Mobile MRI Services Expand in Rural North Dakota

BOWMAN, N.D. — Retta Jacobi stepped onto a metal platform, which lifted her to the entrance of a custom-designed semitrailer. Inside, she laid down on a platform that technicians slid into an MRI machine, hoping it could identify the source of her shoulder pain.

Every Wednesday, a mobile MRI unit visits Southwest Healthcare Services, the hospital serving Bowman, North Dakota. This is crucial for the town’s 1,400 residents, as, without this service, they would need to drive an inconvenient 40 minutes to access an MRI machine—something the local hospital couldn’t afford to maintain on its own.

Southwest Healthcare Services, alongside 21 other independent rural hospitals, is part of the Rough Rider Network. This collaboration allows them to combine patient volumes to negotiate better rates for the mobile imaging services.

New Collaborative Networks

Independent rural hospitals are increasingly joining what some call clinically integrated networks. These collaborative groups enable them to share resources, preventing the need to sell to larger health systems, while still striving to enhance patient care. Some motivations for these partnerships stem from the potential to meet requirements for value-based care contracts, where insurers pay based on the quality of care provided.

Supporters are examining whether the $50 billion allocated through the Rural Health Transformation Program could aid in starting or expanding these networks, aiming to keep rural hospitals operational rather than merging with bigger systems.

Retta, who provides speech therapy for children in her local school district, remarked, “Anything that can support our rural hospitals and expand services is a great development.”

The Landscape of Rural Healthcare

Since 2010, 153 rural hospitals in the U.S. have either closed entirely or stopped offering inpatient services, according to the Sheps Center for Health Services Research at the University of North Carolina. Meanwhile, over 441 hospitals merged with or were acquired by larger systems between 2011 and 2021.

The Rough Rider Network is a vital asset for its members, representing around two-thirds of rural North Dakotans, as indicated by Dennis Goebel, CEO of the Bowman hospital. With the buying power of the network, hospitals can negotiate better contracts that might otherwise be unattainable on an individual basis.

Networks often pool specialized staff that are not required at a single hospital full-time, allowing for efficient resource sharing, as noted by the Commonwealth Fund. Additionally, some networks invest in telecommunications and community projects to foster better health access.

Creating New Networks

Nathan White, CEO of Cibolo Health, which assists in launching and managing these networks, emphasized that hospitals can collaborate on employee health insurance plans. They can also establish joint contracts for various services, including telehealth.

White initiated Cibolo Health after receiving interest from a rural North Dakota hospital seeking collaboration. The Rough Rider Network started recently, bolstered by $3.5 million from the North Dakota Legislature.

Cibolo Health has since helped to establish networks in several neighboring states, extending their reach to over 120 hospitals covering about 4.7 million people. These networks, managed as nonprofits by the hospitals, pay an annual fee to Cibolo Health for its services.

Historically, similar networks have been in existence for over three decades, gaining traction following the 2010 Affordable Care Act.

Reaching Out to Patients

Gabby Wilkie, finance director at St. Kateri hospital in Rolla, N.D., highlighted the outreach efforts made by Caret Health staff. They contacted patients due for annual physicals and screenings, explaining the importance of their health needs. Patients often required multiple outreach attempts before they scheduled appointments, which was previously an implausible task for the hospital on its own.

Wilkie estimated that the outreach program would potentially cost $300,000 for about 1,000 patients, yet the hospital anticipates a return of over $100,000 when patients complete their appointments, aided by support from Cibolo Health and the Rough Rider Network.

As rural hospitals are often key local employers, Goebel noted that remaining independent within a network can bolster local economies. In contrast, larger health systems sometimes cut services and staff after acquiring rural facilities.

Jacobi is currently undergoing medication and physical therapy after reviewing her MRI results. If this treatment doesn’t yield results, she might have to travel five hours round trip to Bismarck for further evaluation. Nevertheless, she expressed gratitude for the local availability of healthcare services, noting, “Anytime we can keep more local control, it benefits our small towns.”