cracks. These are your working poor. And so, we’re doing a very a very good service, I think, in the state of North Dakota by providing that. And I mean, let’s get down to the dollars and cents of it. As long as it’s a 90/10 split, why would you not? I mean, the state of North Dakota is not out anything on that or 10% on that. But, you know, without getting too deep into the weeds, I worry that that’s going to be another cut that comes down the pipeline as we start to evaluate some of these.

JJ: It is what’s already happened. We just got word yesterday that they’re looking at that. Do you participate? You probably don’t. 340B, any of those programs?

BS: So, we’ve got we have our own 340 B program through here. And we have two. We have a contract pharmacy in each of the two towns that we have RHC is in. So that helps right.

JJ: And that’s on the chopping block right now. And so, all of these changes 340 be. Average commercial rate with Medicaid expansion. Now you put in the provisions of Medicaid expansion. And then the biggest hit that we are starting to feel right now is the marketplace, where the tax credits have rolled back and individuals who had premiums that were, let’s say, $800 a month for a family are now looking at $2,400 a month. And so, guess what they do, right? They don’t they don’t get the insurance. And you and I have to treat patients that walk in the E.R. regardless of their ability to pay. And so, we’re just going to compound this problem. I personally don’t believe RHTP is going to help. I think that the title of it is very misleading. It is not going to transform rural health at all. And I guess time will tell. I appreciate your optimism, because hopefully you can lead us in North Dakota by setting the example of what can be done to preserve rural health. But you and I both know with 734 hospital closures predicted over the next few years, this is going to get real. And we’ve already lost over 180 hospitals in this country. All rural. And that safety net that we enjoy today may look much different in 2 to 4 years. And so, we’re all keeping an eye on it. In that vein of questioning, I want to know what keeps you up at night in this job. What do you worry most about in, in. I know it’s so there’s so much. But what really what keeps you up?

BS: I truly think it’s just the long-term sustainability of our hospital and trying to. I mean, in so many of the days we get through it, treading water and trying to keep our head above water. And it’s all right, let’s make payroll in two weeks. Let’s look at I mean, our strategic plans have gone from looking ahead three, five, ten years to are we going to make it to the end of the year? And what are we going to do to get there? And then if we do okay, how do we make it to next year. You know, we we’ve become so and I’ll just speak for us. But we become so shortsighted in our approach because of the fear of the unknown and the fear of all that’s changing around us. And our core mission hasn’t changed at all. The patients that we care for haven’t changed at all over the last hundred years. We’re caring for the same population that we’ve always cared for, but there’s so many other factors that I worry are detracting us from being able to care for that core population that we set out just about 125 years ago to serve. And so that’s what keeps me up at night.

You know, obviously being born and raised here, I have a lot at stake. You know, my daughters receive care here. My mom receives care here. My grandpa receives care here without the hospital. I look at what Northwood becomes, and there’s really nothing that stops it from shriveling up just like every other small town in North Dakota that doesn’t have a hospital. You know, you look at those small towns that are able to sustain. I think you can almost always direct it back to do they have a hospital or not? And that’s the piece that I think it’s lost in translation.

JJ: I think it’s the heaviest weight on all of our shoulders. I was speaking to a mid-sized, vital hospital CEO yesterday, a good friend of mine, and they’re going through significant challenges $2 million a month loss. You can’t sustain that long term. And, you know, I just think about in in all of our conversations, it’s about, you know, we can’t let our community down. You know, we’ve got to be here. We’re the largest employers and it’s a lot of weight. And, you know, we have to really rally the support of our community to utilize our services, but also to lift their voices to Congress and our state legislators to say rural hospitals need help. They need an uplift. There’s been a lot of federal legislation. You’ve got, you know, leaders in Washington saying, you know, we’re going to crack down on the fraud, waste and abuse. And there’s all of these things going on, and we’re going to eliminate the 340B program because, you know, obviously big pharma is in the ear of these people, a lot of reasons to stay up at night. But there’s one thing that, you know, we can rest on. We’re doing mission minded work. We’re taking care of our community. And many days it’s just one day at a time. My wife hung in our closet. She put the words up, and it’s one of my favorite verses. Jeremiah 29:11 “For I know the plans that I have”, and there are days I wake up that I’m like, I don’t know what today is going to bring, but you know what? At the end of the day, I’m not going to be harmed. I’m giving that, you know, that assurance. I know that I’m going to have hope in a future. And I find in that scripture an opportunity to place hope, and that if we don’t have hope, you know, we’ve lost it all. So, you and I are jobs as CEOs is to give hope. And while we talk about very heavy subject matter in, in these and on these podcasts, the reality of it is, is that we can also give hope that we can do it. And you’ve done it for 100 plus years.

