Ground Level

Rural health care under pressure

The pressure on Minnesota's rural health care system is unrelenting. National health care reform, shifting demographics and the overall desire to do something about costs have combined to change the look of rural care. So we've updated a Ground Level exploration published in 2011by adding a package of stories on where the state is on the hospital consolidation front.

All the stories we generated last year are still here, a deep dive into rural health care in Minnesota. But we've added new material as large health care companies get larger and more communities wrestle with new trends.

And, as always, the Ground Level blog maintains steady coverage as the issue unfolds.

Hospital Mapping

Hospitals and their affiliations

Affiliated and independent hospitals support the health infrastructure across Minnesota.

Minnesota's rural hospital crunch

Renegade Doctor

Renegade Doctor

Dr. Susan Wasson in Osakis takes cash, checks but no insurance. She represents dissatisfaction with the health care system.

Uninsured graphic

How is the pressure on rural health care providers more intense than that on urban providers?

Rural areas long have had difficulty maintaining hospitals and attracting doctors, but political, economic and demographic changes are adding to the burden. Learn more »

Let's make a deal: Lessons learned from hospital mergers

Let's make a deal:
Lessons learned from hospital mergers

Communities that want or need to find a larger hospital partner can improve their bargaining efforts, say some who have been through it.
Rural Minnesota retools health care in wave of hospital mergers

Rural Minnesota retools health care in wave of hospital mergers

a new round of consolidations that can add services to communities and let patients stay closer to home but that inevitably lead to the loss of local control.
Trying to go it alone in rural healthcare

Trying to go it alone in rural healthcare

In an environment that increasingly rewards mergers, some hospitals and doctors are taking steps to maintain their independence.
Babbitt's pharmacy victimized by fire, then the times

Babbitt's pharmacy victimized by fire, then the times

A fire last fall destroyed the small town's pharmacy. The trend toward big retailers and mail-order drugs is making it difficult to replace.
Small town docs: The search for someone who does it all

Small town docs: The search for someone to do it all

Outstate communities are finding it increasingly difficult to land doctors who can do it all, like Heidi Korstad does in Bigfork.
Can a small, independent hospital survive? A tale of two northern Minn. hospitals

Can a small, independent hospital survive?

The hospitals in Bigfork and Virginia in northern Minnesota offer a good contrast of how independent hospitals are facing the future.
Electronic records mandate strains rural hospitals

Electronic records mandate strains rural hospitals

The push to increase health care efficiency by creating more electronic records is squeezing rural hospitals' already thin margins.
Telemedicine, midlevel practitioners start to fill physician gap

Telemedicine, midlevel practitioners fill gap

A lack of physicians in rural Minnesota is leading to new ways to deliver health care, including use of midlevel practitioners and innovative ways to deliver care remotely.

Rural health care:
People taking action to make a difference

Health care in rural Minnesota is increasingly under stress. As MPR News has been reporting this week with its Ground Level project, outstate hospitals and clinics face myriad obstacles, including a critical shortage of physicians and nurses. Some spend years trying unsuccessfully to lure a doctor.

In addition, they operate on ever-narrower margins. According to the Minnesota Hospital Association, one quarter of rural hospitals in the state operate in the red. This makes it difficult to keep up with a changing health care landscape, such as the push toward collaborative care and the mandate for electronic medical records.

And yet, there are people all over the state--doctors, paramedics, teachers, administrators, tech experts--trying to deal with those challenges.

Do you have a rural health care story?

Help us cover the story of rural health care by sharing what you know.


Hospital affiliation changes since 2005

Essentia Health Northern Pines

  • Aurora, MN
  • Beds: 16
  • Afffiliation: Essentia Health

Sanford Bagley Medical Center

  • Bagley, MN
  • Beds: 25
  • Affiliation: Sanford Health North

Sanford Bemidji Medical Center

  • Bemidji, MN
  • Beds: 118
  • Affiliation: Sanford Health North

Mayo Clinic Health System in Cannon Falls

  • Cannon Falls, MN
  • Beds: 21
  • Affiliation: Mayo Clinic Health System

Essentia Health Deer River

  • Deer River, MN
  • Beds: 16
  • Affiliation: Essentia Health

Prairie Ridge Hospital & Health Services

  • Elbow Lake, MN
  • Beds: 20
  • Affiliation: Lake Region Healthcare

Lake Region Healthcare Corporation

  • Fergus Falls, MN
  • Beds: 108
  • Affiliation: Lake Region Healthcare

Essentia Health Fosston

  • Fosston, MN
  • Beds: 25
  • Affiliation: Essentia Health

Cook County North Shore Hospital

  • Grand Marais, MN
  • Beds: 16
  • Affiliation: St. Luke's

Regina Medical Center

  • Hastings, MN
  • Beds: 57
  • Affiliation: Allina (25%)

Minnesota Valley Health Center

  • Le Sueur, MN
  • Beds: 24
  • Affiliation: Essentia Health

Mayo Clinic Health System in New Prague

  • New Prague, MN
  • Beds: 25
  • Affiliation: Mayo Clinic Health System

St. Michael's Hospital

  • Sauk Centre, MN
  • Beds: 25
  • Affiliation: CentraCare Health System

Lakeview Hospital

  • Stillwater, MN
  • Beds: 97
  • Affiliation: HealthPartners Inc.

