Northern Rockies Medical Center, Inc.
Community Needs Assessment and Focus Groups
Table of Contents
Introduction .....................................................................................................................................2
Health Assessment Process ..............................................................................................................2
Survey Methodology .......................................................................................................................2
Survey Respondent Demographics .................................................................................................4
Survey Findings ..............................................................................................................................8
Focus Group Methodology ...........................................................................................................46
Focus Group Findings ...................................................................................................................47
Summary .......................................................................................................................................50
Appendix A ...................................................................................................................................51
Steering Committee
Appendix B ...................................................................................................................................52
Public Health and Populations Consultation
Appendix C ...................................................................................................................................54
Survey Cover Letter
Appendix D ...................................................................................................................................55
Survey Instrument
Appendix E ...................................................................................................................................61
Responses to Other and Comments
Appendix F ....................................................................................................................................65
Focus Group Questions
Appendix G ...................................................................................................................................66
Focus Group Notes
Appendix H ...................................................................................................................................77
Secondary Data- Community Profile, Economic Impact Assessment
1
Northern Rockies Medical Center Community Survey
Summary Report
June 2013
I. Introduction
Northern Rockies Medical Center is a 25-bed Critical Access Hospital (CAH) and rural health clinic
based in Cut Bank, Montana. Northern Rockies Medical Center has a service area of just under
3,000 square miles and provides medical services to the Glacier County population of approximately
13,382 people. Northern Rockies Medical Center participated in the Community Health Services
Development (CHSD) Project administrated by the Montana Office of Rural Health and the National
Rural Health Resource Center (NRHRC) in Duluth, Minnesota. A part of this project is community
engagement which includes a health care service survey and focus groups.
In the spring of 2013, Northern Rockies Medical Center’s service area was surveyed about its health
care system. This report shows the results of the survey in both narrative and chart formats. At the
end of this report, we have included a copy of the survey instrument (Appendix D). Readers are
invited to familiarize themselves with the survey instrument and then look at the findings. Our
narrative report touches on the highlights while the charts present data for virtually every question
asked. Please note: we are able to compare some of the 2013 survey data with data from the 2009
survey. If any statistical significance exists, it will be reported. Significance level was set at 0.05.
II. Health Assessment Process
A Steering Committee was convened to assist Northern Rockies Medical Center in conducting
CHSD. A diverse group of community members representing various organizations and populations
within the community (ex. Public health, elderly, uninsured) came together in February 2013. For a
list of all Steering Committee members and their affiliations, see Appendix A. The Steering
Committee met twice during the CHSD process; first to discuss health concerns in the community
and offer their perspective in designing the survey instrument and again to review results of the
survey and focus groups.
III. Survey Methodology
Survey Instrument
In April 2013, surveys were mailed out to the residents in Northern Rockies Medical Center’s
service area. The survey was based on a design that has been used extensively in the states of
Washington, Wyoming, Alaska, Montana, and Idaho. The survey was designed to provide each
facility with information from local residents regarding:
Demographics of respondents
Hospitals, primary care providers, and specialists used plus reasons for selection
Local health care provider usage
Services preferred locally
Perception and satisfaction of local health care
2
Sampling
Northern Rockies Medical Center provided the National Rural Health Resource Center with a list of
outpatient and inpatient admissions. Those zip codes with the greatest number of admissions were
selected to be included in the survey. A random list of 800 residents was then selected from Prime
Net Data Source. Residence was stratified in the initial sample selection so that each area would be
represented in proportion to the overall served population and the proportion of past admissions.
(Note: Although the survey samples were proportionately selected, actual surveys returned from
each population area varied, which may result in slightly less proportional results).
Two focus groups were held to identify the motives of local residents when selecting health care
providers and discover reasons why people may leave the Cut Bank area to seek health care services.
It was intended that this research would help determine the awareness of local programs and
services, as well as the level of satisfaction with local services, providers, and facilities.
Information Gaps
Data
It is a difficult task to define the health of the rural and frontier communities in Montana due to the
large geographic size, economic and environmental diversity, and low population density. Obtaining
reliable, localized health status indicators for rural communities continue to be a challenge in
Montana.
There are many standard health indices used to rank and monitor health in an urban setting that do
not translate as accurately in rural and frontier areas. In the absence of sufficient health indices for
rural and frontier communities in Montana, utilizing what is available is done with an understanding
of access to care in rural and frontier Montana communities and barriers of disease surveillance in
this setting.
The low population density of rural and frontier communities require regional reporting of many
major health indices including chronic disease burden and behavior health indices. The Montana
BRFSS [Behavioral Risk Factor Surveillance System], through a cooperative agreement with the
Center for Disease Control (CDC), is used to identify regional trends in health-related behaviors.
The fact that many health indices for rural and frontier counties are reported regionally makes it
impossible to set the target population aside from the five more-developed Montana counties.
Limitations in Survey Methodology
A common approach to survey research is the mailed survey. However, this approach is not without
limitations. There is always the concern of non-response as it may affect the representativeness of
the sample, thus a mixture of different data collection methodologies is recommended. Conducting
community focus groups and key informant interviews in addition to the random sample survey
allows for a more robust sample and, ultimately, these efforts help to increase the community
response rate. Partnering with local community organizations such as Public Health, Community
Health Center, Senior Center, just to name a few, helps to reach segments of the population that
might not otherwise respond to a survey or attend a focus group.
3
Survey Implementation
In April 2013, the community health services survey, a cover letter from the National Rural Health
Resource Center with Northern Rockies Medical Center’s Chief Executive Officer’s signature on
Northern Rockies Medical Center letter head, and a postage paid reply envelope were mailed to 800
randomly selected residents in the hospital’s service area. A news release was sent to local
newspapers prior to the survey distribution announcing that Northern Rockies Medical Center would
be conducting a community health services survey throughout the region in cooperation with the
Montana Office of Rural Health.
As shown in the table below, 177 surveys were returned out of 800. Of that 800, 60 surveys were
returned undeliverable for a 24% response rate. From this point on, the total number of surveys will
be out of 740. Based upon the sample size, we can be 95% confident that the responses to the survey
questions are representative of the service area population, plus or minus 5.49%.
IV. Survey Respondent Demographics
A total of 740 surveys were distributed amongst Northern Rockies Medical Center’s service area.
One hundred and seventy-seven were completed for a 24% response rate. The following tables
indicate the demographic characteristics of the survey respondents. Information on location, gender,
age, and employment is included. Percentages indicated on the tables and graphs are based upon the
total number of responses for each individual question, as some respondents did not answer all
questions.
Place of Residence (Question 33)
While there are some large differences in the percentages below, the absolute differences are small.
The returned surveys are skewed toward the Cut Bank population which is reasonable given that this
is where most of the services are located.
2009
Location
Cut Bank
Browning
Babb
East Glacier
Valier
Not listed in 2013
Zip Code
59427
59417
59411
59434
59486
59427: North of
Cut Bank, Seville
Other
TOTAL
“Other” comments:
- Heart Butte 59448
- 59424
- Alberta
4
2013
Count
172
21
3
4
0
12
Percent
78.5%
9.6%
1.4%
1.8%
0
5.5%
Count
146
21
3
1
1
0
Percent
83.9%
12.1%
1.7%
0.6%
0.6%
0
7
219
3.2%
100%
2
174
1.1%
100%
Gender (Question 34)
2013 N= 177
2009 N= 228
Of the 177 surveys returned, 64.4% (n=114) of survey respondents were female, 35% (n=62) were
male, and 0.6% (n=1) chose not to answer this question. The survey was distributed to a random
sample consisting of 50% women and 50% men. It is not unusual for survey respondents to be
predominantly female, particularly when the survey is health care oriented since women are
frequently the health care decision makers for families.
5
Age of Respondents (Question 35)
2013 N= 177
2009 N= 222
Twenty-five percent of respondents (n=45) were between the ages of 56-65. Eighteen percent of
respondents (n=32) were between the ages of 46-55 and 17.5% of respondents (n=31) were between
the ages of 76-85. It is important to note that the survey was targeted to adults and therefore no
respondents are under age 18. Older residents are also more invested in health care decision making
and, therefore, are more likely to respond to health care surveys, as reflected by this graph.
6
Employment Status (Question 36)
2013 N= 174
Forty-nine percent (n=85) of respondents reported working full time while 31.6% (n=55) are retired.
Seven percent of respondents (n=12) indicated they work part time. Respondents could check all
that apply so the percentages do not equal 100%. Three respondents chose not to answer this
question.
“Other” comments:
- In the process of applying for Social Security disability
- Farmer and ranch
- Ranching cows and calves
7
V. Survey Findings
Impression of Community (Question 1)
2013 N= 167
2009 N= 218
Respondents were asked to indicate how they would rate the general health of their community.
Sixty-five percent of respondents (n=109) rated their community as “Somewhat healthy.” Twentyone percent of respondents (n=35) felt their community was “Healthy” and 13.2% (n=22) felt their
community was “Unhealthy.” Ten respondents chose not to respond to this question.
*In 2009, significantly more respondents rated the community as Healthy than in 2013 (2009: 43.5%; 2013: 21%) and in
2013, significantly more respondents rated the community as Somewhat healthy than in 2009 (2013: 65.3%; 2009:
41.3%)
8
Health Concerns for Community (Question 2)
2013 N= 177
2009 N= 228
Respondents were asked what they felt the three most serious health concerns were in their
community. The number one health concern identified by respondents was “Alcohol abuse/
substance abuse” at 71.8% (n=127). “Cancer” was also a high priority at 48% (n=85) then
“Obesity/overweight” at 34.5% (n=61). Respondents were asked to pick their top three serious
health concerns so percentages do not equal 100%.
2009
Health Concern
Alcohol abuse/substance abuse
Cancer
Obesity/overweight*
Diabetes**
Heart disease
Tobacco use
Lack of exercise
Child abuse/neglect
Mental health issues***
Motor vehicle accidents
Environmental/water quality
Access to healthy foods
Domestic violence
Depression/anxiety
Lack of access to health care
Stroke
Work related accidents/injuries
Lack of dental care
Recreation related accidents/injuries
Other
2013
Count
Percent
149
65.4%
106
46.5%
48
21.1%
76
33.3%
35
15.4%
29
12.7%
39
17.1%
18
7.9%
8
3.5%
16
7.0%
Not asked in 2009
Not asked in 2009
21
9.2%
Not asked in 2009
16
7.0%
10
4.4%
Not asked in 2009
7
3.1%
Not asked in 2009
11
4.8%
Count
127
85
61
41
26
26
22
21
20
18
18
15
14
12
11
11
4
4
1
2
Percent
71.8%
48.0%
34.5%
23.2%
14.7%
14.7%
12.4%
11.9%
11.3%
10.2%
10.2%
8.5%
7.9%
6.8%
6.2%
6.2%
2.3%
2.3%
0.6%
1.1%
*In 2013, significantly more respondents indicated obesity as a serious health concern than in 2009 (2013: 34.5%; 2009:
21.1%)
**In 2009, significantly more respondents selected diabetes as a serious health concern than in 2013 (2009: 33.3%;
2013: 23.2%)
***In 2013, significantly more respondents cited mental health issues as a serious health concern than in 2009 (2013:
11.3%; 2009: 3.5%)
“Other” comments:
- Mental health doctors
- Smoking
9
-
Psychologist
Cancer
-
Prescription drugs and suboxone
Components of a Healthy Community (Question 3)
2013 N= 177
2009 N= 228
Respondents were asked to identify the three most important things for a healthy community. Fiftynine percent of respondents (n=104) indicated that “Access to health care and other services” is
important for a healthy community. “Healthy behaviors and lifestyles” was the second most
indicated component at 40.7% (n=72) and third was “Good jobs and healthy economy” at 39.5%
(n=70). Respondents were asked to identify their top three choices, thus the percentages will not add
up to 100%.