We celebrated 110 years last year. And so, we’ve been doing this for an equally long time, and our mission is really not changed. And if we have hope and we’re mission minded, we can conquer hell with a squirt gun. And that’s really at the end of the day, what we’re doing. So, keep up the great work. You’re doing a phenomenal job. You were recognized nationally. This is why I got the email about you. That’s how I contacted you. National company had reached out and said this, this guy is doing some great things, and I’m going to encourage you to keep up that great work that you’re doing. Be interdependent. It’s so important you can’t put sandbags up. You know, independent is great. Interdependent is better. Reach out to your community. Lift your voice. When you lift your voice, Brock. For your community, you’re lifting it for mine. And that’s so very important. And so, I want to thank you for being a guest today. You’ve done a phenomenal job at representing your community hospital, but you’re doing some great things, and I want to encourage you to keep that up.

I want your perspective. You’re somewhat of a young leader, right? And you’ve obviously been doing this for over a decade. And that speaks volumes. You’ve been thrown into the fire like we all have of Covid. I took over CEO during Covid. And so, you know, we faced a lot of challenges. But today the modern CEO is getting appointed, is facing far greater challenge than I did when I started this industry 16 years ago. And I want your perspective. What advice, what sage advice, what wisdom? We have leaders from across the country that listen to this podcast, and they’re waking up every day, maybe as new leaders. How do I deal with this? The government retention, staffing, budgets, cuts, board demands, staff demands. What sage advice? What wisdom would you give a new leader rising up today to be encouraged, to give them hope? What is it? What would that look like from your perspective?

BS: You know, it’s going to sound cliche because we’ve been talking about interdependence throughout this episode, but I think that’s truly what’s gotten me through. This is I think the worst thing you could do is cut off all communications and just, you know, stay within your facility and stay within your problems. You know, we really are all better together. You’ve alluded to the fact that there’s over 700 hospitals at risk of closure. You know, you’re not in this alone. But that being said, you can be as alone as you want to be in this. And so really for me, it was it was creating that that network. And, you know, for us with the Rough Rider, you know, I have 22 other CEOs that I can call it any time of the day or night that I know they’ll take my call and I will do the exact same to them as our facilities, although we may be spread across the state, are all facing the same challenges, the same struggles. They might look a little different, but at their core they’re all the same issues, and I think we all need to work through them together, as opposed to everybody trying to recreate at the wheel at their facilities. Because if we start to segment ourselves and we start to go every facility for themselves, you’re going to have come to fruition. I’ll 700 of those hospitals closing. I think in order for us to swim our way out of this or dig our way out of this or however you want to say it, I think we really all need to do it together, because our state and our nation as a whole, need each and every one of us to serve our communities.

JJ: That’s right, that’s right. Brock, CEO of Northwood Deaconess Health Center, with us today from North Dakota.  I firmly believe that I’ll be reading your name and national news about some things that you’re going to be doing, leading you got to fight, continue the fight. I firmly believe leaders like yourself in your prime, ready to take on some of these most daunting challenges as it obviously the torch passes from one generation to the next. You’re leading, and I’m very appreciative of the work that you’re doing. And thank you so much for joining us on the podcast today.

BS: Absolutely. It’s been a pleasure. I’ll be looking forward to it.

JJ: Awesome. And thanks to our listeners for tuning into Rural Health Today. Catch our next segment, Rural Health News, to stay up to date on the current state of rural health every Monday, wherever you get your podcasts. And don’t forget to check out our latest episodes and resources for Rural Health Today at ruralhealthtoday.com, and make sure you subscribe to the show so that you never miss an episode. Until next time, remember rural health strong.