Sanford Thief River Falls Medical Center

  • Theif River Falls, MN
  • Beds: 25
  • Affiliation: Sanford Health North

Sanford Wheaton Medical Center

  • Wheaton, MN
  • Beds: 15
  • Affiliation: Sanford Health North

Virginia Regional Medical Center

  • Virginia, MN
  • Affiliation: Affiliation with Essentia Health pending final closing, expected Fall 2012

Source: Minnesota Hospital Association

Hospital affiliation in Minnesota

Source: Minnesota Hospital Association

Click to show a list of affiliated hospitals.

Click to show a list of independent hospitals.

Ground Level reporter Jennifer Vogel talks about hospital consolidation on All Things Considered:

People all over the state--doctors, paramedics, teachers, administrators, tech experts--trying to deal with those challenges. Here are just a handful of those people.

Terry Hill, rural eyes and ears

Heidi Korstad, 30 years in Bigfork

Jim Boulger, rural doc spotter

Jane Hovland, video psychologist

Gary Wingrove, expanding paramedic role

Jodi Nelson, networking rural health care

Al Vogt, running a rural hospital

Susan Rutten Wasson, renegade doctor

Ground Level chose six towns to look at where change seems to be in the wind and will revisit them every once in a while to see how people are faring. Here is an introduction to each.

Virginia, signing on with a network

Bigfork, keeping patients satisfied

Duluth, rural health epicenter

Montevideo, midlevel practioners

Staples, expanding but staying local

Bemidji, expanding with a network

National Rural Health Association

The National Rural Health Association is a national membership organization with more than 20,000 members whose mission is to provide leadership on rural issues through advocacy, communications, education and research.

National Rural Health Resource Center

The National Rural Health Resource Center is a nonprofit organization dedicated to sustaining and improving health care in rural communities.

Rural Assistance Center

A product of the U.S. Department of Health and Human Services' Rural Initiative, the Rural Assistance Center (RAC) was established in December 2002 as a rural health and human services "information portal."

We asked nine doctors, nurses, paramedics and others around Minnesota to show us what it looks like where patient and provider meet. Three online discussions explored the personal experiences of medical staff and the public in the rural health system. Each of the discussions led with a question to start.

Question 1: Barriers to care

Please share an anecdote or an incident that serves as an example of how a patient in need of help faced a barrier of distance or inability to pay. What happened?

Question 2: Name one change?

Is there one aspect of the medical system you would most like to see changed in order for patients to receive better care?

Question 3: Better or worse?

Is there something specific you have seen that explains why you think health care either will get better in rural Minnesota or will suffer from increasing obstacles?

Rural health - what do you think?

Sanford, a growing rural health network

A conversation with a top official of one of Minnesota's fastest growing rural health networks.

People all over the state--doctors, paramedics, teachers, administrators, tech experts--trying to deal with those challenges. Here are just a handful of those people.

We identify topics that are significant and complex and that play out uniquely at the local level. We want to explore those issues in which people taking action in their communities make a difference and can serve as guides for others.

Ground Level launched in early 2010 and shines a light on a variety of topics, from the growing complexity of Minnesota's local food system to cities preparing for new fiscal realities, from exurban growth in Baldwin Township to the quest to expand broadband access across the state.

We experiment with coverage on a variety of platforms. This includes text, audio and video online, of course - the Ground Level blog, a series of topics pages and social networking, for example. It also includes on-air coverage, public forums both virtual and real-world and collaboration with community-based media.

Our audience consists of Minnesotans interested in community life, particularly those who are taking an active part in it or helping others do the same.

Ground Level is very much an experiment -- in finding ways to learn about and tell stories, in working with other organizations, in walking up to the line between providing insight and advocating specific actions. Our goal is to inform and give people the ability and incentive to engage with their community. We invite your feedback and your ideas, via the blog, twitter at @MPRGroundLevel, phone calls, emails, whatever. Join us.

About the team:

Dave Peters

Dave Peters directs MPR's project on community journalism, looking for ways Minnesota residents are making their towns, cities and neighborhoods better places to live. He joined MPR News in 2009 after more than 30 years as a newspaper and online reporter and editor. Contact Dave

Bush Foundation

Support for Ground Level is provided
by the Bush Foundation.