David Jahn, President & CEO of Chippewa County War Memorial Hospital

David Haynes sits down with David Jahn, President and CEO of Chippewa County War Memorial Hospital. David has been with War Memorial for 15 years, and prior to that he was CEO and CFO at Schoolcraft Memorial Hospital in Manistique (his hometown) for 22 years.

David has his undergraduate degree in Business Administration from Michigan Technological University and an MBA from Lake Superior State University. He is currently a member of the Michigan Health and Hospital Association Board of Directors and the Vice-Chairman of the Michigan Center for Rural Health Board of Directors.

In this episode, David Jahn discusses healthcare in the Eastern Upper Peninsula, and the difficulties that are being faced not just at his facility but in hospitals throughout the UP, including nursing shortages and strain, the impacts of COVID, new partnership opportunities with downstate universities to help attract and recruit more doctors, and funding difficulties from decreasing Medicare reimbursement rates.

Transcript

David Haynes:

Well, hello, everybody. Welcome to this edition of Rural Insights podcast and video. This week we’re pleased to have David Jahn with us. David is the CEO of War Memorial Hospital in Chippewa County and is a national expert on rural health issues. We’ll be talking to him about that. Chippewa County and Sault Ste. Marie, our second largest county and city in the upper peninsula, serve an amazing amount of people and they’re an important part of the peninsula in healthcare. So, David, let me just ask you the broad general question, what’s going on over at War Memorial and the Eastern UP with healthcare these days?

David Jahn:

Well, there’s lots of things going on. We’ll save the COVID information for a little bit, but we’re seeing some interesting dynamics here. Some of the positives are that I think the COVID pandemic has improved our ability to recruit physicians to rural areas because some want to get out of the hotspots and so we’ve seen a pretty good a year as far as physician recruitment and bringing in new specialists. So, that’s a positive to it. The negative to it is that there’s a lot of people who are from the local area that may not have a whole lot of ties, maybe they just got out of Lake State’s nursing program and had two or three or four years experience here and they don’t have kids, they don’t have a husband yet, and they’re deciding to leave us and go travel and earn a bunch of money as a travel nurse and that’s really impacting our ability to staff.

I think right now we probably have 25% of our positions are open, which is something that probably every industry in the UP can say. Currently we have 17 travelers that we’ve hired from other places to come in and help us staff. So, it’s a double-edged sword. We’re getting more physicians in, that means there’s more patients that can stay in the local hospital, but if we don’t have enough staff to staff the beds, then it gets interesting. This week, for some reason, COVID is hitting more here now, but our hospital has no COVID patients right now, but we’re full. Yesterday, we tried to transfer some patients to McLaren and Petoskey, to Munson, and Traverse City, UP system in Marquette, and they were all full as well. We had seven patients that needed to be admitted that stayed overnight our ER because there was no hospital that had a bed, and this is without a COVID surge.

David Haynes:

When you say 25% of your positions, other than nurses and doctors, what kind of positions are we talking about?

David Jahn:

Just about everywhere, phlebotomists, medical assistants in the clinics, environmental services staff, housekeeping, food/nutrition is a big one. We’re struggling to be able to keep our cafeteria open for employees. Sometimes we have to shut it down because there’s not enough staff and we have to take care of the patients and the residents first, but just about at every level there’s openings and we’re trying as best we can to find innovative ways to try to attract more people here, be flexible with people, because we know the younger people that have family obligations maybe can’t work a full-time job. They need childcare.

Some of the retirees who maybe still want to work a day a week or so, maybe two days a week, how do we fit them into the picture as well? Back in the day, it was always in order to get health insurance, you got to work full-time. Well, we’re revisiting that and saying, “Well, maybe if you work 60% of the time, you can get health insurance,” especially some people that want to retire before they get on Medicare. They may be willing to work three days a week instead of five if they get health insurance.

David Haynes:

Do you draw your nurses from all around the country or do you recruit at the universities?

