6A
Friday, December 8, 1989 / University Daily Kansan
Office examines rural health
By Melanie Matthes Kansan staff writer
Stanley Handsy entered his patient's room with a smile on his face, walked to the side of the bed and reached out to hold the man's
"How ya doin,' kid?" he asked the elderly man.
The patient rubbed his white hair and shrugged his shoulders. The man's wife and relatives waited quietly in the corner of the room.
"You could go to that doctor in Wichita or you could go to Kansas City," Handshy said. "It makes no difference to me, kid, but I want to know where you're going to go I can be in touch with that doctor."
Handshy said that if his patient wanted to see a specialist for his lung cancer, he had no alternative than traveling outside the county.
Situations such as this one, where patients are having to drive more than 60 miles for medical services, are occurring in rural communities (state, said Steve McDowell, director of the Office of Rural Health.
In order to guide rural Kansas to a better system of health care delivery the Kansas Department of Health and Environment created the Office of Rural Health (ORH) in April, McDowell said.
The problems that the ORH has identified with rural health care are the lack of access to services, the shortage of manpower and the need of statute and regulatory changes in rural health care, McDowell said.
Kenna Member/KAMILAN
Handsby, a general practice physician in rural southeast Kansas, said he provided for the medical needs of about 5,000 patients at his private practices in Erie and Thayer. There are about a dozen physicians in western Kansas in the towns of Erie and Thayer and has a population of about 20,000.
RURAL HEALTH CARE
But many of Handsy's patients travel from within a 65-mile radius to
If they need to be hospitalized, they must travel to Parsons or Chanute, which are about 19 miles from Erie, he said. If they need to see a specialist, they must travel to a larger metropolitan area such as Wichita or Kansas City. Handy travels every day to four small towns to treat his patients.
Dealing with the problem
McDowell recently traveled to five rural communities to meet with area health care providers and to discuss problems and their proposed solutions.
"I think that in terms of trying to create a dialogue with the rural health care providers, I have succeeded," McDowell said.
The rural health care providers think that it is important to have a resource like the ORH for gathering the input of the rural communities and taking action on that input, he said.
He said that his next step was to put together an agenda for action on the rural health issue. This plan will be based on the input of health care providers and will assure action regarding access to services, adequate manpower and unfair statutes and regulations.
The following recommendations were offered by rural health care providers at a meeting on Nov. 10 at the Onaga Community Hospital. The locations address the rural community's lack of access to medical services.
> Improve community awareness of access problems at the local level and develop community education skills.
> Develop an advocacy group, in
▶ Examine the possibility of cooperative programs with neighboring communities and establish incentives for creation of such programs.
▶ Define the essential services for the rural community and develop a data base to aid in decision-making at the legislative level.
order to provide leadership for action on the access issue.
Rural health care providers also suggested actions addressing the lack of manpower and regulations said they were unfair, McDowell said.
Attracting students to rural areas
areas
The University of Kansas Medical Center has participated in the Kansas Medical Scholarship program since it was established in 1979, said Billie Jo Hamilton, director of financial aid at the Med Center. The scholarship provides tuition reimbursement to medical students who agree to practice in a rural community after they graduate.
Jim Sieler, second-year medical student from Wichita, receives tuition reimbursement under the scholarship. He said that if he had not received the scholarship he would not actively pursued a rural health career.
"I don't want to be the only doc in a town, though" he said. "There has to be enough going on there that I'll be able to take a living and not starve to death."
The Board of Regents recently established a scholarship program similar to the Kansas Medical Scholarship that will provide tuition reimbursement to students who agree to practice in local community when they graduate.
The Med Center currently has 106 students enrolled under the Kansas Medical Scholarship and will participate in finishing Scholarship Program next year.
But the U.S. Congress recently passed legislation that is designed to relieve rural hospitals of the financial burden of less-than-adequate reimbursements,
care are rising medical malpractice insurance and unfair Medicare reimbursement policies.
