A struggling hospital, a fire chief with an erratic heart and a doctor who sees tech as the answer
Last year, J.C. Blair Memorial Hospital confronted a painful reality: Without radical change, the 107-year-old rural Huntingdon County hospital wasn’t going to survive.
The hospital turned to Robert Gillio, 64, a Mayo Clinic-trained lung specialist, to attack the problem.
Dr. Gillio, J.C. Blair’s new medical director for population health and clinical innovation, proposed a more efficient, less costly way of treating patients through a videoconference hookup called telemedicine — connecting doctors with patients online. He enlisted students at nearby Juniata College in developing educational videos about opioid addiction and childbirth that patients could retrieve from the hospital’s website.
Then Dr. Gillio ran into a problem. The telemedicine hookup he envisioned relies on broadband access — the cable, satellites and fiber that makes getting onto the internet possible.
But he could barely get internet access at his home near the county seat of Huntingdon, where he and his wife, Beth, 61, who teaches online college courses, had moved.
Their house was just four miles from his office. He said Comcast, a local broadband provider, quoted a price of $100,000 to get their street online.
It is a familiar problem to many people living in rural areas.
Even as businesses in Pittsburgh compete to commercialize artificial intelligence and give machines the human quality of “learning,” just a three-hour drive away people struggle with dial-up connections — if there are internet connections at all.
More than 24 million Americans — 800,000 in Pennsylvania and mostly in rural areas — lack an internet connection that meets a federal minimum standard for speed. The result is a yawning divide in commerce, education and medicine that’s splitting America into the digital haves and have-nots.
“We’re basically being cut off from the 21st century,” Huntingdon County Planning Director Mark Colussy said.
D.J. Drenning, 37, chief of the Robertsdale, Wood & Broad Top Volunteer Fire Co., has an erratic heartbeat, an occasional circus rhythm, that leaves him lightheaded, clammy and exhausted.
Doctors at J.C. Blair implanted a small monitor in his chest to capture the unusual rhythm, enabling them to understand how to treat it. For a while, Mr. Drenning — whose father had a major heart attack at age 34 — carried a handheld device that, when activated, noted the time of the symptoms.
But the wireless signals that transmitted his heart rhythms only sporadically reached his doctor’s office.
It’s not only broadband access to the internet that is lacking in this part of central Pennsylvania. The towers needed to make cell phones work are also lacking for the same reason broadband hasn’t caught on: too many miles, too few subscribers.
Lainie Drenning, a registered nurse who lives with her husband and three children in Waterfall, Fulton County, seems resigned to the disparity.
“We just don’t get the services everybody else gets,” said Ms. Drenning, 37, whose cell connection can be squelched by a rainstorm and whose internet goes dark for days. “It’s something we don’t think we’re going to have.”
The equipment that the doctors hoped would alert them to problems with Mr. Drenning’s heartbeat was mostly useless because of the spotty connections.
Today, the handheld device gathers dust in the family’s kitchen.
‘Costing us lives’
“The damage done to a 21st-century community by not being part of the 21st-century economy is astoundingly bad,” said Sascha Meinrath, a telecommunications policy specialist at Penn State University who believes the number of people without usable internet connections is higher than government estimates.
“Our lack of connectivity is costing us lives.”
Huntingdon is among six counties that make up central Pennsylvania. It’s a place of rolling Allegheny Mountains, lush farms and a maximum security prison. The county, population 46,000, draws more than a million tourists every summer.
While many embrace the allure of a slower lifestyle, there are limits to living virtually off the digital grid. Expanded broadband and cell service was named as a top priority by the Southern Alleghenies Planning and Development Commission in a March planning document.
Public safety and economic competitiveness were cited as reasons.
Central Pennsylvania’s disability rate, 14.1 percent, exceeds the state level of 11 percent and national rate of 10.3 percent, according to the Southern Alleghenies Planning and Development Commission.
The region has an aging population that has been declining. One-third of homeowners in the six-county region are 65 or older. While 10,200 people moved out of the area between 2010 and 2016, only 969 moved in.
Troubling correlations have been drawn between poor health and the areas of the country where broadband is lacking. Federal Communications Commissioner Mignon Clyburn, in a February speech, called it “alarming.”
