June 18, 2018
What’s happening at Mayo Clinic Health System in Springfield and Lamberton?
Kelsey Nylander, D.O., medical director at Mayo Clinic Health System in Springfield and Lamberton, has submitted her resignation effective October 2018. This was a difficult, emotional decision for Dr. Nylander, but her choice was made for family reasons.
Dr. Nylander’s departure leaves a single physician provider in Springfield. One physician cannot maintain the rigorous 24/7 on-call schedule required at a rural hospital in addition to a busy clinic practice.
In addition to Dr. Nylander’s departure, LeRoy Hodges, M.D., Springfield’s outreach general surgeon from Mayo Clinic Health System in Fairmont, recently submitted his resignation to accept a position closer to family in Georgia. Dr. Hodges’ departure in August 2018 will eliminate Mayo Clinic Health System in Springfield’s General Surgery and GI Endoscopy practice.
Can Mayo Clinic Health System recruit new physicians to cover these gaps?
We have been aggressively recruiting physicians to the Springfield practice for the past five years. During this time, we have engaged three separate external recruiting firms while offering an extremely competitive compensation package. Despite these efforts, a very small number of physicians have expressed interest in the position over the last five years.
One family medicine physician accepted an offer in March 2017. However, due to circumstances beyond our control, he was unable to meet the necessary credentialing and privileging requirements needed for the job. We expect that recruitment challenges will continue into the future given the growing physician shortage nationwide. Similar recruitment challenges are being experienced at rural health care practices across the country.
Are any physician, nurse practitioner or physician assistant positions posted for the Springfield practice?
Yes, our recruitment efforts for a family medicine physician, family medicine nurse practitioner/physician assistant and emergency medicine nurse practitioner/physician assistant continue. All positions are posted on the Mayo Clinic jobs website: jobs.mayoclinic.org.
Are there other major challenges with the Springfield practice?
Many patients in the Springfield market utilize health care facilities in neighboring communities instead of Mayo Clinic Health System in Springfield. The reason for this is multifactorial — including patient choice, insurance contracting and the abundance of health care providers within the area (e.g. four health care facilities within a 35-mile radius of Springfield). We have a wonderful facility, compassionate staff, expert providers, positive patient satisfaction scores and high-quality outcomes. Despite this, we cannot sustain a hospital and clinic when so many patients seek care outside of Springfield.
Are any changes planned for the call center?
Based upon feedback from patients and staff, a comprehensive review of the call center was launched several months ago to evaluate how to improve processes and better serve our patients. After several months of evaluation and testing, we are happy to share that local scheduling staff (based in Springfield) will begin scheduling primary care, physical therapy and radiology appointments for the Springfield and Lamberton communities. This change is part of a broader plan to shift to a hybrid scheduling model for the Southwest Minnesota region. Hybrid scheduling refers to a model in which the call center will continue to support appointment scheduling for several clinical areas; however, local clinics and individual departments will be able to answer patient calls and manage appointment requests on a routine basis.
Phone numbers for the Springfield and Lamberton sites will not change. Instead, calls will be routed to the local appointment desk in Springfield instead of the Mankato call center.
What role has the Springfield community board of directors played during this situation?
Mayo Clinic Health System in Springfield is fortunate to have an outstanding board of directors comprised of six engaged, insightful and supportive community members. The intent of the community board is for members to serve as the “voice of their communities.” They have been involved from the very beginning of this situation and remain instrumental as we explore options for the future of health care in Springfield and Lamberton. Ultimately, the community board will help influence the final decision regarding how Mayo Clinic can best serve the patients of Springfield and Lamberton in a viable way.
How do we move forward, and what are next steps?
Given the departure of Dr. Nylander and Dr. Hodges, as well as our ongoing challenges with physician recruitment, the current model of providing comprehensive care within both the hospital and clinic setting in Springfield will be difficult, if not impossible, to sustain.
