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Building project at MRH&C planned

A building project that will deal with significant infrastructure issues at Mobridge Regional Hospital and Clinics is currently in the planning stages.
At a public meeting held Saturday, Dec. 22, MRH&C’s CEO John Ayoub told a group of residents the infrastructure of the original facility, built in 1958-59, has significant issues with the plumbing, heating and cooling and electrical systems, that are original to the structure.
Although there have been several construction projects that have expanded the facility, measures must be taken now to deal with a poor adjacency problem between departments and staffing issues caused by these existing problems.
Ayoub showed the group the distance between the emergency room and radiology and diagnostic equipment located in the newer area of the hospital. Emergency room (ER) patients must be wheeled through several long hallways to get to the needed equipment. These hallways are public areas, where ER patients can come in contact with visitors.
Ayoub said when the emergency room area was built itwas constructed for an average of 1,000 emergencies visits per year. ER visits this past year were 4,100. He said with a growing area population and an aging population, those ER visits are expected to grow.
This is the same situation that occurs in the surgical unit.
This unit was constructed in 1999. It was built for the surgical technology and methods of the time. It does not have adequate supply storage or infrastructure to support new surgical equipment.
With these units spread throughout the facility, it presents staffing problems as well. With staffing needed in several areas of the facility, including obstetrics, it stretches the staff thin with so much distance between the departments in the current facility.
“We have been studying this for a long time,” said Ayoub. We have held several planning retreats with the board of directors, administration, department heads and architects to research what is needed to resolve these issues.”
He said during the course of this research the group decided principles were needed to guide these renovations.
The principles included:
• Communications between all involved, cost control, and making sound financial decisions.
• Safety and security, taking into consideration measures needed to ensure patient, visitors and staff at the facility at all times.
• Access to care and expansion of services with adequate equipment and staff to provide service to the community.
• Privacy and confidentially for patients and public.
• Instill a confidence of high quality and compassionate care and uphold the reputation of the facility as one of the top 100 critical care hospitals in the nation.
• Leadership in this community and a sense of pride in this community.
Ayoub said MRH&C is the largest employers in a five county area. There are approximately 200 employees of MRH&C.
He said having a high-quality care facility in Mobridge brings people to the community. They may buy gas or have a meal while they are in town. They may shop here and consider moving into the community.
Ayoub said the purpose of the new construction is to build on what the facility already provides. The new construction would accommodate future outpatient and procedural volume, flexibility in the facility layout, and upgrade the electrical and mechanical infrastructure.

Two options
Ayoub explained that two options are currently being considered for this project.
The first would be to move the outside storage building and build to the north.
This would include a new surgery unit, moving the emergency room area to the north and provide a shared nursing station to allow staffing in these two departments as well as obstetrics at the same time.
This plan would have the diagnostic area within this horseshoe shaped area.
After the new section is constructed, the original building area would be demolished.
In the second option, the helicopter pad would be moved and a two-phased project would be used to build a new structure to house the above departments and the second to remodel the existing facility.
To finance the project the MRH&C board will seek funding from the United States Department of Agriculture and 10 percent through capital contributions. The USDA financing, a low-interest loan, will cover 80 percent of the cost of the project. The financing was hoped to have been secured under the a lower interest rate, but the recent government shutdown may have put that rate in doubt.
The other 15 to 20 percent of the cost of construction would be borrowed from banks. Ayoub said local banks will be given the opportunity to finance the project before any national banks.
Because MRH&C is designated as a critical access hospital, the government reimburses 99 percent of Medicare, Medicaid, veteran’s and Indian Health Service payments to the hospital. This helps to secure the financial status of the facility.
MRH&C has a four-star Medicare rating and was recently named one of the top 100 rural critical access hospitals in the country.
“The government recognizes facilities that provide high-quality care in rural areas as critical access,” explained Ayoub. “With that designation, smaller rural hospitals get the larger percentage of Medicare reimbursements.”
He said the facility’s financial well-being will make the project affordable.
“We just want to make sure we do this in the most cost-efficient manner,” he told the group.
When asked about a timeline for the project, Ayoub said the focus will be on first getting the financing at the lower rate in place. The board will then make the decision on which direction the project will go. He said there will be input from hospital staff, and architects in this decision.
It could take three and a half to five years to complete the project, according to Ayoub, depending on which plan they chose.

Questions
When asked if the old portion of the building could be saved and used for a senior care wing, Ayoub said that would not feasible.
“We do need a senior care facility in this community, but there are certain factors in this closing that are undesirable for this facility,” he said. “South Dakota has the lowest Medicare reimbursements in the nation. We would be jeopardizing our financial well-being by getting into this branch of care right now.”
He said MRH&C is a very important health care facility to the region and it would not practical to take on the role of a senior health care facility with the reimbursement rates so low.
He said several other options are being researched including expanding services provided by the Walworth County Care Center in Selby.
– Katie Zerr –