Important Component
Access to health care and other services
Healthy behaviors and lifestyles*
Good jobs and healthy economy
Strong family life
Good schools
Low crime/safe neighborhoods
Religious or spiritual values
Clean environment
Good water quality
Affordable housing
Community involvement
Tolerance for diversity
Low level of domestic violence
Parks and recreation
Low death and disease rates
Arts and cultural events
Other
2009
Count
Percent
133
58.3%
70
30.7%
104
45.6%
58
25.4%
59
25.9%
42
18.4%
44
19.3%
36
15.8%
Not asked in 2009
34
14.9%
27
11.8%
7
3.1%
9
3.9%
11
4.8%
3
1.3%
4
1.8%
5
2.2%
2013
Count
Percent
104
58.8%
72
40.7%
70
39.5%
45
25.4%
35
19.8%
35
19.8%
35
19.8%
31
17.5%
31
17.5%
30
16.9%
15
8.5%
11
6.2%
8
4.5%
6
3.4%
4
2.3%
1
0.6%
2
1.1%
* In 2013, significantly more respondents indicated Healthy behaviors and lifestyles were important components of a
healthy community than in 2009 (2013: 40.7%; 2009: 30.7%)
“Other” comments:
- All of the above contribute to a healthy community
10
Overall Awareness of Health Services (Question 4)
2013 N= 175
2009 N= 216
Respondents were asked to rate their knowledge of the health services available. Sixty-three percent
(n=110) of respondents rated their knowledge of health services as “Good.” Nineteen percent
(n=33) rated their knowledge as “Fair” and 14.9% of respondents (n=26) rated their knowledge as
“Excellent.” Two respondents chose not to answer this question.
*In 2013, respondents rated themselves as more knowledgeable about available health services than in 2009 (2013:
87.7% (excellent or good); 2009: 64.8% (excellent or good))
11
How Respondents Learn of Health Care Services (Question 5)
2013 N= 177
2009 N= 228
The most frequent method of learning about available services was “Health care provider” at 60.5%
(n=107). “Friends/family” was the second most frequent response at 55.9% (n=99) and “Word of
mouth/reputation” was reported at 53.1% (n=94). Respondents could select more than one method so
percentages do not equal 100%.
2009
Method
Health care provider
Friends/family
Word of mouth/reputation*
Newspaper
Radio
Mailings/newsletter**
Public Health
Website/internet***
Emergency response
Presentations
Other
Count
Percent
Not asked in 2009
Not asked in 2009
149
65.4%
86
37.7%
38
16.7%
16
7.0%
Not asked in 2009
7
3.1%
Not asked in 2009
8
3.5%
17
7.5%
2013
Count
107
99
94
76
36
25
19
17
13
4
10
Percent
60.5%
55.9%
53.1%
42.9%
20.3%
14.1%
10.7%
9.6%
7.3%
2.3%
5.6%
*In 2009, significantly more respondents learned of health care services via word of mouth/reputation than in 2013
(2009: 65.4%; 2013: 53.1%)
** In 2013, significantly more respondents learned of health care services via mailings/newsletter than in 2009 (2013:
14.1%, 2009: 7.7%)
***In 2013, significantly more respondents learned of health care services via the Website/internet than in 2009 (2013:
9.6%, 2009: 3.1%)
“Other” comments:
- Magazines in doctor’s office
- Walk in
- Receptionist at the clinic
- IHS
- Papers and radio
- Work place
- Looking into it for myself
- Work at hospital
12
Cross Tabulation of Service Knowledge and Learning about Services
Analysis was done to assess respondents’ knowledge of services available at Northern Rockies
Medical Center with how they learn about services available in their community. The chart below
shows the results of the cross tabulation. How respondents learned of health care services was a
multiple response item, thus totals cannot add up to 100%.
KNOWLEDGE RATING OF NORTHERN ROCKIES MEDICAL CENTER SERVICES
BY
HOW RESPONDENTS LEARN ABOUT HEALTH CARE SERVICES
Health care provider
Mailings/newsletter
Website/internet
Friends/family
Newspaper
Presentations
Public Health
Word of mouth/reputation
Radio
Emergency response
Other
13
Excellent
19
(17.8%)
5
(20%)
3
(17.6%)
21
(18.4%)
15
(20%)
1
(25%)
4
(21.1%)
12
(12.8%)
7
(20%)
4
(30.8%)
3
(30%)
Good
70
(65.4%)
19
(76%)
12
(70.6%)
62
(54.4%)
51
(68%)
3
(75%)
13
(68.4%)
65
(69.1%)
21
(60%)
6
(46.2%)
5
(50%)
Fair
17
(15.9%)
1
(4%)
2
(11.8%)
27
(23.7%)
8
(10.7%)
Poor
1
(0.9%)
Total
107
25
17
2
(2%)
1
(1.3%)
99
75
4
2
(10.5%)
14
(14.9%)
6
(17.1%)
2
(20%)
19
3
(3.2%)
1
(2.9%)
3
(23.1%)
94
35
13
10
Other Community Health Resources Utilized (Question 6)
2013 N= 177
2009 N= 228
Respondents were asked which community health resources, other than the hospital or clinic, they
had used in the last three years. “Pharmacy” was the most frequent community health resource cited
by respondents at 78.5% (n=139). “Dentist” was also a highly utilized resource at 61% (n=108)
followed by “Civic Center” at 29.9% (n=53). Respondents could select more than one resource so
percentages do not equal 100%.
Resource
Pharmacy*
Dentist
Civic Center
Physical Therapy
Public Health
Mental Health
Other
2009
Count
Percent
156
68.4%
143
62.7%
Not asked in 2009
Not asked in 2009
18
7.9%
15
6.6%
13
5.7%
2013
Count
Percent
139
78.5%
108
61.0%
53
29.9%
49
27.7%
24
13.6%
12
6.8%
12
6.8%
*In 2013, significantly more respondents indicating utilizing pharmacy services in the past three years than in 2009
(2013: 78.5%: 2009: 68.4%)
“Other” comments:
- Mental health doctors
- Mental health was a waste of my money. I wish I hadn’t gone.
- IHS (2)
- Eye Doctor (2)
- VA
- Chiropractor
- Hospice
14
Improvement for Community’s Access to Health Care (Question 7)
2013 N= 177
2009 N= 228
Respondents were asked to indicate what they felt would improve their community’s access to health
care. Forty-seven percent of respondents (n=83) reported that “More primary care providers” would
make the greatest improvement. Forty percent of respondents (n=71) indicated they would like
“Financial assistance/counseling” and 33.3% (n=59) indicated “More specialists” would improve
access to care. Respondents could select more than one method so percentages do not equal 100%.
Method
More primary care providers
Financial assistance/counseling
More specialists
Home Health assistance
Improved quality of care
Greater health education services*
Transportation Assistance**
Outpatient services expanded hours***
Cultural sensitivity
Expanded pharmacy hours
Telemedicine
Interpreter services
Other
2009
Count
Percent
111
48.7%
Not asked in 2009
76
33.3%
Not asked in 2009
63
27.6%
32
14.0%
27
11.8%
21
9.2%
Not asked in 2009
Not asked in 2009
6
2.6%
Not asked in 2009
21
9.2%
2013
Count
Percent
83
46.9%
71
40.1%
59
33.3%
56
31.6%
43
24.3%
42
23.7%
38
21.5%
30
16.9%
17
9.6%
7
4.0%
6
3.4%
1
0.6%
9
5.1%
*2013, significantly more respondents indicated Greater health education services would improve the community’s access
to health care than in 2009 (2013: 23.7%; 2009: 14%)
**In 2013, significantly more respondents indicated Transportation Assistance would improve the community’s access to
health care than in 2009 (2013: 21.5%; 2009: 11.8%)
***In 2013, significantly more respondents indicated Outpatient services expanded hours would improve the
community’s access to health care than in 2009 (2013: 16.9%; 2009: 9.2%)
“Other” comments:
- More options, including alternative medicine
- Mental health doctors
- Some of the ER and ambulance are extremely apathetic and judgmental
- Having doctors actually believe patients have pain. Stop suspecting everyone of being drug
seeking
- Happy with what we have
- Better billing department that won’t double your bills
15
Interest in Educational Classes/Programs (Question 8)
2013 N= 177
Respondents were asked if they would be interested in any educational classes/programs if offered
locally. The most highly indicated class/program indicated was “Fitness” at 37.3% of respondents
(n=66). “Health and wellness” was selected by 36.2% of respondents (n=64) and “Weight loss” at
34.5% (n=61). Respondents could select more than one method so percentages do not equal 100%.
Educational Class/Program
Fitness
Health and wellness
Weight loss
Nutrition
Women’s health
Living will
Diabetes
Cancer
First aid/CPR
Alzheimer’s
Heart disease
Support groups
Men’s health
Smoking cessation
Grief counseling
Alcohol/substance abuse
Parenting
Mental health
Prenatal
Other
“Other” comments:
- Childbirth
- Too old
- Stress reduction
16
Count
66
64
61
56
45
36
35
33
32
31
25
23
22
20
18
17
14
9
3
6
Percent
37.3%
36.2%
34.5%
31.6%
25.4%
20.3%
19.8%
18.6%
18.1%
17.5%
14.1%
13.0%
12.4%
11.3%
10.2%
9.6%
7.9%
5.1%
1.7%
3.4%
Economic Importance of Local Health Care Providers and Services (Question 9)
2013 N= 177
2009 N= 220
The majority of respondents (73.4%, n=130) indicated that local health care providers and services
(i.e.: hospitals, clinics, nursing homes, assisted living, etc.) are “Very important” to the economic
well-being of the area. Twenty-three percent of respondents (n=41) indicated they are “Important”
and three respondents, or 1.7% indicated that they are “Not important.”
17
Needed/Delayed Hospital Care During the Past Three Years (Question 10)
2013 N= 165
2009 N= 213
Thirty-five percent of respondents (n=57) reported that they or a member of their household thought
they needed health care services but did not get it or had to delay getting it. Sixty-six percent of
respondents (n=108) felt they were able to get the health care services they needed without delay and
twelve respondents chose not to answer this question.
*In 2013, significantly more respondents did not receive needed medical services or delayed services than in 2009
(2013: 34.5%; 2009: 23.9%)
“Other” comments:
- Wanted another option besides prescription drugs
18
Reasons for NOT Being Able to Receive Services or Delay in Receiving Health Care Services
(Question 11)
2013 N= 57
2009 N= 51
For those who indicated they were unable to receive or had to delay services, the reasons most cited
were: “It costs too much” (36.8%, n=21), “Service not available locally” (31.6%, n=18) and “Too
long to wait for an appointment” (26.3%, n=15). Respondents were asked to indicate their top three
choices, thus percentages do not total 100%.
2009
Reason
It costs too much
Service not available locally
Too long to wait for an appointment
Could not get an appointment
My insurance didn’t cover it
No insurance*
Not treated with respect
It was too far to go**
Could not get off work
Don’t like doctors
Too nervous or afraid
Unsure if services were available
Transportation problems
Office wasn’t open when I could go
Didn’t know where to go
Not culturally sensitive
Language barrier
Had no one to care for the children/dependents
Other
Count
Percent
26
51.0%
Not asked in 2009
12
23.5%
10
19.6%
7
13.7%
20
39.2%
10
19.6%
2
3.9%
3
5.9%
4
7.8%
2
3.9%
1
2.0%
4
7.8%
8
15.7%
2
3.9%
Not asked in 2009
0
0
3
5.9%
8
15.7%
2013
Count
Percent
21
36.8%
18
31.6%
15
26.3%
13
22.8%
12
21.1%
10
17.5%
9
15.8%
9
15.8%
8
14.0%
7
12.3%
7
12.3%
6
10.5%
6
10.5%
5
8.8%
2
3.5%
0
0
0
0
0
0
6
10.5%
*In 2009, significantly more respondents did not receive medical care or delayed needed services due to not having insurance
than in 2013 (2009: 39.2%; 2013: 17.5%)
**In 2013, significantly more respondents stated they did not receive medical care or delayed needed services because it was
too far to go than in 2009 (2013: 15.8%; 2009: 3.9%)
“Other” comments:
- Sickness from other people while you’re
waiting to be seen for your services
- Emergency room service was very poor
- Waiting in the ER
- Improper scheduling
- I went all the way to a specialist to find
out the referral for my MRI was not sent
19
-
-
IHS
Why should anyone pay the going rate
for a PA with half the education? Even
the expertise of current MDs leaves a lot
to be desired
Afraid of being accused of being a drug
seeker
Utilization of Preventative Services (Question 12)
2013 N= 177
Respondents were asked if they had utilized any of the preventative services listed in the past year.
