BROOKINGS — A recent report by South Dakota News Watch published in the April 2 issue of The Brookings Register carried the headline: “High costs may have South Dakotans putting off health care.” For a local look at health care in Brookings and its multiple small surrounding communities, the Register had an interview recently with Jason Merkley, president and CEO of the city-owned Brookings Health System. He’s been on the job more than 12 years.

Where there’s health care, there’s insurance and vice versa was for the president   one takeaway from the report.

“(They are) one and the same, in that lots of people have insurance for health care,” he noted. “But the cost of insurance is really beginning to skyrocket, not that it wasn’t expensive to begin with. And I would say that the patient liability associated with those insurance plans, maybe employer-sponsored or otherwise, are beginning to shift more of that liability to the patient or the individual or the carrier of that.”

High deductible plans, health savings account (HSA) plans “have such a huge front-end burden to meet on those deductibles. … They might save on some premiums, but them they come to the hospital and they’ve got (a high-dollar) deductible to meet. … The challenge with us is that reimbursement doesn’t go up in the same level … When our costs go up by 20 percent we might get a 2 or 3 percent increase, if any.”   

Merkley did admit that Brookings, as an “affluent community” and a “little bit different than maybe some of the other communities in South Dakota. I would say geographically there are some much more challenges in other areas than there are in Brookings. We don’t have to look very far. Obviously the reservations fit that mode. Also, the more rural you are, the more challenging it is sometimes. Sometimes even access to health care gets more challenging.”

Add another plus for many Brookings residents: Major employers offer “sponsored plans (that are) for the most part self-funded with the employers paying a large portion of that cost.” Smaller employers or individuals “are out on the market place trying to find plans. The cost of those is continuing to increase.”

Nursing homes face ‘extreme challenges’

Merkley noted that in the past in South Dakota there were people in the “gap” who could not qualify for Medicaid; they didn’t have a low enough income to qualify, didn’t have employer-sponsored health insurance, or could not afford the cost of employer-sponsored insurance. But those people in the gap now may be eligible for coverage.

The CEO explained that the Brookings Health System doesn’t have “a huge amount of Medicaid (patients) in its payer mix.” It used to be about to 7 to 8 percent of total. “It’s much, much different than in other parts of South Dakota. We’re in one of the lower spots in our Medicaid-payer mix.”

Two key elements of the health system include the 49-bed Brookings Hospital and The Neighborhoods at Brookview, a 79-bed skilled nursing home.

“The nursing home profession has its extreme challenges,” Merkley said.  “Lots of them are workforce related, but also in regard to reimbursement. The Legislature in the state has done some things to help that over the past couple of years.

“But we’re still not to a point where those facilities can be able to reinvest in their operations, get their employees the things they need; we’re seeing depleting facilities.

“I don’t want to say it’s necessarily a financial drain on an organization, by any means; but at the same point in time, certainly those things are challenged — and have a unique set of challenges, based upon the needs of our population as they grow older, and the access to care in those beds.”

Proof in performance

“I would say we’re fortunate,” Merkley said, in addressing the issue of access. “From a standpoint of how we do things here, it’s been really good. Are we maybe lucky that we’re in one of the great communities in South Dakota? That helps. Do we have lots of great people that work for this organization? That helps. We’re committed. We have good people and good quality and all those things. And some of our awards demonstrate that.”

As to its proof of performance, the Brookings Health System has an impressive list of awards and accolades, such as: in February being named to Newsweek’s list of World’s Best Hospitals; in March, recognized for the seventh straight year as a Top 20 Rural Community Hospital; and in July 2023, a 5-Stars rating by the Centers for Medicare & Medicaid.

The president tells the BHS nine-member Board of Trustees, “all the time, we’re very fortunate. That’s not the case in health care across the country, and in some cases across the state. It’s really in a state of challenging times.”

Contributing to the challenges are: “higher costs, financial strain. I just read that 51% of the hospitals across the country are not making money.”

Merkley recognizes that the system doe not serve a big enough population base to warrant certain specialties on a full-time basis, but they are in some instances  covered by “circuit-rider” providers or by referring patients to more specialized health care facilities.

“I think we have some of the outreach that comes up where we can’t sustain the practice, the specialty,” he explained. “Cardiac might be a good example. We don’t have enough people in our population, in our service area to have that be a sustainable specialty here. We have North Central Heart providers (a division of Avera Heart Hospital in Sioux Falls) come up and provide services to our community and our outreach clinic. We do some of the services, some of the rehabilitation, some stress testing, that sort of thing. But we don’t do the whole gamut of taking care of that patient from a cardiac standpoint all here in Brookings. Sometimes they’ve got to drive down to Sioux Falls to get things done.”

Looking to the future, the CEO sees “health care moving extremely quickly. As we’re still reeling a little bit from the pandemic and other things that happened, the one thing that’s really challenging us sometimes is workforce and capacity-related issues.”

With population growth, be it in Brookings or Sioux Falls, come the above challenges. “It’s great to have growth,”Merkley said. “But you’ve got to have places for those people to go. And you have to have people to work those positions, to be able to take care of those people from a health-care standpoint. We’re struggling a little bit with that in Brookings and certainly in Sioux Falls even.

“We really don’t have enough nurses. That’s just one example. We don’t have enough anything, to be honest.”

Noting those issues as challenges, Merkley noted via a sports analogy, that BHS doesn’t have a “huge bench”; there aren’t “people just waiting to step up. … It can be really challenging, especially when you hit some of those high levels of volume in some services.”

When it comes to a “driver” in all aspects of health-care services, including insurance and rising costs, Merkley cited one word: utilization. “What we’re seeing is more seniors and people who are older or in worse health driving those costs up. They need more services. That’s typically what drives insurance costs along with inflation and some other things.”

— Contact John Kubal at jkubal@brookingsregister.com.