We have reached a critical point for the challenges facing this practice. Leadership, with critical input from the Springfield community board, local leaders, staff members and community stakeholders, is engaged in a thoughtful process that will consider several options for viable ways to best serve our patients in Springfield and the surrounding communities. Our efforts to connect with staff, community members and other invested parties are ongoing.
Regardless of how we choose to move forward, know that Mayo Clinic Health System is deeply committed to our patients in Springfield, Lamberton and the surrounding communities.
What future health care models are being considered for Springfield?
Mayo Clinic leadership and the Springfield community board of directors are committed to exploring all feasible options for the medical center. However, it is important to remember that all future care models for Springfield will be highly dependent on recruitment of medical professionals and support from the community — including seeking care locally.
Our teams are working diligently to understand what level of care is possible with our current staffing situation. We have engaged legal and regulatory experts throughout Mayo Clinic to help identify any laws or Centers for Medicare and Medicaid Services (CMS) requirements that may restrict what we are able to offer within the clinic, hospital and emergency department settings. Additionally, we are partnering with telemedicine colleagues to assess opportunities to leverage technology to support patients within Springfield, Lamberton and the surrounding communities.
Some of our leaders had an in-depth discussion with a non-Mayo health care facility in Wisconsin about their current use of a nurse practitioner hospital coverage model. A site visit to the facility is also being planned. While there is still more to learn, we discovered numerous barriers and potential regulatory challenges with this model because of differences from the Springfield practice, including the fact that this facility has a team of physicians to evaluate, assess and admit patients to the hospital and provide initial evaluations in the Emergency Department 24/7.
Our teams are continuing to research, discuss and evaluate several options in conjunction with the Springfield community board of directors. We expect to reach a final decision about the new model of care for Springfield by early- to mid-August.
Why are health insurance plans in the Springfield area unfavorable to Mayo Clinic?
Mayo Clinic accepts most insurance plans and has contracts with most major insurers. However, having an agreement with an insurance provider does not always mean Mayo Clinic is the lowest cost option for patients. A patient’s cost of care is determined through a complex process after insurance companies and the state of Minnesota evaluate each health care organization within a geographic area. It’s important to note that Mayo Clinic Health System will see patients regardless of their insurance plan. However, the patient’s financial responsibility after insurance payment is between the patient and the insurance plan provider.
For example, the state and participating insurance companies divide the State Employee Group Insurance Plan (SEGIP) into four tiers of coverage. Health care facilities included in tier one of the plan require the least out-of-pocket expense for patients. Conversely, health care facilities in tier four of the insurance plan require the most out-of-pocket expense by the patient. Essentially, the insurance plan covers a portion of the cost of care, and the patient pays the remaining balance. Patients can choose to receive care at any facility, but their costs may vary based on the tier level of that facility.
Insurance providers and the state of Minnesota have determined that Mayo Clinic Health System is a tier four health care provider within the Springfield market area. In other markets, Mayo Clinic Health System is a tier two provider. Although Mayo Clinic is continually negotiating with insurance plans to elevate above a tier-four designation, the state and individual insurance companies make the final decision when determining tier classification. However, community members receiving health care through the SEGIP program and legislators may provide input into the tiering process by talking to their local (work or union) leaders or the Minnesota Department of Management and Budget.
What health care services are available at Mayo Clinic Health System in Springfield?
- Diabetes Education
- Ear, Nose and Throat
- Emergency Medicine
- Family Medicine
- Obstetrics and Gynecology
- Occupational Therapy
- Physical Medicine and Rehabilitation
- Radiology and Imaging
- Social Services
- Urgent Care
Has Mayo Clinic discussed the situation in Springfield with other health care organizations?
Yes, Mayo Clinic Health System leadership has met with two area health care organizations to explain the current situation and entertain questions. One organization expressed no formal interest in acquiring the hospital or clinic. The other organization requested more information about our practice before assessing their level of interest. However, the dialogue remains strictly preliminary at this point in time.