“Routine blood pressure check” was selected by 54.8% of respondents (n=97). Fifty-one percent of
respondents (n=90) indicated they received a “Flu shot” and 49.7% of respondents (n=88 each) had a
“Cholesterol check” and “Eye exams.” Respondents could check all that apply, thus the percentages
will not equal 100%.
Service
Routine blood pressure check
Flu shot
Cholesterol check
Eye exams
Routine dental checkup
Routine health checkup
Mammography
Immunizations
Pap smear
Diabetes screenings
Prostate (PSA)
Colonoscopy
Children’s checkup/Well baby
None
Other
“Other” comments:
- I have to go out of town for my mental health doctor
- Blood draw
- Birthday blood test
- Surgery, rectal removal
- Shingles shot
20
Count
97
90
88
88
82
77
61
44
41
37
32
29
18
7
6
Percent
54.8%
50.8%
49.7%
49.7%
46.3%
43.5%
34.5%
24.9%
23.2%
20.9%
18.1%
16.4%
10.2%
4.0%
3.4%
Desired Local Health Care Services (Question 13)
2013 N= 177
Respondents were asked to indicate which health care professionals or services presently not
available would they use if available locally. Respondents indicated the most interest in having
“Nutrition/dietician” services available at 28.2% (n=50) followed by “Home Health assistance” at
15.8% (n=28), then “Occupational Therapy” at 7.3% (n=13). Respondents were asked to check all
that apply so percentages do not equal 100%.
Service
Nutrition/dietician
Home Health assistance
Occupational Therapy
Obstetrics
Emergency mental health
Other
“Other” comments:
- Naturopath (2)
- Chiropractor (2)
- Hospice (2)
- Herbalist
- More doctors, especially mental health
- Midwifery
- Orthopedics
- Substance abuse
- Good providers
21
Count
50
28
13
9
8
11
Percent
28.2%
15.8%
7.3%
5.1%
4.5%
6.2%
Hospital Care Received in the Past Three Years (Question 14)
2013 N= 169
2009 N= 223
Sixty-eight percent of respondents (n=115) reported that they or a member of their family had
received hospital care during the previous three years. Thirty-two percent (n=54) had not received
hospital services and eight respondents chose not to answer this question.
22
Hospital Used Most in the Past Three Years (Question 15)
2013 N=115
2009 N= 171
Of the 115 respondents who indicated receiving hospital care in the previous three years, 44.8%
(n=43) reported receiving care at Northern Rockies Medical Center in Cut Bank. Twenty-three
percent of respondents (n=22) went to Benefis in Great Falls, and 11.5% of respondents (n=11)
utilized services from Indian Health Services (I.H.S.) in Browning. Nineteen of the 115 respondents
who reported they had been to a hospital in the past three years did not indicate which hospital they
had utilized.
Hospital
Northern Rockies Medical Center – Cut Bank
Benefis – Great Falls
Indian Health Services (I.H.S.) – Browning
Kalispell Regional Medical Center – Kalispell
Marias Medical Center – Shelby
Pondera Medical Center – Conrad
Other
TOTAL
“Other” comments:
- Whitefish
- Kalispell
- Glacier Medical Center (2)
- Great Falls
23
2009
Count Percent
84
54.2%
15
9.7%
21
13.5%
10
6.5%
15
9.7%
4
2.5%
6
3.9%
155
100%
2013
Count Percent
43
44.8%
22
22.9%
11
11.5%
8
8.3%
4
4.2%
2
2.1%
6
6.2%
96
100%
Reasons for Selecting the Hospital Used (Question 16)
2013 N= 115
2009 N= 171
Of the 115 respondents who had a personal or family experience at a hospital within the past three
years, the primary reason given for selecting the facility used most often was “Closest to home” at
55.7% (n=64). “Prior experience with hospital” was selected by 40% of the respondents (n=46) and
38.3% (n=44) selected “Referred by physician.” Note that respondents were asked to select the top
three answers which influenced their choices; therefore the percentages do not equal 100%.
Reason
Closest to home
Prior experience with hospital
Referred by physician
Hospital’s reputation for quality*
Emergency, no choice
Indian Health Services (I.H.S.) eligible
Recommended by family or friends**
Cost of care
Closest to work
Required by insurance plan
VA/Military requirement
Other
2009
Count
Percent
114
66.7%
70
40.9%
63
36.8%
37
21.6%
60
35.1%
28
16.4%
13
7.6%
17
9.9%
19
11.1%
6
3.5%
2
1.2%
12
7.0%
2013
Count
64
46
44
43
32
24
20
16
7
3
2
7
Percent
55.7%
40.0%
38.3%
37.4%
27.8%
20.9%
17.4%
13.9%
6.1%
2.6%
1.7%
6.1%
*In 2013, significantly more respondents selected a hospital based on its reputation for quality than in 2009 (2013:
37.4%; 2009: 21.6%)
**In 2013, significantly more people selected a hospital because of a recommendation from family or friends than in
2009 (2013: 17.4%; 2009: 7.6%)
“Other” comments:
- Patient’s desires respected (liberty)
- Weather
- Family lives there
- Cultural sensitivity
- More helpful and friendly
- Caring staff
- Providers
24
Cross Tabulation of Hospital and Residence
Analysis was done to examine where respondents utilized hospital services the most in the past
three years with where they live by zip code. The chart below shows the results of the cross
tabulation.
LOCATION OF MOST OFTEN UTILIZED HOSPITAL BY RESIDENCE
Cut Bank
59427
Valier
59486
Northern
Rockies
Medical
Center
(Cut Bank)
Indian
Health
Services
(I.H.S)
(Browning)
Kalispell
Regional
Medical
Center
(Kalispell)
Marias
Medical
Center
(Shelby)
Benefis
(Great
Falls)
Pondera
Medical
Center
(Conrad)
Other
Total
40
(51.9%)
1
(100%)
3
(3.9%)
7
(7.8%)
3
(3.9%)
19
(24.7%)
1
(1.3%)
5
(6.5%)
77
1
1
(100%)
East
Glacier
59434
Babb
59411
1
(50%)
Browning
59417
1
(7.1%)
1
1
(50%)
8
(57.1%)
2
3
(21.4%)
1
(7.1%)
1
(7.1%)
Other
14
0
TOTAL
25
42
(44.2%)
11
(11.6%)
8
(8.4%)
4
(4.2%)
22
(23.2%)
2
(2.1%)
6
(3.6%)
95
Cross Tabulation of Hospital and Reason Selected
Analysis was done to assess respondents’ most utilized hospital with why they selected that hospital.
The chart below shows the results of the cross tabulation. Reason hospital was selected was a
multiple response item, thus totals cannot add up to 100%. Hospital location is across the top of the
table and reason for selection is along the side.
LOCATION OF MOST UTILIZED HOSPITAL BY REASONS HOSPITAL SELECTED
Cost of care
Closest to home
Closest to work
Emergency, no choice
Hospital’s reputation
for quality
Indian Health
Services eligible
Prior experience with
hospital
Recommended by
family or friends
Required by
insurance plan
Referred by
physician
VA/Military
requirement
Other
26
Northern
Rockies
Medical
Center
(Cut Bank)
3
(27.3%)
38
(70.4%)
4
(57.1%)
16
(57.1%)
8
(22.9%)
Indian
Health
Services
(I.H.S)
(Browning)
3
(27.3%)
6
(11.1%)
4
(14.3%)
2
(5.7%)
Kalispell
Regional
Medical
Center
(Kalispell)
1
(9.1%)
1
(1.9%)
1
(14.3%)
1
(3.6%)
6
(17.1%)
1
(6.2%)
11
(68.8%)
1
(6.2%)
19
(47.5%)
1
(2.5%)
2
(5%)
3
(7.5%)
12
(30%)
1
(2.5%)
2
(5%)
40
6
(33.3%)
2
(11.1%)
3
(16.7%)
1
(5.6%)
3
(16.7%)
1
(5.6%)
2
(11.1%)
18
1
(50%)
16
(43.2%)
1
(16.7%)
Marias
Medical
Center
(Shelby)
Benefis
(Great
Falls)
Pondera
Medical
Center
(Conrad)
2
(18.2%)
8
(14.8%)
1
(14.3%)
3
(8.6%)
7
(25%)
13
(37.1%)
Other
Total
2
(18.2%)
1
(1.9%)
1
(14.3%)
11
1
(16.7%)
4
(10.8%)
1
(16.7%)
7
28
3
(8.6%)
3
(18.8%)
35
16
1
(50%)
1
(2.7%)
54
2
1
(2.7%)
11
(29.7%)
1
(16.7%)
1
(2.7%)
1
(16.7%)
3
(8.1%)
37
2
(100%)
2
1
(16.7%)
6
Primary Care Received in the Past Three Years (Question 17)
2013 N= 173
2009 N= 224
Ninety-five percent of respondents (n=165) indicated that they or someone in their household had
been seen by a primary care provider (such as a family physician, physician assistant, or nurse
practitioner) for health care services in the past three years. Eight respondents had not seen a
primary care provider (4.6%) and four respondents chose not to answer this question.
27
Location of Primary Care Provider (Question 18)
2013 N= 156
2009 N= 193
Of the 165 respondents who indicated receiving primary care services in the previous three years,
65.4% (n=102) reported receiving care in Cut Bank. Fifteen percent of respondents (n=23) went to
Browning and 9% of respondents (n=14) utilized primary care services in Great Falls. Nine of the
165 respondents who reported they had utilized primary care services in the past three years did not
indicate where they received those services.
Clinic
Cut Bank*
Browning**
Great Falls***
Shelby
Conrad
Kalispell
Other
TOTAL
2009
Count
Percent
140
72.5%
17
8.8%
3
1.6%
20
10.4%
6
3.1%
4
2.1%
3
1.5%
193
100%
2013
Count
Percent
102
65.4%
23
14.7%
14
9.0%
10
6.4%
7
4.5%
0
0
0
0
156
100%
*In 2009, significantly more respondents utilized primary care services in Cut Bank than in 2013 (2009: 72.5%; 2013:
65.4%)
**In 2013, significantly more respondents utilized primary care services in Browning than in 2009 (2013: 14.7%; 2009:
8.8%)
***In 2013, significantly more respondents utilized primary care services in Great Falls than in 2009 (2013: 9%; 2009:
1.6%)
“Other” comments:
- Columbia Falls
- VA
- Polson
- Lewiston
- Red Deer, Alberta
- Big Fork
- Glacial Community Health Center in Cut Bank
- Bozeman
- Kalispell (2)
28
Reasons for Selection of Primary Care Provider (Question 19)
2013 N= 165
2009 N= 212
Those respondents who indicated they or someone in their household had been seen by a primary
care provider within the past three years were asked to indicate why they chose that primary care
provider. “Closest to home” and “Prior experience with clinic” (43.6%, n=72) were each the most
frequently cited factors in primary care provider selection followed closely by “Long term
relationship with provider” at 43% (n=71). Respondents were asked to check all that apply so the
percentages do not equal 100%.