The state and federal regulations that are affecting the rural community's ability to deliver quality health
Under the former Medicare reimbursement policy, rural hospitals were reimbursed about 35 percent less than urban hospitals, McDowell said, and many rural hospitals depend upon Medicare reimbursements from more than 50 percent of their patients.
The 50 smallest hospitals in Kansas have 80 to 90 percent Medicare patients, he said.
"Your revenue goes right along with that," McDowell said. "If 80 to 90 percent of your patients are on Medicare, that means that 80 to 90 percent of your revenue is Medicare reimbursed."
Premiums too high
Malpractice insurance premiums for the rural physician can sometimes exceed the physician's revenue and, as a result, rural physicians are having to cut back on services that are essential to their obstructed, or are leaving their practices altogether, rural health care providers said.
Handshy said that when he opened his practice in 1982 his malpractice insurance was about $3,000 a year, which included coverage for obstetrics. Although he has never been sued his insurance now is $19,800.
As a result of expensive malpractice insurance and Medicare reimbursement policies, Handshy said that many rural physicians are more careful about the kinds of costs they cause their patients and about their diagnoses of patients. This way the physician protects himself against accusations that he misdiagnosed someone or claimed a reimbursement that was more than the service warranted.
To federal government officials, a medically underserved community is one where a physician treats more than 3,500 patients, McDowell said. But to medical officials, a medically underserved community is one where a physician treats more than 2,000 patients.
Continued from p. 1A
Rural
Physicians few and far between
Cameron Knackstedt shares the burden of serving Phillipsburg's population of 10,000 with his three partners.
"That is very unusual to have that many doctors in a small town," he said. "We are very fortunate."
Knackett said he liked the fishing and hunting opportunities available to him in rural Kansas. The quiet community also provides a good place for him to raise his 13- and 16-year-old children.
But Knackstedt said he considered leaving Phillipsburg before two new physicians recently joined his practice.
The new physicians have lessened the work load, he said, and have allowed Knackstedt and his wife time to get away every now and then. They spend weekends in Kansas City as often as they can.
"If we wouldn't do that, we couldn't be able to stand it," he said.
The program sends first- and second-year medical students to observe a physician's practice in rural Kansas.
Neal Erickson, a second-year medical student at the University of Kansas Medical Center, participated last spring in the rural health weekend program offered through the Med Center.
Erickson said he thought Handshy was lucky that his wife worked in his office because the long days seemed to leave little time for a wife and
Erickson, who is from Overland Park, spent his rural health weekend in Erie with Handshy.
"He sees patients seven days a day he said. There are no days off up his neck."
family. On the Friday that Erickson was there, Handsy had to cancel dinner plans with his family because a patient had gotten hurt.
Erickson said he did not know whether he would pursue a medical career in a rural area, but his experienc did not discourage him from doing so.
Joy and sorrow
"I was really impressed because he was more than just their doctor, he was a counselor and an educator," he said. "He knew every patient and he knew all about them."
At his practice in Thayer, Handshy treated a teen-age girl for an eye abrasion. As he looked into her eye, he teased her about the new boyfriend and gave her some advice on boys and life. He leaned close to her when he talked to her and called her "kid."
When the visit was over, Handsy walked the girl to the door with a hand on her shoulder around her shoulder before he turned back and moved on to the next patient.
On the same day that he performed the hysterectomy, Handsy told an elated woman that she was pregnant and in a man that he had terminal cancer.
He has learned to cope with the depressing aspects of his job by spending time with his animals and open fields of his farmland, be said.
He likes to talk to his mules, J.R. and Sue Ellen, to his wife's horse, Bonnie, and to the many other animals that belong to his collection. Sometimes he likes to just stare across the vast fields of the Kansas prairie and to dream about the house he would someday like to build there.
"You gotta have your games," he said, holding out a handful of tobacco for a hungry mule. "That's how I escape the real world.
“This is what I like to call the unreal world,” he continued. “Tak-ing to you, maybe, maybe that’s what really matters. I don’t know. It’s hard to tell.”
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