David Jahn:

Yeah. I would say probably 80% of our nurses come from Lake Superior State’s program. We’ve been fortunate to have that great partnership for so many years. We do get some from Sault Ontario and that took a little bit of a hit when the pandemic started because the Sault area hospital told their nurses they had to choose, either work on one side or the other. They couldn’t work on both sides. There was about 12 nurses that decided to stay over in Canada. They’ve changed that now, as long as you’re fully vaccinated, you can work on both sides, so we’re getting some of those back. But it’s difficult to find nurses. I tell people, hospitals are our own worst enemy sometimes because when we need staff, we’re willing to shell out the big bucks to get staff, but then that kind of cannibalizes the other places where these nurses are coming from.

Maybe the fix would be okay, every hospital in the country says no more travel nurses and all the nurses have to go back home to where they live and maybe we’ll solve our staffing issue. But that won’t solve it because we need to have more nurses in the pipeline, just like more physicians. It’s a tough job and I think we’re losing nurses who have been in the business for many years because they see what happened during COVID and there’s high anxiety, there’s high stress, there’s high burnout because we’re asking them to work extra shifts. It’s just not a good situation and I think that could be echoed probably at every hospital in the UP.

David Haynes:

So when we interviewed Brian Chapman, the City Manager of the Sault, he was talking to us about one of the problems are recruiting. They’re having positions open and trying to recruit, and an issue is housing within Sault Ste. Marie. Does that impact you as well, the availability of housing and pricing?

David Jahn:

The availability for sure, because we just had somebody who was going to come up and I think they were an advanced practitioner and they couldn’t find a house, and so they said, “Well, we’re going to accept this other job we were offered where we can find housing.” Then we were able to go and find an apartment to where we said, “Well, we can get this for six months and by that time, you should be able to find a house.” But just yesterday, my CFO came and said, “Hey, I found a couple apartments that are open right now that we could put our name on and rent for the next year even though we don’t have anybody to live in them right now. Should I do that?” And I said, “Yes,” because we need a little bit of a cushion flexibility for people coming in the area that can’t find a house. But that’s definitely a problem here now and I guess to some degree, it’s a good problem because housing values are going up and everything’s rented and everything’s bought and whatever.

Part of that probably has to do with the Locks project and that’s only going to get more stressful because if it all gets funded and it’s a seven-year project, that’s going to bring a lot more people into Sault Ste. Marie.

David Haynes:

Yeah, absolutely. It’s a growing place. So David, you and I have talked about this before this, but stories about you affiliating with the University of Michigan, or other people. You’re on the I-75 corridor. U of M is already I think an Alpina and Midland. Is that in the works for you all at War Memorial, or is that still a discussion item for the future?

David Jahn:

Well, the process started a few years ago. We had a couple not so good financial years. Part of it was implementing a new electronic health record and the cost of that. So we started looking for a partner and we sent out an RFP in I think six different health systems within Michigan. Applied at a couple of them. Once they learned more about it, they just said, “We’re too far away. We don’t think we can provide value to you being that far away.” And then we narrowed it down to a couple. We visited. We met with people. And then we narrowed it down to one and that was Mid Michigan Health out of Midland who has an affiliation with the University of Michigan.

They have an agreement. And so, right now we’re in the due diligence process and I tell people it’s kind of like that period between when you get engaged and when you get married and you find out a lot more information about the person you’re going to marry and probably 90% of the time the marriage happens, but there’s 10% of the time that something happens during that period that isn’t going to work out.

We’re working through those things right now and if all of those items are satisfactory, then we would sit down and negotiate a definitive agreement, which would actually put everything we’re talking about in writing.

David Haynes:

You would have a formal affiliation with Midland and the U of M?

David Jahn:

Right, yeah. If it happened, it will be with the Mid Michigan Health out of Midland. It would be part of their system, which includes, they have the hospital in Alpina, West Branch, Gratiot County, I think Claire. They have quite a few of them and if it worked out, we’d be part of that. And then they in turn have an agreement with University of Michigan so that they basically on their signage and whatever have the block M and there’s some perks to being part of that system as far as transfers of tertiary and quaternary care patients, that sort of thing.

David Haynes:

Would you have the block M on your buildings?

David Jahn:

From what I gather, yes we would.