Reason
Closest to home
Prior experience with clinic
Long term relationship with provider
Appointment availability
Clinic’s reputation for quality
Indian Health Services (I.H.S.) eligible*
Cost of care
Length of waiting room time
Assigned due to availability
VA/Military requirement
Recommended by physician or other provider
Required by insurance plan
Referred by physician or other provider
Other
2009
Count
Percent
103
48.6%
95
44.8%
Not asked in 2009
69
32.5%
42
19.8%
12
5.7%
21
9.9%
20
9.4%
Not asked in 2009
9
4.2%
Not asked in 2009
5
2.4%
22
10.4%
23
10.8%
Count
72
72
71
57
35
25
15
13
9
8
8
7
6
10
2013
Percent
43.6%
43.6%
43.0%
34.5%
21.2%
15.2%
9.1%
7.9%
5.5%
4.8%
4.8%
4.2%
3.6%
6.1%
*In 2013, significantly more respondents selected a clinic due to Indian Health Services (I.H.S.) eligibility than in 2009
(2013: 15.2%, 2009: 5.7%)
“Other” comments:
-
29
Shelby
Benefis Services in Great Falls
Only one available
Reputation for staying in the same place and not hopping from place to place
OB/GYN
One of the few primary care providers left here
Kind and caring
Recommended by a friend
Was available in the clinic
Cross Tabulation of Primary Care and Residence
Analysis was done to examine where respondents went most often for primary care with where they
live by zip code. The chart below shows the results of the cross tabulation.
LOCATION OF CLINIC MOST UTILIZED BY RESIDENCE
Cut Bank
59427
Cut Bank
96
(73.8%)
Valier
59486
East Glacier
59434
Shelby
9
(6.9%)
1
(100%)
30
Conrad
5
(3.8%)
Other
4
(22.2%)
101
(65.2%)
Total
130
1
1
Other
TOTAL
Great Falls
11
(8.5%)
1
(100%)
Babb
59411
Browning
59417
Browning
9
(6.9%)
10
(6.5%)
1
(33.3%)
12
(66.7%)
1
(50%)
23
(14.8%)
1
(33.3%)
1
(5.6%)
1
(50%)
14
(9%)
1
(33.3%)
1
(5.6%)
3
18
2
7
(4.5%)
0
155
Cross Tabulation of Clinic and Reason Selected
Analysis was done to examine where respondents went most often for primary care services with
why they selected that clinic/provider. The chart below shows the results of the cross tabulation.
Reason clinic/provider was selected was a multiple response item, thus totals cannot add up to
100%.
LOCATION OF PRIMARY CARE PROVIDER BY REASONS CLINIC SELECTED
Appointment availability
Assigned due to
availability
Clinic’s reputation for
quality
Closest to home
Cost of care
Length of waiting room
time
Long term relationship
with provider
Prior experience with
clinic
Recommended by
physician or other
provider
Referred by physician or
other provider
Required by insurance
plan
VA/Military requirement
Indian Health Services
(I.H.S.) eligible
Other
31
Cut Bank
Shelby
Browning
Great Falls
44
(81.5%)
7
(77.8%)
22
(71%)
57
(82.6%)
8
(57.1%)
11
(91.7%)
44
(65.7%)
57
(85.1%)
2
(33.3%)
2
(3.7%)
6
(11.1%)
2
(22.2%)
1
(3.2%)
10
(14.5%)
4
(28.6%)
2
(3.7%)
5
(71.4%)
6
(85.7%)
1
(4.3%)
4
(44.4%)
4
(12.9%)
1
(7.1%)
9
(13.4%)
4
(6%)
1
(11.1%)
Other
Total
54
9
2
(6.5%)
1
(2.9%)
1
(7.1%)
4
(6%)
3
(4.5%)
1
(16.7%)
4
(6%)
1
(1.5%)
3
(50%)
2
(33.3%)
1
(14.3%)
4
(66.7%)
1
(14.3%)
1
(14.3%)
21
(91.3%)
1
(11.1%)
Conrad
2
(22.2%)
2
(6.5%)
31
69
14
1
(8.3%)
6
(9%)
2
(3%)
12
67
67
6
6
7
7
1
(4.3%)
1
(11.1%)
23
9
Use of Health Care Specialists during the Past Three Years (Question 20)
2013 N= 169
2009 N= 201
Seventy-five percent of the respondents (n=126) indicated they or a household member had seen a
health care specialist during the past three years. Twenty-five percent (n=43) indicated they had not
seen a specialist and eight respondents chose not to answer this question.
“Other” comments:
- Dentist/Optometrist
32
Location of Health Care Specialist (Question 21)
2013 N= 126
2009 N= 158
Of the 126 respondents who indicated they saw a health care specialist, 54.8% (n=69) saw one in
Great Falls. Cut Bank was utilized by 35.7% (n=45) of respondents for specialty care and Kalispell
was reported by 34.9% (n=44). Respondents could select more than one location; therefore
percentages do not equal 100%.
2009
Location
Great Falls
Cut Bank
Kalispell
Browning
Other
“Other” comments:
- Havre
- Shelby (5)
- Conrad
- Bozeman
- Seen by a travelling specialist (2)
- Missoula (3)
- Billings
- Texas
33
Count
Percent
85
53.8%
53
33.5%
45
28.5%
Not asked in 2009
41
25.9%
2013
Count
69
45
44
14
13
Percent
54.8%
35.7%
34.9%
11.1%
10.3%
Type of Health Care Specialist Seen (Question 22)
2013 N= 126
2009 N= 158
The respondents (n=126) saw a wide array of health care specialists. The most frequently indicated
specialist was an “Orthopedic Surgeon” at 27.8% of respondents (n=35) having utilized their
services. “Dentist” was the second most utilized specialist at 23% (n=29) and “Cardiologist” was
third at 22.2% (n=28). Respondents were asked to choose all that apply so percentages do not equal
100%.
2009
Health Care Specialist
Orthopedic Surgeon
Dentist*
Cardiologist
Chiropractor**
Optometrist***
Physical Therapist
Gastroenterologist
OB/GYN
Urologist
General Surgeon
Podiatrist
Mental Health Counselor
Dermatologist
Neurologist****
Oncologist
Ophthalmologist
Rheumatologist
ENT (ear/nose/throat)*****
Pulmonologist
Radiologist******
Endocrinologist
Allergist
Occupational Therapist
Pediatrician
Dietician
Psychiatrist (M.D.)
Psychologist
Speech Therapist
Neurosurgeon
Geriatrician
Social Worker*******
Substance Abuse Counselor
Other
34
Count
Percent
39
24.7%
90
57.0%
41
25.9%
42
26.6%
58
36.7%
30
19.0%
17
10.8%
24
15.2%
17
10.8%
28
17.7%
18
11.4%
6
3.8%
18
11.4%
26
16.5%
7
4.4%
18
11.4%
7
4.4%
18
11.4%
4
2.5%
28
17.7%
Not asked in 2009
Not asked in 2009
1
0.6%
4
2.5%
5
3.2%
5
3.2%
2
1.3%
0
0
Not asked in 2009
Not asked in 2009
5
3.2%
2
1.3%
15
9.5%
2013
Count
35
29
28
21
18
18
17
17
14
13
13
11
10
9
8
8
7
6
6
6
5
3
2
2
1
1
1
1
1
0
0
0
12
Percent
27.8%
23.0%
22.2%
16.7%
14.3%
14.3%
13.5%
13.5%
11.1%
10.3%
10.3%
8.7%
7.9%
7.1%
6.3%
6.3%
5.6%
4.8%
4.8%
4.8%
4.0%
2.4%
1.6%
1.6%
0.8%
0.8%
0.8%
0.8%
0.8%
0
0
0
9.5%
Question 22 continued…
*In 2009, significantly more respondents saw a dentist than in 2013 (2009: 57%; 2013: 23%)
**In 2009, significantly more respondents saw a chiropractor than in 2013 (2009: 26.6%; 2013: 16.7%)
***In 2009, significantly more respondents saw an optometrist than in 2013 (2009: 36.7%; 2013: 14.3%)
****In 2009, significantly more respondents were seen by a neurologist than in 2013 (2009: 16.5%; 2013: 7.1%)
*****In 2009, significantly more respondents saw an ENT (ear/nose/throat) than in 2013 (2009: 11.4%; 2013: 4.8%)
******In 2009, significantly more respondents saw a radiologist than in 2013 (2009: 17.7%; 2013: 4.8%)
*******In 2009, significantly more respondents saw a social worker than in 2013 (2009: 3.2%; 2013: 0)
“Other” comments:
- Midwife
- ER
- MRI
- Mammogram
- Knee specialist
35
Overall Quality of Care at Northern Rockies Medical Center (Question 23)
2013 N= 177
2009 N= 228
Respondents were asked to rate a variety of aspects of the overall care provided at Northern
Rockies Medical Center. Respondents were asked to rate the services using the scale of
4=Excellent, 3=Good, 2=Fair, 1=Poor and “Don’t know.” The sums of the average scores
were then calculated with “Physical therapy” receiving the top average score of 3.4 out of 4.0.
“Laboratory,” “Radiology,” and “Specialty Clinics” all received scores of 3.3 out of 4.0. The
total average score was 3.2, indicating the overall services of the hospital to be “Excellent” to
“Good.”
2013
Physical Therapy
Laboratory
Radiology
Specialty Clinics
Clinical Services
Surgical Services
Emergency Room
TOTAL
2009
Laboratory
Physical Therapy
Radiology
Emergency Room
Surgical Services
TOTAL
36
Excellent
(4)
33
57
38
26
46
17
43
260
Good
(3)
19
56
45
15
42
10
41
228
Excellent
(4)
85
39
34
53
16
227
Good
(3)
63
34
55
57
16
225
Fair
(2)
10
12
6
9
23
8
23
91
Fair
(2)
11
8
13
30
3
65
Poor
(1)
0
3
1
1
5
3
8
21
Poor
(1)
1
1
1
7
5
15
Don’t
know
101
42
76
112
47
123
54
No
Answer
14
7
11
14
14
16
8
No
Answer
68
146
125
81
188
N
228
228
228
228
228
N
177
177
177
177
177
177
177
Average
3.4
3.3
3.3
3.3
3.1
3.1
3.0
3.2
Average
3.5
3.4
3.2
3.1
3.1
3.2
Prevalence of Depression (Question 24)
2013 N= 177
Respondents were asked to indicate if there were periods of at least three consecutive months in
the past three years where they felt depressed on most days, although they may have felt okay
sometimes. Twenty-three percent of respondents (n=41) indicated they had experienced periods
of feeling depressed and 72.9% of respondents (n=129) indicated they had not. Seven respondents
(3.9%) chose not to answer this question.
37
Physical Activity (Question 25)
2013 N= 170
Respondents were asked to indicate how frequently they had physical activity for at least twenty
minutes over the past month. Thirty-five percent of respondents (n=60) indicated that they had
physical activity of at least twenty minutes “2-4 times per week” over the past month and 31.8%
(n=54) indicated they had physical activity “Daily.” Nine percent of respondents (n=15)
indicated they had “No physical activity” and seven respondents chose not to answer this
question.
38
Cost and Prescription Medications (Question 26)
2013 N= 177
Respondents were asked to indicate if, during the last year, medication costs had prohibited them
from getting a prescription or taking their medication regularly. Thirteen percent of respondents
(n=23) indicated that, in the last year, cost had prohibited them from getting a prescription or
taking their medication regularly. Seventy-three percent of respondents (n=130) indicated that
cost had not prohibited them, and four respondents (2.3%) chose not to answer this question.
39
Pharmacy Availability (Question 27)
2013 N= 177
Respondents were asked to indicate how many times, in the past year, they were unable to fill a
prescription because the pharmacy was not open or available. The majority of respondents, 88.7%
(n=157) were able to fill their prescriptions as needed. Seven percent of respondents (n=12) found
they were unable to fill needed prescriptions 1-3 times and 1.1% (n=2) found they were unable to
fill prescriptions 4-6 times in the last year. Five respondents chose not to answer this question.
40
Medical Insurance (Question 28)
2013 N= 145
2009 N= 199
Respondents were asked to indicate what type of medical insurance covers the majority of their
medical expenses. Thirty percent (n=43) indicated they have “Employer sponsored” coverage.
Twenty-one percent (n=31) indicated they have “Medicare” and “Private insurance/private plan”
was indicated by 19.3% of respondents (n=28). Thirty-two respondents chose not to answer this
question.
Insurance Type
Employer sponsored
Medicare
Private insurance/private plan*
Indian Health Services (I.H.S.)