Based on 2015 data, the least-connected counties in the U.S. generally have the highest rates of chronic disease: obesity is 25 percent higher; diabetes, 41 percent higher; and preventable hospitalizations, 1.5 times higher when compared to digitally connected counties — leaving 36 million people on the wrong side of the digital divide, Ms. Clyburn said. And it’s getting worse.
“In sum, the data show that the rural/urban broadband health gap appears to be growing,” said Ms. Clyburn, who stepped down from the FCC in early June.
Losing money on every patient
J.C. Blair’s financial woes were sown over the decades with each hospital addition ribbon-cutting. As the capacity to care for more patients inside the building grew, technology smoothed the way for medicine’s move to clinics outside the hospital, where costs were lower and the profit margins higher.
The result: The overall capacity of J.C. Blair, a 66-bed hospital, is between two and two and a half times bigger than necessary to meet community needs, said Adam Dimm, 39, the hospital’s CEO. That means the hospital loses money on treating nearly every patient who walks in the door.
“We have to figure out how to reduce the costs and improve the quality,” Mr. Dimm said. “We’re so fragile, just barely getting by, which makes it so hard to innovate.”
Most rural hospitals in Pennsylvania lost money in fiscal 2016, according to the Harrisburg trade group Hospital and Healthsystem Association of Pennsylvania, but things are worse at Huntingdon County’s only hospital, where Mr. Dimm said the losses have been mounting for more than 20 years. Last year’s loss of $1 million was the smallest ever.
J.C. Blair’s maternity ward alone lost $1.5 million in 2017, but Mr. Dimm said he’s loathe to close the unit, which would force pregnant women in Huntingdon to drive 30 miles to the next county to deliver.
Another point of financial pressure: 65 percent of the hospital’s patients are either covered by Medicare or Medicaid, government programs that pay less than commercial insurers, Mr. Dimm said.
The hospital, as many of its peers have done, is looking outside the county for funding and expertise.
J.C. Blair is shopping for a deep-pocketed partner, which Mr. Dimm said will only be a stopgap measure. Keeping hospital units open will require a bold solution.
The scenic overlooks and winding roads around 30-mile-long Raystown Lake attract tourists to Huntingdon County. But the geography means that half of J.C. Blair’s patients are a 30- to 80-minute drive from the hospital.
More than 800 missed medical appointments at the hospital annually are due to problems that patients have in getting a ride there, Mr. Dimm said.
The telemedicine opportunity
Congestive heart disease, chronic breathing problems and behavioral health issues are among the top community medical issues identified in a survey done by the hospital. Registered nurse Vanessa Locke, 59, who has worked in home health for 27 years, has seen the value of telemedicine.
One of her patients, a man in his his 70s, had been hospitalized 10 times in one year for congestive heart disease, a condition that can turn life-threatening without careful attention.
Through a special program around 2004, the patient received a home-monitoring unit, which recorded his weight and vital signs daily. Doctors kept tabs on the readings, tweaking his care plan accordingly, using a basic telephone connection.
After getting the unit, the patient did not have to be hospitalized once in the next four years, said Ms. Locke, who lives on a 300-acre farm in Shade Gap.
“It probably saved his life,” she said. “He did wonderfully.”
But the program that made the patient’s home-monitoring unit possible has since lapsed.
In January, Medicare began covering at-home patient monitoring while increasing the number of payments for patient consults with a distant physician at a doctor’s office or hospital. The payments rose 28 percent to $28.7 million between 2016 and 2017.
Electronic home monitoring of vital signs isn’t technically considered telemedicine by Medicare, according to Foley & Lardner LLP, a law firm specializing in health regulations.
Even without an increase in reimbursement, a videoconference link between doctors and patients at home could save Medicare and other health insurance carriers $5 million while avoiding more than 1,000 unnecessary hospital admissions annually at J.C. Blair, Dr. Gillio said, citing an internal study.
It would also dramatically shrink the cost of providing medical care, in part, by shrinking unnecessary hospitalizations. The hospital could start running in the black.
As it is, more than half of J.C. Blair’s patients don’t have internet access, said Dr. Gillio.
He wants to tap a high-speed fiber cable that runs through Huntingdon County to expand broadband coverage. Harrisburg nonprofit Keystone Initiative for Network Based Education and Research, which serves schools, hospitals and other clients, owns the cable. Details of connecting to it are not finalized.
Meanwhile, the Veterans Administration has monitored patients with chronic health conditions at home for years, including Pat Easton, 77, a retired military employee who lives with wife Carol, 61, on the Tussey Mountain Ridge in James Creek, “way back in the hills,” he said.