David Haynes:

So the next time I interview you, you might be wearing maize and blue.

David Jahn:

That’s going to be tough because I’m a Spartan fan. I know a lot of our physicians graduated from either the MSU College of Medicine or the College of Human Medicine, and they said, “We’re okay with this as long as I don’t have to wear maize and blue.”

David Haynes:

Maize and blue, yeah. That can go on the side door or something. Yeah. So how far in the future you think this is? A year, two years, months?

David Jahn:

I would think if everything went well, it could happen between January of next year to June of next year, or something like that. From our end, our financial situation is really robust right now. Even though we shut down last year for two and a half months, it was one of the better years we ever had. So the question becomes now, what are the benefits you get other than the financial that are going to impact the community and that’s all part of that negotiating the definitive agreement. I mean, we think we want all this grandiose stuff and what are we going to be able to get to help bring services, retain services, in our local community.

David Haynes:

So as you look out at healthcare in the Eastern UP for the next three years, obviously this new affiliation is an opportunity, what are the challenges, the threats, to rural healthcare in the Eastern UP? What’s out there that keeps you up at night?

David Jahn:

Well, certainly the staffing situation is the biggest issue right now. As staffing gets tighter and tighter, you need to increase your wages and benefits to be competitive with those who you’re competing with and when you do that, then your expenses go up and I’m sure the reimbursement isn’t going to go up as fast as the expenses. So, Medicare, Medicaid, Blue Cross, they have a financial obligation they have to meet too and they’re just not going to throw money at us. So, our thing is we want to retain as many services as we can in the local communities so people don’t have to travel. But if push comes to shove, what specialty services that we’re doing now might have to be discontinued because we can’t afford to do them anymore, so that’s a concern.

And keeping up with technology and making sure we have the most up-to-date technology, it’s not easy. We just purchased another robot for surgery, a DaVinci, and those things are really expensive, but if we’re ever going to recruit new physicians to our area for general surgery, OB/GYN, urology, any of those specialties, they’re all being trained on the robot. I don’t know that in the future that the new grads coming out will be able to do surgery without the robot and so what does that mean for small rural communities that can’t afford a $1 million, or a $2 million or a $3 million robot. I look at it and I worry that it’s going to be more travel unless we get to a point where, like they do in the military, the surgeons that do things on the battlefield aren’t on the battlefield. They’re off on a Navy ship somewhere and they’re controlling that robot remotely. That would be a nice thing for rural areas.

Telemedicine is great. I mean, even in the Eastern UP, people on Drummond Island have to jump on a ferry and drive an hour to get to a War Memorial, or an hour to get Mackinac Straits Hospital. If we can provide them service via telemedicine and insurance companies are willing to pay for that, it’s going to be much more efficient for everybody. But I also know that the telemedicine piece brings in competition, because if you can do telemedicine from Sault Ste. Marie to Drummond Island, you can do telemedicine from Detroit to Drummond Island, or California to Drummond Island, or Florida to Drummond Island, and what part of the market is going to be taken away by that, which is then not there to support our rural hospitals?

David Haynes:

So as somebody who has been involved in discussions in national rural health care and solutions, what things should our listeners know about nationally, rural healthcare? Is there everyone going through the same thing we are? Are there solutions out there that you have found are besides the one you’ve already talked about what you’re really creative, but is this, is everybody in rural areas having the same kinds of issues or are there different issues?

David Jahn:

No, I think they’re the same issues in the entire country. I mean, we’re fortunate here that we haven’t had a lot of rural hospitals close, but there are some areas of the country that have had a lot of rural hospitals close. But at the same time, back in the day when all these rural communities were able to get hospitals, back in the day of Hill-Burton and the money that you could get from the federal government to build a new hospital. That was in the 60s and the 70s, and there isn’t that money around anymore. And with the ratcheting down of reimbursement rates and what we have to pay to attract physicians and others here, and with the lower volumes, we just can’t make that up just based on volume like they can in urban areas.