No insurance
Medicaid
VA/Military
Health Savings Account
State/other
Agricultural Corp. Paid
Healthy MT Kids
Medicare Advantage
Medical Saving Account
Other
TOTAL
2009
Count
Percent
71
35.7%
59
29.6%
14
7.0%
14
7.0%
13
6.5%
8
4.0%
6
3.0%
0
0
0
0
0
0
1
0.5%
4
2.0%
1
0.5%
8
4.0%
199
100%
2013
Count
Percent
43
29.7%
31
21.4%
28
19.3%
17
11.7%
9
6.2%
8
5.5%
6
4.1%
1
0.7%
1
0.7%
0
0
0
0
Not asked in 2013
Not asked in 2013
1
0.7%
145
100%
*In 2009, the survey asked respondents if ‘self-paid insurance’ covered the majority of their medical expenses.
“Other” comments:
- AARP [American Association of Retired Persons]
41
Health Insurance Coverage (Question 29)
2013 N= 177
Respondents were asked to indicate which services (medical, vision, dental) their insurance
covers. Eighty percent (n= 142) indicated they had medical coverage. Thirty-seven percent
indicated they had dental coverage (n= 66) and 33.9% (n=60) had vision coverage.
Medical Insurance Type
Medical
Dental
Vision
I have no insurance
42
Count
142
66
60
31
Percent
80.2%
37.3%
33.9%
17.5%
Insurance and Health Care Costs (Question 30)
2013 N= 151
2009 N= 208
Respondents were asked to indicate how well they felt their health insurance covers their health
care costs. Forty-eight percent of respondents (n=73) indicated they felt their insurance covers a
“Good” amount of their health care costs. Twenty-five percent of respondents (n=38) indicated
they felt their insurance is “Excellent” and 19.2% of respondents (n=29) indicated they felt their
insurance was “Fair.”
43
Barriers to Having Health Insurance (Question 31)
2013 N= 9
2009 N= 13
Those respondents who indicated they did not have medical insurance were asked to indicate why
they did not. Eighty-nine percent (n=8) reported they did not have health insurance because they
could not afford to pay for it and 11.1% (n=1) indicated “Employer does not offer insurance.”
Respondents were asked to mark all answers that applied, thus the percentages do not equal
100%.
Reason
Cannot afford to pay for health insurance
Employer does not offer insurance
Choose not to have health insurance
Cannot get health insurance due to health issues
Other
2009
Count
Percent
11
84.6%
3
23.1%
2
15.4%
1
7.7%
1
7.7%
“Other” comments:
- Medicaid
- VA
- IHS eligible
- We have our own plan because of cost
- If I pay for health insurance, I cannot pay for basic needs
- Medicare supplement (2)
44
2013
Count
Percent
8
88.9%
1
11.1%
0
0
0
0
0
0
Awareness of Health Payment Programs (Question 32)
2013 N= 162
2009 N= 206
Respondents were asked to indicate their awareness of programs that help people pay for health
care bills. Forty-four percent of respondents (n=72) indicated they were aware of these types of
programs, but did not qualify to utilize them. Twenty-five percent (n=40) indicated that they were
not aware or did not know of these programs and 16% of respondents (n=26) indicated they were
aware and utilized them. Fifteen respondents chose not to answer this question.
“Other” comments:
- Sliding fee scale
45
VI. Focus Group Methodology
Two focus groups were held in Cut Bank, Montana in May 2013. Focus group participants were
identified as people living in Northern Rockies Medical Center’s service area.
Eight people participated in the two focus group interviews. The focus groups were designed to
represent various consumer groups of health care including senior citizens and local community
members. Both focus groups were held at Northern Rockies Medical Center. Each group lasted
up to 90 minutes in length and followed the same line of questioning in each session
(Appendix F). The questions and discussions at the focus groups were led by Angela Bangs with
the Montana Office of Rural Health.
Focus group notes can be found in Appendix G of this report.
46
VII. Focus Group Findings
The following themes and issues emerged from the responses participants gave to the line of
questions found in Appendix F.
Major Issues in Health Care- A variety of themes were discussed throughout the focus
group meetings. Much of the discussion was related to health education needs, home
health services, and need for obstetrical care as well as a pediatrician to enable patients to
receive all their family health care needs in one location.
Opinion of services and quality of care at Northern Rockies Medical Center:
Quality of Care- The majority of participants had favorable opinions of the quality of care
provided at Northern Rockies Medical Center. Many felt that the care is “very good.” One
participant noted that the communication between staff creates a high quality experience
for the patients, “From admission to discharge, it all has to be worked out. The work with
the doctors has been absolutely great. The patient has been placed where they need to be.
They are moved out, stabilized, or moved to a higher level of care if needed. I think the
screening, observation, and nursing staff are just wonderful. Because of the smooth
process, patients receive the level of care they need.”
Number of Services- In general, participants seemed happy with the number of services
available. Staffing availability was noted as a barrier to providing consistent services, as
many services have been provided in the past only to have turnover in staff and the
program halted. Others appreciated having traveling doctors as an option because, “It
provides access to more services.”
Hospital Staff- Participants discussed the hospital staff in terms of style of care and
competence. Hospital staff was viewed well as reflected in the remarks: “All staff seem
friendly and knowledgeable,” and “When my son was hospitalized, they took very good
care of us and were accommodating to me and my other children which I appreciated.” A
number of participants noted staff turnover has been a concern.
Hospital Board and Leadership- The Hospital Board and Leadership were spoken of very
highly. Participants praised their involvement and commitment to the facility and
community stating, “The Board is a cohesive group that works well together. They have a
general idea of the needs of the community and try to work towards improving that;” and
“The Board of Directors is very much involved in the hospital. They do everything they
can to keep the hospital going.”
Business Office- Participants had mixed opinions of the business office. Some noted, “The
staff in the business office works hard” while others expressed frustration with
communication between the hospital and insurance companies. Participants also expressed
confusion in the amount billed and which services they are paying for. One participant
noted, “Bills are not truly explained to patients why the bill is the way it is. Patients are
47
usually more satisfied once the bill is thoroughly explained to them, especially if they
receive two different bills.”
Condition of Facility and Equipment- Participants expressed appreciation for the facility’s
upgraded equipment noting, “I think we’re getting a lot of neat equipment in. The hospital
just got a new x-ray scan machine. I like that they at least get the diagnostic equipment.”
Participants also noted the facility itself is dated and would benefit from having a new
building that is “more modern and set up the way it should be.”
Financial Health of the Hospital- The financial health of the hospital was a concern for
participants. They noted that in the small community there is a low census but that other
small rural communities were faced with the same issues. Participants also expressed
appreciation for the Chief Executive Officer (CEO) stating, “She is a great CEO;” and
“The current CEO really knows what needs to be done and cares about our hospital.”
Cost- Participants felt that the cost of services was expensive, but comparable to other
places.
Office/Clinic Staff- Participants felt the clinic staff is “great” and indicated they have had
“good experiences with them.” One participant added, “I just changed all my health care
needs to Northern Rockies Medical Center’s clinic.”
Availability- Availability was viewed very differently among the focus group participants.
Some felt that availability was “pretty good” and “you can go into the clinic and if they
can’t take you right then, they’ll see you in the afternoon or the next day.” Others
indicated, “I can’t get in when I want to. The clinic is always booked;” “Whenever I call, I
can’t get in so I go to the clinic downtown;” and “The clinic downtown can usually get me
in that day or the next morning.”
Opinion of local providers- Participants indicated they use local providers as their or their
family’s personal provider because it is convenient and it is local. One participant
indicated a desire for another “OB/family doctor so I could do all my health care here.
Then I wouldn’t have to coordinate my family’s care. I like going to one doctor for my
whole family and they know you and your family’s history.”
Opinion of Local Services:
Emergency Room- Participants all noted that the ER provided good care but privacy was a
large concern stating, “The biggest problem is privacy. The ER is too small. HIPAA-wise,
you can hear everything because there are just curtains.”
Ambulance Service- Participants felt the ambulance service was “good” and “they are
great in the community and do a good job.” Another participant acknowledged the
communication between emergency responders and ER staff noting, “They [emergency
responders] let the ER staff know what they are bringing in so that the ER can prep.
EMT’s will stick around and help lift and move people around too, they’re great.”
48
Health Care Services for the Elderly- Participants had not had much experience with
senior care services or needs. Participants indicated a need for: Alzheimer’s care as well as
dental and vision services. A few participants noted the importance of discharge planning
with seniors as well as follow-up care at home to boost “continuity of care.”
Public/County Health Department- One participant spoke very highly of the public health
nurse noting, “She is great. She runs a tight ship. She’s very giving to this community;
very involved and helps anyone that walks through her door or calls her up.” Others noted
that the health department has a tight budget and works with limited hours.
Health Care Services for the Poor- Participants indicated a large need for health care for
those with low- to no-income. Participants noted staff is available to help individuals/
families enroll in cost assistance programs and/or Medicaid. Another participant noted a
new dentist accepts Medicaid and emphasized the importance of this in the community.
Nursing Home/Assisted Living Facility- Participants seemed content with the care
provided by the Nursing Home. Most had not had personal experiences but indicated they
had only heard good things about the care and services provided.
Pharmacy- Participants felt that both pharmacies available are fantastic noting, “They
always have my prescriptions filled right away. They are friendly and knowledgeable.”
What would make the community a healthier place to live- Participants indicated a desire
for additional health and wellness opportunities for youth and adults. Discussion focused
on recreational opportunities such as walking and bike trails, improving current park
spaces, and having areas that are more accessible to children year-round. Other topic areas
were related to drug use/abuse and home health services.
Why people might leave the community for health care services- Generally, participants
would leave the Cut Bank area if services weren’t offered locally, or they had a previous
experience that caused them to seek services elsewhere. Others indicated privacy concerns
as well as a need for a Saturday clinic so that patients would have another option besides
utilizing the ER.
Health Services needed in the Community- Additional services that participants felt were
needed was OB and pediatric services, senior services (hospice/home health),
opportunities for health and wellness activities, and health education specific to
sexual/reproductive health, diabetes, childhood immunizations, and parenting. In addition,
participants suggested increasing/enhancing marketing health education classes/programs
and addressing mental health needs as well as drug use/abuse.
49
VIII. Summary
One hundred seventy-seven surveys were completed in Northern Rockies Medical Center’s
service area for a 24% response rate. Of the 177 returned, 64.4% of the respondents were
females, 62.7% were 56 years of age or older, and 48.8% work full time.
Respondents rated the overall quality of care at the hospital as excellent to good, scoring 3.2 out
of 4.0 on a scale of 4.0 being excellent and 1.0 being poor.
Over half of the respondents (65.3%) feel the Cut Bank area is a “somewhat healthy” place to
live. Significantly more respondents rated the Cut Bank area as less healthy than in 2009.
Respondents indicated their top three health concerns were: alcohol abuse/substance abuse
(71.8%), cancer (48%), and overweight/obesity (34.5%). Significantly more respondents
identified overweight/obesity to be a concern than in 2009. When respondents were asked which
health related educational programs or classes they would be most interested in, the top choices
were: fitness (37.3%), health and wellness (36.2%), and weight loss (34.5%).
Overall, the respondents within Northern Rockies Medical Center’s service area are seeking
hospital care at a rate that is typically seen in rural areas. Area residents recognize the major
impact the health care sector has on the economic well-being of the area, with 73.4% of
respondents identifying local health care services as “Very important” to the economic well-being
of the area.
The majority of participants appeared to have very favorable opinions of the services with most
praising the care received. Participants were appreciative of the care available while identifying
additional services or needs.
In summary, respondents report support for local health care and many prefer to seek care locally
whenever possible for convenience and out of trust for local providers.