Diabetes and high blood pressure are among Mr. Easton’s medical problems, which the VA monitors with an ordinary telephone wire and a table top device that records blood pressure, heart rate and other vital signs.
If any of the readings are out of whack, he gets a call from a VA nurse.
“You need stability” in vital signs, he said. “This forces people to take their medications on time or it will show up. The whole idea is to track it.”
The Veterans Administration doesn’t offer the technology to non-veterans.
Trying to go digital
“We actually don’t have a lot of presence in rural areas across the country,” Comcast spokeswoman Sena Fitzmaurice said. “We may be near rural areas, but that’s not where most of our operations are.”
A Verizon spokeswoman declined to comment about broadband service. Even though they’re different technologies, internet and cell phone communications are out of reach in places like Huntingdon because the necessary infrastructure has never been built.
“If you don’t have networks, you have nothing,” said Blair Levin, a former FCC official who oversaw the 2010 National Broadband Plan, a blueprint for improving internet access. “Rural folks risk being left even further behind.”
In addition to boosting health care options, better broadband access has the potential to spark an economic revival — an idea partly supported by the Southern Alleghenies Planning and Development Commission — for a county with an unemployment rate of 5.6 percent, in excess of the statewide average of 4.7 percent.
Free broadband in Huntingdon could attract entrepreneurs from Penn State University 30 miles away. Huntingdon’s hollowed out business district might begin humming with startup companies. Coffee shops and boutiques would follow.
Other initiatives could also help to pull central Pennsylvania into the digital age, including a first-of-its-kind Federal Communications Commission auction in July. The lowest bidders will receive $1.98 billion in government aid over 10 years to build out the digital infrastructure in rural areas of the country, including Huntingdon.
In the meantime, the Gillios are house hunting.
Fire companies and fish fries
Mr. Drenning, a union pipefitter in addition to a fire chief, says he has more pressing communication concerns than his heart rhythm. Huntingdon County is switching to digital emergency dispatch, but his fire company hasn’t been able to pay to upgrade radios to receive the new signal.
Of 16 fire companies in the county, all volunteer, only four received grant money for the switch, said Huntingdon County 911 Director Chris Stevens.
“It’s going to put a huge strain on them,” Mr. Stevens said. “Some of them are going to have to shut the doors.”
Robertsdale is among the fire companies with precarious finances, depending on regular fish fries, spaghetti dinners and raffles to keep the station lights on.
Bad news came a few months ago when the Federal Emergency Management Agency turned down the company’s application for a grant to cover the cost of upgrading to digital from low-band communications, a technology that cities such as Pittsburgh dropped several years ago.
Big parts of America don’t yet know the educational, economic and public safety improvements the internet offers, 23 years after the first glimpse of the world wide web, said Paul Goodman, interim telecommunications director at the Greenling Institute, an Oakland, Calif.-based policy research nonprofit.
“We have enormous rural areas where no one is providing service or it’s very shoddy service,” Mr. Goodman said. “We’ve really lost sight of how creative the world could be, what people could be doing.”
Mr. Drenning remembers the time a fire chief from a neighboring company was unable to summon help with a low-band portable radio after falling through the roof of a burning house into the basement. Luckily, his injuries were not life-threatening.
Now, Robertsdale is scrambling to come up with $80,000 for new equipment, almost equal to the fire company’s annual budget of $90,000.
The iPads go blank
The sun was setting on a recent spring day in Robertsdale, a village in southwest Huntingdon County. About 35 people had turned out for a night of bingo, fried fish sandwiches and chicken tenders at the fire company’s social hall.
It was a good crowd, Mr. Drenning said. Inside a Robertsdale fire engine truck and ambulance are iPads loaded with the latest software, where details of an emergency call — with maps and pictures — light up the screen.
The technology is standard in larger cities, allowing first-responders to more quickly identify the origin and nature of an emergency than is possible with the dog-eared, typewritten pages of the past.
But Robertsdale’s spotty wireless — only 45 percent of the company’s 24-square-mile service area has a cell phone connection — means the iPads go blank almost as soon as the vehicles pull out of the station.
Maybe it would have been better not to have even known about such advancements, Mr. Drenning said.
“I almost wish we’d never have seen what we could’ve had,” he said.
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