You need to look at rural and you need access. I think every American should have access to healthcare, but there’s going to be a point in time where, what does access mean? Does it mean access to primary care or does it mean access to specialty care, and are people in rural hospitals or rural communities going to have to drive distances for that specialty care? Which is going to put a burden on the community, because there’s some that probably don’t mind driving, but there’s others that don’t have the resources to drive. And I can tell you this, in rural communities, the local businesses should be locked in with the hospital because every time somebody drives to another town to get their healthcare services, they’re going to the big box stores and buying things down there that take away from the mom and pop shops in the local community and they’re spending available resources away from their local community, which then also impacts local businesses.

David Haynes:

Yeah, Congress are calling that in rural areas the Costco effect. David, anything else you’d like to tell us about War Memorial or healthcare or things you’re doing before we close?

David Jahn:

Well, we didn’t touch much on a COVID. We are seeing increases, as every place in the UP is. We’re not seeing increases in the number of people we’ve had to admit because we don’t have anybody admitted right now, but we’re seeing increases. The thing over here, which is interesting because we’re so joined at the hip with Canada, is that when the Canadian government opened the border for Americans to go over to Canada as long as they had a negative COVID test and were vaccinated, all of a sudden we’re getting an influx of people who want a COVID test that don’t necessarily have any symptoms. They just want to travel. Well, we only have so many people that can run those tests and they want a PCR test, which is a test that takes 15 minutes each to run. You can’t batch them or whatever. And so we’re getting people that are getting angry that we aren’t able to offer those tests.

But again, we’re not in the business of doing testing for travel. So, that’s a concern. And my biggest concern for rural, and this would take into account all the UP, is rural America has the lowest vaccination rates of anywhere and we also have the least amount of healthcare resources. So, if this Delta variant gets going and it’s really impactful to those that aren’t vaccinated, are our local hospitals in UP going to keep be able to keep up with it?

David Haynes:

What’s your vaccination rate over in Chippewa?

David Jahn:

In Chippewa County, we have 51.3% of our population fully vaccinated. In the 12 to 19 category, only 28%. I know we’re doing much better in the 65 and over category. I think we’re over 75%. We’re doing pretty good with our employees. I think we’re close to 80%, which is one of the higher numbers. But now we’re ramping up for the possibility that in September they’re going to recommend third doses and a booster shot, and we want to make sure our employees who want that third shot get it. But we joined the group of the health department, the Lake State University, the Sault tribe, the Bay Mills tribe, the clinic out in Pickford. We all meet once a week and discuss the vaccine. We planned mass vaccination clinics at the start where we used Lake Superior State’s Cisler center and did I think over 1,000 one day and 700 or 800 another day.

That took a lot of resources, but that was in the crisis, and now for these third doses, I don’t know that we have the resources to do that. Is there enough of the vaccine available, which I hear there is, that they could get their vaccine from their local primary care physician, the health department, the pharmacies that are doing the vaccine? We’re hoping the people in the community can get those third doses through there, but it’s obvious to us, and I’m not political at all, I just look at the data, and it’s obvious that people that are vaccinated have a much less likely chance of being admitted to a hospital and a much less likely chance of dying from the virus.

I think it was the Michigan State College of Medicine Dean that I read a thing the other day, we want to try to get more people vaccinated, but for the people that don’t want to get the vaccine, we need to keep them as safe as possible so that they don’t overwhelm the healthcare system. The issue is that the people that don’t want to get the vaccine are also the people that don’t want to wear masks. So it’s a double whammy on those people and that’s their right. They should have that right, but we also need to protect the resources to take care of the people that are having heart attacks or the people that need the cancer surgery or have pneumonia or whatever, because they’re just as important in the mix as a person with COVID. And if you’re overrun by COVID, how are you going to keep taking care of the other people?

David Haynes:

Well, David, thank you. Our listeners and our readers, we always appreciate you doing this. Your articles, our readers have really enjoyed. And so today we are happy and pleased that we got to talk to David Jahn, the CEO of Chippewa County War Memorial Hospital. So David, thank you for your time and best of luck. And as they say, mask up.

David Jahn:

Thanks, David.

David Haynes:

See you my friend. Bye-bye.

David Jahn:

See you. Bye.