50
Appendix A- Steering Committee Members
Steering Committee- Name and Organization Affiliation
1. Adrianne Wood – Community Member
2. Amy Overstreet – Chamber of Commerce
3. Carol McDivitt – Glacier County Health Department
4. Cherie Taylor – CEO, Northern Rockies Medical Center
5. Chris Ouellette – CNO, Northern Rockies Medical Center
6. Dan Wood – Family Nurse Practitioner, Northern Rockies Medical Center provider
7. Dean Berkram – School Board
8. Diane Anderson – Prairie Winds Oxygen
9. Gloria Weaver – Job Services
10. Jennifer Biegler – Civic Center/Youth Programs
11. Jenny Krapf – Glacier County Health Department
12. Jessica Crane Munoz – Pastor, Lutheran Church
13. Kandie Lemieux – Human Resources, Northern Rockies Medical Center
14. Lon Peterson – Local Farmer/Northern Rockies Medical Center Board Member
15. Renee Lowery – Local Dentist/ Northern Rockies Medical Center Board Member
16. Rich Greenwald – Pastor
17. Ron Rides At The Door – Glacier County Commissioner
18. Sherina Whitford – Center for Mental Health
51
Appendix B - Public Health and Populations Consultation
Public Health and Populations Consultation Worksheet
1. Public Health
a. Name/Organization
Carol McDivitt – Glacier County Health Department
Jenny Krapf – Glacier County Health Department
b. Date of Consultation
First Steering Committee Meeting:
February 12, 2013
c. Type of Consultation (Interview, Steering Committee, Focus Group, etc.)
Steering Committee
d. Input and Recommendations from Consultation
Interested in perceptions of the community of health concerns in Glacier County
Environmental impacts on health such as water quality
High rates of tobacco use county-wide
Impressive rates of childhood immunizations in Glacier County
2. Populations Consultation (a leader or representative of populations such as medically
underserved, low income, minority and/or populations with chronic disease)
1. Population- Tribal/American Indian
a. Name/Organization
Ron Rides At The Door – Glacier County Commissioner
b. Date of Consultation
First Steering Committee Meeting:
February 19, 2013
c. Type of Consultation (Interview, Steering Committee, Focus Group, etc.)
Steering Committee
d. Input and Recommendations from Consultation
Low education level in the county
Low income level in the county
52
2. Population: Mental Health
a. Name/Organization
Sherina Whitford – Center for Mental Health
b. Date of Consultation
First Steering Committee Meeting:
February 19, 2013
c. Type of Consultation (Interview, Steering Committee, Focus Group, etc.)
Steering Committee
d. Input and Recommendations from Consultation
Suicide rate in Glacier County is double the national rate
It takes eight hours to get mental health placement for people that attempted a suicide
53
Appendix C- Survey Cover Letter
54
Appendix D- Survey Instrument
55
56
57
58
59
60
Appendix E- Responses to Other and Comments
2. In the following list, what do you think are the three most serious health concerns in our
community?
- Mental health doctors
- Smoking
- Psychologist
- Prescription drugs and suboxone
- Cancer
3. Select the three items below that you believe are most important for a healthy community:
- All of the above contribute to a healthy community
5. How do you learn about the health services available to you?
- Magazines in doctor’s office
- Walk in
- Receptionist at the clinic
- IHS
- Papers and radio
- Work place
- Looking into it for myself
- Work at hospital
6. Which community health resources, other than the hospital or clinic, have you used in the
last three years?
- Mental health doctors
- Mental health was a waste of my money. I wish I hadn’t gone.
- IHS (2)
- Eye Doctor (2)
- VA
- Chiropractor
- Hospice
7. In your opinion, what would improve our community’s access to health care?
- More options, including alternative medicine
- Mental health doctors
- Some of the ER and ambulance are extremely apathetic and judgmental
- Having doctors actually believe patients have pain. Stop suspecting everyone of being drug
seeking
- Happy with what we have
- Better billing department that won’t double your bills
8. Which education classes/programs would you be most interested in taking?
- Childbirth
- Too old
- Stress reduction
61
10. In the past three years, was there a time when you or a member of your household thought
you needed health care services but did NOT get or delayed getting medical services?
- Wanted another option besides prescription drugs
11. If yes, what were the three most important reasons why you did not receive health care
services?
- Sickness from other people while you’re waiting to be seen for your services
- Emergency room service was very poor
- Waiting in the ER
- Why should anyone pay the going rate for a PA with half the education? Even the expertise of
current MDs leaves a lot to be desired
- Improper scheduling
- I went all the way to a specialist to find out the referral for my MRI was not sent
- IHS
- Afraid of being accused of being a drug seeker
12. Which of the following preventative services have you used in the past year?
- I have to go out of town for my mental health doctor
- Blood draw
- Birthday blood test
- Surgery, rectal removal
- Shingles shot
13. What additional health care services would you use if available locally?
- Naturopath (2)
- Chiropractor (2)
- Hospice (2)
- Herbalist
- More doctors, especially mental health
- Midwifery
- Orthopedics
- Substance abuse
- Good providers
15. If yes, which hospital does your household use the MOST for hospital care?
- Whitefish
- Kalispell
- Glacier Medical Center (2)
- Great Falls
16. Thinking about the hospital you were at most frequently, what were the three most
important reasons for selecting that hospital?
- Patient’s desires respected (liberty)
- Weather
- Family lives there
62
Comments #16 continued…
- Cultural sensitivity
- More helpful and friendly
- Caring staff
- Providers
18. Where was that primary health care provider located?
- Columbia Falls
- VA
- Polson
- Lewiston
- Red Deer, Alberta
- Big Fork
- Glacial Community Health Center in Cut Bank
- Bozeman
- Kalispell (2)
19. Why did you select the primary care provider you are currently seeing?
- Shelby
- Benefis Services in Great Falls
- Only one available
- Reputation for staying in the same place and not hopping from place to place
- OB/GYN
- One of the few primary care providers left here
- Kind and caring
- Recommended by a friend
- Was available in the clinic
20. In the past three years, have you or a household member seen a health care specialist (other
than your primary care provider/family doctor) for health care services?
- Dentist/Optometrist
21. Where was the health care specialist seen?
- Havre
- Shelby (5)
- Conrad
- Bozeman
- Seen by a travelling specialist (2)
- Missoula (3)
- Billings
- Texas
22. What type of health care specialist was seen?
- Midwife
- ER
- MRI
63
Comments #22 continued…
- Mammogram
- Knee specialist
28. What type of medical insurance covers the majority of your household’s medical expenses?
- AARP [American Association of Retired Persons]
31. If you do NOT have health insurance, why?
- Medicaid
- VA
- IHS eligible
- We have our own plan because of cost
- If I pay for health insurance, I cannot pay for basic needs
- Medicare supplement (2)
32. Are you aware of programs that help people pay for health care expenses (i.e. services for
free or at a reduced fee)?
- Sliding fee scale
33. Where do you currently live, by zip code?
- Heart Butte 59448
- 59424
- Alberta
36. What is your employment status?
- In the process of applying for Social Security disability
- Farmer and ranch
- Ranching cows and calves
Additional Comments:
- Household has two different expenses. I am able to get IHS but my wife can’t go to IHS so
she goes to Glacial Community Health because of the sliding fee scale.
64
Appendix F- Focus Group Questions
Purpose: The purpose of the focus groups was to identify motives of local residents when selecting
health care providers and why people may leave the community to seek health services. This market
research will help determine the awareness of local programs and services, as well as satisfaction or
dissatisfaction with local services, providers, and facilities.
1. What would make this community a healthier place to live?
2. What do you think are the most important local health care issues? (Probe question: What do
you think are the biggest issues facing local health care services?)
3. We are now going to ask you for your views about the hospital. What do you think of the hospital
in terms of:
Quality of care
Number of services
Hospital staff (style of care, competence)
Hospital board and leadership (good leaders, trustworthy)
Business office
Condition of facility and equipment
Financial health of the hospital
Cost
Office/clinic staff
Availability
4. Are any of the local providers your personal provider or personal provider to your family
members? Why?
5. What do you think about these local services:
Emergency Room
Ambulance service
Health care services for Senior Citizens
Public/County Health Department
Health care services for low-income individuals
Nursing Home/Assisted Living Facility
Pharmacy
6. Why might people leave the community for health care?
7. What other health care services are needed in the community?
65
Appendix G- Focus Group Notes
Focus Group #1
Friday, May 17, 2013; 9am-10am – Northern Rockies Medical Center
6 attendees (0 male, 6 females)
1. What would make this community a healthier place to live?
- One thing is we don’t have community health nursing in this area. Hospital staff can’t
refer dressing changes to get patients back into their homes right away. Continuity of
care seems to break right when the patient leaves the hospital. Unless the patient
comes in for follow-up care or an appointment, there is no continuity of care once they
are discharged.
- We are so remote in this area. The closest home service I would know is Indian
Health Services (IHS) but they don’t come into this area.
- Medicaid does come into this area and provides in-home follow-up on people
that are disabled in some way who may have appointments somewhere and
can’t get to their appointments. Medicaid works with their family to get them
to their appointments and makes sure their medications are refilled.
- Cut Bank does have one public health nurse but I don’t think she goes out into the
community.
- Planned Parenthood would be very good for this community. There is nothing for
young ladies and gentlemen. Maybe that would prevent some of the teen pregnancy
because it is common in Glacier County.
- I don’t know that they have a system in place to address the drug and meth abuse in
Glacier County. There needs to be some kind of education to show how horrible it is
and the awful things that it is made of. Meth gets people real high and it’s cheap so
kids can get it real easily.
- Prescription drug abuse is a big problem. Recently this person, who is eighty-five
years old, got beat up by a young woman. He got beat up pretty badly. I know it was
related to drugs. Family members abuse the elders for money and they use everybody
and abuse the system. They need some sort of education and awareness in the area.
2. What do you think are the most important local health care issues?
- There is a lack of education for younger people in regards to sexual health and drug
abuse.
- We have a lot of kids that have been born to parents that used drugs during their
pregnancy. These children may have behavioral issues in the future.
- There is a lot of cancer in this area.
- We really need a hospice.
- Home Health aides would be helpful to simply help recently discharged patients for 23 hours a day.
- Ongoing Home IV’s could be performed by community health nurses rather than
having patients come back into the hospital for IV therapy.
66
-
-
The recent Pertussis outbreaks. Follow-up on immunizations are important. Young
mothers aren’t keeping up on their children’s immunizations. There has been more
Pertussis in this past year that we are seeing but that’s not just Glacier County, it’s
happening everywhere.
Education for young mothers. If your kid has a fever, give them something to reduce
their fever; don’t just bring them straight to the ER.
- Parenting classes would be helpful.
- A majority of ER use is not emergent.
- A lot of ER utilization is well-child.
- Using the ER is a convenience factor because the mom works all day
and has to take the kids in after 5pm. ER use is really overwhelming in
Browning. Parents are using the ER as a clinic over there.
3. What do you think of the hospital in terms of:
Quality of Care
- I feel like there’s very good communication between departments especially with past
patient history.
- I agree.
- From admission to discharge, all of that has to be worked out with the doctors. The
work with the doctors has been absolutely great. The patient has been placed where
they need to be. They are moved out, stabilized, or moved to a higher level of care if
needed. I think the screening, observation, and nursing staff are just wonderful.
Because of the smooth processes, patients receive the level of care they need.
- When you go out into our community, it is fifty-fifty on how people feel they are
being cared for. They either like the hospital or don’t like the hospital. Often, we hear
they don’t think that hospital staff cares for them. The hospital needs better customer
service. You often hear people say, “staff acts like they’re too busy for us and act like
we’re bothering them.”
- I think the care here is very good.
Number of Services
- The hospital is going in to OBGYN pretty soon.
- I think the number of services is good. If you come in as a walk-in, you can always be
seen. You’re never turned away up there.
- If I was to go to Browning, I’d wait a month then I’d have to use their ER
again.
- I work here and have also been a patient here many times and always thought the care
was good.
Hospital Staff
- It’d be nice to get more General Practitioners, family medicine. One of the things you
hear from older people is they want to see a real doctor, not an FNP [Family Nurse
Practitioner].
- There are complaints about attitude. It depends on if there is an emergency and then
the waiting times are longer.
67
-
The hospital is in the process of getting electronic medical records. The staff is
learning the new system so that may explain why people have the perception
that hospital staff doesn’t have time for them.
Hospital Board and Leadership
- I think the leadership is very educated in what they’re doing. The CEO [Chief
Executive Officer], the CFO [Chief Financial Officer], the DON [Director of Nursing],
and head of CPSI [Computer Programs and Systems, Inc.] are well-versed in
everything that goes on. If it weren’t for the leadership, I wouldn’t learn as much.
- The board of directors is very much involved in the hospital. They do everything they
can to keep the hospital going.
Business Office
- Staff in the business office works hard.
- I wouldn’t want to be them.
Condition of Facility and Equipment
- It would be so nice to have a new building. One that is more modern and set-up the
way it should be.
- When they built the building, one side was the hospital. They didn’t foresee the future
very much. They didn’t plan for expanding. The restructuring is major because of
building materials and space.
- There is one piece of equipment in the lab that is huge and it takes up the entire lab
space. Equipment is larger than it used to be and the space doesn’t accommodate that.
Our x-ray machine is becoming obsolete and they’re very expensive but to stay
competitive in our area we still need that level of equipment.
- To go from the clinic to downstairs, there is no elevator so patients have to go out to
their car and drive around and go in the other doors.
Financial Health of the Hospital
- Low census.
- Everybody’s hours got cut.
- As the CFO puts it, we need “people in the beds” for revenue.
- Our hospital isn’t the only one to go through low census, Havre has gone through it.
Cost
-
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Mammograms are more expensive than other areas. I don’t know if that plays into
people going somewhere else for their mammogram.
There have been fewer mammograms done lately.
Some complaints we receive regarding cost are about billing. The rates for CT scans
are confusing to patients and they don’t realize the extent of the scan. Bills are not
truly explained to patients why the bill is the way it is. Patients are usually more
satisfied once the bill is thoroughly explained to them, especially if they receive two
different bills. As long as you explain it to them they seem to be okay with the cost.
Office/Clinic Staff
- We’ve also had a very large turnover with business office employees. We have
basically all new people working right now. New people plus a new system… yikes.
- I think the clinic staff is great.
- I’ve had good experiences with them.
- In fact, I just changed all my health care needs to Northern Rockies Medical Center’s
clinic.
- They are very good at getting patient orders. There is hardly any wait for the patient.
Availability
- It is not difficult to get an appointment but if the family is on Medicaid, they have to
make a copay and if it’s an ER visit, they don’t have that copay. Then that amount just
goes to bad debt.
- We have been hit with the new system for electronic medical records and everyone is
trying to learn how to use it so the process takes a little longer. Staff has been
receiving a lot of negative remarks about time-consuming sign-ins for patients. We are
trying to sign people in quickly. Staff finds something wrong with this system every
day. It’s so new that it’s frustrating. Until everyone knows how to use it, it won’t be
smooth going.
- Doctors need to complete all the records so the business office can complete all the
charges. The doctors are very busy.
- Availability is pretty good.
- You can go into the clinic and if they can’t take you right then, they’ll see you in the
afternoon or the next day. It’s very quick.
4. Are any of the local providers your personal provider or personal provider to your family
members? Why?
- Yes, because they’re from Cut Bank. Location is important.
- Convenience.
- People’s providers are here.
5. What do you think about these local services:
Emergency Room
- The ER has done very well every time I’ve been in there.
- From the family perspective, I thought the ER was very good. The provider was
excellent. The provider was very helpful and helped to calm my mom down, they were
very caring. Then, the process of getting her into Great Falls was smooth.
- The biggest problem is privacy. The ER is too small. HIPAA-wise you can hear
everything because there are just curtains.
Ambulance Service
- I think we have a good ambulance service here.
- Emergency responders are good about letting the ER staff know what they are
bringing in so the ER can prep. EMT’s will stick around and help lift and move people
around too, they’re great.
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Health Care Services for Senior Citizens
- Discharge planning is important. When they are getting into their daily care, their
doctor will start looking at whether they can function in their own home or else they
can be placed in a Nursing Home in Cut Bank or surrounding communities like
Conrad, Shelby, etc.
- Elderly care always seems to have issues for dental and vision. Medicare doesn’t pay
for any of that.
- Follow-up at home is difficult. There is a lack of continuity of care.
Public/County Health Department
- It is difficult to reach anyone by phone.
- The health department has a very low budget. They have very limited hours.
- I’m not sure what the health department actually provides for the community.
- The only thing I know is they offer flu shots.
Health Care Services for Low-Income Individuals/Families
- Health care for low-income is a big issue. If patients come in with low income or no
income we have to try to assess what their needs are. We usually have to work through
family members and try to help them enroll in Medicaid. We have paperwork to do for
charity care. A couple people in our office usually help them with applications.
- We see a lot of care for low-income now because of drug issues and grandparents
raising grandchildren.
Nursing Home/Assisted Living Facility
- I’ve been hearing a lot of negative comments lately about patients not getting in the
Nursing Home if they have no way of paying for their care.
- It gets right down to money.
- Some Nursing Homes take “Medicaid pending.” That’s why patients are often placed
all the way down in Helena.
- Have to get letters of justification from nursing homes for not accepting a patient.
Shelby’s Nursing Home is good about providing letters of denial.
- We can keep them on charity care while Medicaid is pending.
- I finally helped get a patient into the Nursing Home after months of waiting on
Medicaid to come through and then he passed away that first week of being in the
Nursing Home.
Pharmacy
- I don’t use the pharmacy that much.
- I use the locally-owned pharmacy and they’re fantastic. They always have my
prescriptions filled right away. They’re friendly and knowledgeable.
6. Why might people leave the community for health care?
- If they had a bad experience. I quit going here because I had been making payments on
my bill every paycheck but I still had charges that were twelve months old so they sent
me to collections. Even though I was paying regularly, I was still sent to collections.
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-
-
I had a friend who recently had a heart attack. He felt he was treated badly by the ER
nurses so he won’t come back again.
One bad experience is all it takes. You have to treat the customer right.
It doesn’t even need to be your own bad experience. Word of mouth is huge.
Privacy is a big issue here.
- I would say patients go to Kalispell or Great Falls because they are unknown
there.
Once a doctor here stops prescribing to a drug seeker, they go somewhere else.
- Then the drug seeker find out that hospitals are on the same system. They
figure out where they can go to get the services they are seeking.
7. What other health care services are needed in the community?
- Hospice
- More General Practitioners
- Home Health
- Health education
- Parenting classes
- I think more dental care is needed. If you get an appointment, you better keep it
because cleaning is booked for six months.
- It would be great to have a walking path.
- One that is secure, safe, and well-lit.
- An indoor pool would be beneficial. A lot of people don’t have money to go to the
Civic Center.
- If the Civic Center was less expensive it would be better.
- Make the Civic Center like a YMCA where they reduce fees for people.
- The Civic Center is only open at 7am. Many people would like to work out
before going to work.
- There needs to be more opportunities for health and wellness.
- There are only three parks here. Kids don’t use them very often. Parents are so worried
about safety. It’s not necessarily an issue in this community but you just hear so many
stories and there are so many “weirdo’s” out there.
- In this area we had workers for the windmills come in and they were complete
strangers. And now we’re getting a new plant in the community, that’ll bring income
into the hospital but will bring more strangers again.
- The windmill people were good people though.
- It would be good to have nutritional classes. We had weightwatchers in the past but
they won’t come back.
- There are no outside activities for adults. Other communities have softball. In
Missoula, there were sports teams for adults every night of the week.
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Focus Group #2
Friday, May 17, 2013, 10am-11am – Northern Rockies Medical Center
2 attendees (0 male, 2 female)
1. What would make this community a healthier place to live?
- More physical activity arenas for youth. Areas that are more accessible to children
year-round. We do have the Civic Center but it would be nice if we had more parks or
better parks with play equipment.
- Right now we are in baseball season. The only place to play baseball is at the sports
complex which is closed.
- It’d be nice to have a walking trail that we can go on walks and bike rides with kids.
- Where we live, we are not close to a park. I have to drive them there.
- In comparison, Conrad has awesome parks. They are nice and well-kept where you
feel like you could enjoy that outside time with your family.
- I like the Civic Center but you have to pay.
2. What do you think are the most important local health care issues?
- We are missing OB ability here.
- That is the biggest issue.
- We don’t have a pediatrician here.
- For both OB and Pediatrics we go out of town so that draws away a specific
population that eventually may stay away for all their care.
- It is difficult to find providers for your kids.
- Retaining providers is difficult. We get a lot of doctors for the write-off for
their schooling. Once that is met, they are gone.
- We have a significant older generation.
- The new Nursing Home has been a definite asset to the community.
- The VA clinic helps a lot.
3. What do you think of the hospital in terms of:
Quality of Care
- I haven’t been to the hospital in Cut Bank for a long time. All of my kids get their care
out of town. We’ve used the ER a couple times and it was pretty good. When I
delivered one of my children at Northern Rockies Medical Center nine years ago, I
didn’t like the setup. More privacy would be great. The setup is not very good
compared to Conrad or Great Falls. In Conrad, you labor and deliver in one room.
- As far as quality of care, most recently it has been good. I feel like we have good staff.
Nurses take good care of patients.
- I had a bad incident five years ago and that person no longer works here but that
experience sticks with me.
- I haven’t heard of too many people who have had bad experiences.
Number of Services
- I think they try to offer a lot of services but retention is difficult.
- We have had a dietician off and on because they leave.
- I like having the travelling doctors. It provides access to more services.
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-
It would’ve been nice to have a lactation consultant when I had my last child. They
have one on staff now. It was difficult to have to contact Great Falls when I wanted
information.
Hospital Staff
- I have not had any issues with staff.
- High turnover of staff.
- All staff seem friendly and knowledgeable.
- I love Martha who comes down from Great Falls.
- My bad experience in the ER turned me off to the hospital. We won’t be back unless
it’s life or death. Since then, we have used the ER a handful of times and it has been
fine.
- When my son was hospitalized, they took very good care of us and were
accommodating to me and my other children which I appreciated.
- I like that the staff knows you. They live in this community and take good care of you.
Hospital Board and Leadership
- They are trying very hard to improve the hospital and keep it thriving.
- The Board is a cohesive group that works well together. They have a general idea of
the needs of the community and try to work towards improving that.
- It’s a tough financial time to bring on any extra services or staff.
Business Office
- I haven’t had much to do with the business office for a long time. In the past, I had
problems with my insurance. It took a year and a half to pay for my epidural. Since
then, I’ve just had ER visits.
- Staff are the only ones who know why things are billed the way they are. It is very
frustrating not knowing why you pay what you pay.
- There is a lack of communication in the business office. I thought the hospital
would’ve notified my insurance that my son was being admitted but they didn’t, so I
got dinged. Communication between the hospital and insurance seems to be going a
lot better now.
Condition of Facility and Equipment
- The facility is dated.
- It’s difficult to say when you compare it to the hospital in Great Falls.
- I think we’re getting a lot of neat equipment in. The hospital just got a new x-ray scan
machine. I like that they at least get the diagnostic equipment.
Financial Health of the Hospital
- The past CEO ran down the hospital but the current CEO really knows what needs to
be done and cares about our hospital.
- She is a great CEO.
- I know that with the new electronic medical records there is a lot of concern for our
hospital to fund the system.
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-
Cost
-
-
It cost a lot to implement the system for electronic medical records. There is a
concern whether the hospital will be able to sustain that financial burden and
cost of the records.
Health care is expensive.
Cost is high. Even with a good deductible, I just paid $600 for ER services. That’s
hard. I understand the situation. People will say that when they are billed they
comment on the high expense.
Costs at Northern Rockies Medical Center seem comparable to other places.
Availability
- My only complaint with the clinic is that I can’t get in when I want to. The clinic is
always booked. Whenever I call, I can’t get in so I go to the clinic downtown. The
clinic in the hospital has lost our business a lot for not getting us in to an appointment.
- The clinic downtown can usually get me in that day or the next morning.
- I don’t want to drive to Great Falls. I like to stay in Cut Bank for the clinic.
- I like the clinic in the hospital, not the other one in town.
4. Are any of the local providers your personal provider or personal provider to your family
members? Why?
- Because it is here. Convenience more than anything else.
- I agree. It will be nice to have another OB/family doctor to do all of our health
care here. Then I won’t have to coordinate my family’s care. I like going to one
doctor for my whole family and they know you and your family’s history.
5. What do you think about these local services:
Emergency Room
- Privacy concerns.
- The layout of the ER could improve.
- The waits are long but I understand why.
- It’s difficult to have adults and kids in the same waiting room.
Ambulance Service
- The ambulance service is good.
- They are great in the community and do a good job.
Health Care Services for Senior Citizens
- The VA [Veteran’s Affairs] is great.
- I’m not sure. My parents live in Conrad.
- I heard from someone that they don’t treat Alzheimer’s here. It would be great if they
treated that here, otherwise we’ll have to look into going to Shelby. I’d have to look
into it more to see if they treat Alzheimer’s at the Nursing Home in Cut Bank though.
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Public/County Health Department
- The public health nurse is great. She runs a tight ship. She’s very giving to this
community; very involved and helps anyone that walks through her door or calls her
up.
Health Care Services for Low-Income Individuals/Families
- We have a dentist now that accepts Medicaid at the Glacier Care Dentist. It helps
when providers can accept Medicaid.
- A lot of our community utilizes IHS [Indian Health Services] if they qualify.
- This hospital, I don’t know if they still do, has grants or scholarships you can apply for
if you have financial hardship. I know Shelby does, I think Cut Bank has some sort of
program. If they don’t, that’s really something that helps a lot.
Nursing Home/Assisted Living Facility
- I would like to know if they treat Alzheimer’s at the Nursing Home.
- I’ve only heard one negative thing.
- Everything I’ve heard has been positive.
Pharmacy
- Both pharmacies do a good job.
- I go to the Osco pharmacy in Albertson’s. Everyone is fantastic and friendly. I don’t
use DrugMart but have heard they are great too.
- We use both pharmacies. They have it setup where you can email the pharmacy for
questions.
6. Why might people leave the community for health care?
- For other services that are not offered and better qualifications. I know other moms
who would rather go to an actual pediatrician. That is a big thing when they are
looking for care for their family.
- If people have had a misdiagnosis. I know someone who went to the clinic several
times and missed the diagnosis. Then, she went to another facility and was finally
diagnosed correctly.
- We go to a pediatrician in Great Falls. They even give you their cell phone number. I
can call and ask questions and not go all the way there to be seen. They also have late
hours so I don’t have to pull my kids out of school for appointments.
- There is always an hour and a half wait with Dr. Barran in Conrad.
- My pediatrician coordinates time to be with you.
- I want the hospital to take the time and work with people’s work schedules. Either to
be open late or even be open on Saturdays. There is no Saturday clinic. Then you end
up going to the ER. I don’t want to have to use the ER if it is not an emergency. It’s
too expensive and takes time.
- As far as misdiagnosis, the clinic told me I needed to get my kid to the hospital right
away because she didn’t know why certain numbers were high. I rushed him to Conrad
and he had pneumonia. That was a total overreaction, and scared me to death for no
reason.
- Those negative experiences stay with you.
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7. What other health care services are needed in the community?
- A pediatrician or even just a family doctor. That would be best for my family in order
to treat everybody.
- Longer hours and being open on Saturdays.
- Get a pediatrician to cycle on the travelling specialist schedule so we don’t have to
drive out of town.
- Continue services like lactation education to be available. Retention.
- Improve awareness of the services we do have here. I know they put it in the paper but
that doesn’t reach everybody.
- The hospital doesn’t have a doctor for diabetes. My mom goes all the way to Kalispell.
Instead of just cycling surgeons, add specialists to the cycle.
- Diabetes rates are very high especially because of our location near the reservation. I
don’t know if IHS has diabetes specialists or education.
- For a while the hospital was offering diabetes education but it’s not consistent and we
don’t know when it is offered or even if it still is offered. The hospital needs to
increase awareness of those services.
Additional Comments:
- I hope our hospital stays in the community and gets utilized in the way it is intended. I
would be heartbroken if we lost the hospital. Our community would suffer if it was not
in our town
- I’m excited to have the OB back. I hope they stick around. Now that Conrad lost their
OB, and Shelby may be losing theirs, perhaps Cut Bank could grab some of those
patients instead of losing them all to Great Falls.
- If the hospital picks up OB, they will need to change the setup because moms don’t
like that. They like the privacy.
- The hospital has improved immensely in the past five years.
- When they didn’t have OB, if you were sick and pregnant you couldn’t be seen at the
hospital here in Cut Bank.
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Appendix H – Secondary Data
County Profile
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Economic Impact Assessment
Demographic Trends and Economic Impacts:
A Report for Northern Rockies Medical Center
William Connell
Brad Eldredge Ph.D.
Economist Research and Analysis Bureau
Montana Department of Labor and Industry
Introduction
This report responds to requests by MHA for the location quotient of the hospital sector in
Glacier County and for information on the county’s demographics. In addition, the report includes
analysis of the economic impact of the hospital sector on Glacier County’s economy. Section I gives
location quotients for the hospital sector in Glacier County using both state and national employment
as the basis of comparison. Section II looks at the demographic profile of Glacier County. Section III
presents the results of an input-output analysis of the impact of Northern Rockies Medical Center on
the county’s economy.
Section I Location Quotients
A location quotient measures how the level of employment concentration in a geographic area
compares with that of another geographic area. For example, if 20 percent of workers in county A
worked in manufacturing and 10 percent of the workers in that county’s state worked in
manufacturing, then the location quotient for county A would be:
County A Percent employed in manufacturing = 20% = 2.
State Percent employed in manufacturing
10%
Intuitively, county A’s location quotient of 2 indicates that its employment in manufacturing is about
double what one would expect given the size of manufacturing employment in the state.
Two location quotients for hospital employment in Glacier County were calculated. The first
compares Glacier County’s hospital employment concentration to that of the State of Montana, and
the second compares it to hospital employment in the United States. The calculations use 2010 annual
averages.
Hospitals Location Quotient (compared to State of MT) = .35
Hospitals Location Quotient (compared to U.S.) = .40
A location quotient near 1 indicates that the employment concentration in the county mirrors
that of the larger geographic region. In the case of Glacier County, the location quotient of 0.35
indicates that employment in the county is less than half as concentrated in hospitals as it is in
Montana as a whole. When compared to the nation, the location quotient of 0.40 reveals that the
percentage of total county employment accounted for by the hospital is only about half as
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concentrated as we would expect given U.S. employment patterns. Glacier County appears to serve
more people per employee than most hospitals in the state and nation.
Another way to look at the location quotient is to ask how many employees would be employed in the
hospital sector if Glacier County’s employment patterns mirrored the state or the nation. Northern
Rockies Medical Center averaged 83 employees in 2010. This is 155 less than expected given the
state’s employment pattern and 124 less than expected given the national employment pattern. The
presence of Indian Health Services in Browning may contribute to the lower than expected
employment in Northern Rockies Medical Center. In addition, in 2010 Northern Rockies Medical
Center accounted for 1.9% of county nonfarm employment and 2.6% of the county’s total wages.
(Source of Employment Data: Quarterly Census of Employment and Wages, Research and Analysis Bureau,
Montana Department of Labor and Industry)
Section II Age Demographics
The 2010 Census reported that there were 13,399 residents of Glacier County. The breakdown
of these residents by age is presented in Figure 1. Glacier County’s age profile is different from most
rural counties in Montana. Young people make up the largest proportion of the population in Glacier
County. There is a relative lack of 30 to 44 year olds in the county, perhaps because young people are
leaving for more populated areas. Glacier County’s unique population profile results from the fact
that, like most reservation counties, it has a higher birth rate than most Montana counties.
Figure 1: Age Distribution of Glacier County Residents
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Figure 2: Percent of the population by age groups, Glacier County vs. Montana
Figure 2 shows how Glacier County’s population distribution compares to Montana’s. A careful
examination of Figure 2 and the underlying data reveals that, compared with the State as a whole,
Glacier County has a higher proportion of people 0 to 19 years old (34.8 percent vs. 25.3 percent)
and a lower percentage of 50 and older (28.4 percent vs. 37.0 percent). According to the 2010
Census, Glacier County had a median age of 31.7, making it the third youngest county in the state.
These demographic statistics are important when planning for health care provision both now, and in
the future.
Section III Economic Impacts
Businesses have an economic impact on their local communities that exceeds the direct
amount of people they employ or wages they pay. For example, individuals employed at Northern
Rockies Medical Center spend a portion of their salary on goods and services produced in Glacier
County, thus supporting jobs and income in those local businesses. Likewise, the hospital itself may
purchase goods and services from local suppliers. These businesses and employees then spend a
portion of their income on local goods and services which, in turn, supports other local jobs and
companies. Thus, the effect of one dollar of wages is multiplied as it circulates through the
community.
The amount of jobs and income in a local community attributable to a particular industry
sector can be determined by calculating its employment and income multipliers. Industries with the
highest multipliers generally are those who buy supplies, services, and labor from the local
community, sell products and services outside the local community, and pay a high income to their
employees. Although hospitals in rural areas do not usually sell their services to non-residents, they
can still generate significant multiplier effects for their communities given that much of their funding
comes from outside the region in the form of public and private insurance reimbursements. The
relatively high wages earned by hospital employees also tend to boost hospitals’ multipliers.
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Multipliers are calculated using a methodology called input-output modeling. The Research
and Analysis Bureau uses IMPLAN software to do regional input-output modeling. The R&A staff is
able to correct the underlying IMPLAN data with confidential employment and earnings data from
the unemployment insurance system, which allows us to produce more accurate multipliers than
would otherwise be possible.
According to the input-output analysis, the hospital industry sector in Glacier County has the
following multipliers:
Hospital Employment Multiplier = 1.26
Hospital Employee Compensation Multiplier = 1.16
Hospital Outputs Multiplier = 1.29
What do these numbers mean? The employment multiplier of 1.26 can be interpreted to mean that for
every job at Northern Rockies Medical Center, another .26 jobs are supported in Glacier County.
Another way to look at this is that if Northern Rockies Medical Center suddenly went away, about 22
additional non-hospital jobs would also be lost in the county (based on 2010 hospital employment of
83). The employee compensation multiplier of 1.16 simply states that for every dollar in wages and
benefits paid to the hospital’s employees, another 16 cents of wages and benefits are created in other
local jobs in Glacier County. Put another way, if Northern Rockies Medical Center suddenly went
away, about $611,168 in additional annual wages would be lost from other jobs in the county.
Finally, the output multiplier indicates that for every dollar of goods and services produced by
Northern Rockies Medical Center, output in the county increases by another 29 cents.
There are other potential economic impacts of hospitals beyond those identified by the inputoutput analysis. Novak (2003)1 observes that “…a good health care system is an important indication
of an area’s quality of life. Health care, like education, is important to people and businesses when
deciding where to locate” (pg. 1). Thus, all other things being equal, the presence of a quality health
care system gives communities an advantage when competing for new businesses. An effective health
care system can also attract retirees to the community. Finally, health care may provide an
opportunity for young people to stay in the communities where they were raised and still earn a high
wage. In areas of the state where economic opportunities are scarce, many hospitals are experiencing
shortages of qualified workers. In this situation, “growing your own” workforce may be a viable
option.
This study has sought to outline the economic importance of Northern Rockies Medical
Center to the county’s economy. Tangible economic impacts have been presented, and intangible
economic development impacts have also been discussed. Any questions regarding the data or
methodology can be addressed to the author.
1
Novak, Nancy L. (2003) “Bridging the Gap in Rural Healthcare” The Main Street Economist: Commentary on the Rural
Economy, Center for the Study of Rural America: Federal Reserve Bank of Kansas City. September 2003
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