A Conversation With UP Rural Health Leader Dennis Smith

In this episode of the Rural Insights Podcast, David Haynes sits down for a conversation with Dennis Smith. Dennis is the President of Dennis H. Smith Consulting, a firm working in the Rural Healthcare space focusing on Policy, Strategic Planning and Advocacy. He’s also the former President and CEO of Upper Peninsula Health Plan and its related companies.

Transcript

David Haynes:

Good afternoon and welcome to our latest edition of Podcasts of Rural Insights. And today we're really pleased to have a good friend of ours, Dennis Smith, who you've seen before on this show and heard before. For those of you that just do it audio, Dennis is the former is the former c e o at up health plans, and he is I gotta say on more boards than I know of anyone else. He's so active in community and downstate. So welcome Dennis. Glad you're with us.

Dennis Smith:

Well, thanks. Thanks for having me, David.

David Haynes:

So, I, you know, I was telling Dennis, I, we wanna just focus on, as I look at trying to get my notes up here, that just what's going on and there's so much stuff going on with healthcare in the up and rural areas. We, the national, those are region, regionally, and Yep. Peninsula you know, there's a new cancer center going up in Iron Mountain with Marshfield and also they're in talks with essential health, a Duluth based system to build a a four state system. The U of M and Sparrow Downstate did an agreement that continue and, and balances up growth and also with our friends at LifePoint and Marquette and around the peninsula. What's happening, what does this all mean, all this turmoil and change? Or maybe if not that much change, I don't know, but it sounds like a lot of activity. And of course we hear a lot back from, from our readers and listeners about availability of healthcare and specialists, et cetera. More and more of them talk about they're willing to drive to get healthcare. So I'm gonna stop and let you just talk about what does this mean.

Dennis Smith:

I think for the up, I think it's kind of a positive

Activity on several fronts. I think number one, you know, you had a comment there about specialists, and I think the more multi-systems that come through, the residents of the UP will have more access to various specialties. I think one of the things that's very, been very, very hard in the up since, I won't get corny into the beginning of time, but for the last 30, 40, 50 years, has been recruiting physicians. And it really doesn't matter who's in charge or who's, whether it's Marquette general or LifePoint or, or Spyrus or whatever. I mean, it's really, when you come to the up to practice medicine, it's not just that you want to practice medicine, but it's a whole different lifestyle. You know, you can be in Grand Rapids and practice medicine all day, go home in a few minutes, have dinner, and then if you wanna go to the symphony or you wanna go this or that or whatever, you can do that.

You know, here, when you come out and you do have the symphonys, you've got the, the, you know, the, the universities and things like that that you can do some things, but it's really much more of an outdoor environment. And so you're really kind of focusing on, you know, hiking or, or maybe snowshoeing or biking or outdoor activities, cross-country skiing, things like that. And I think historically that's always been a big deal. And that's what's made recruiting physicians, no matter what, they are very hard for the up. And I don't care if it's Colton, Marquette, Sain Marie, or whatever, then you have these things. And, and so when you get into the smaller hospitals, it really kind of, even, it, it magnifies it. And so the cost historically has always been, maybe it's changed now. But when it, before all the big systems came in, the cost of recruiting a physician to come to the up to practice was almost double what it was anywhere else.

And maybe before you were attaching them, you were kind of contacting maybe their first year residency program, and then you maybe you got, you went back to the internships and now people are reaching out to medical schools, kind of, you know, laying those carrots out there of things to do and this, that, or whatever. And, you know, in the federal government for years was trying to do a good job by having these loan things if you went there. But, you know, getting a, a highly skilled orthopedic surgeon or trauma surgeon or surgeon or endocrinologists and things that are very high specialties, they're very difficult I think, for the rural communities. And so I think having some of these larger systems, we'll have more access, whether it's on a consistent basis, they're gonna live there, or whether they'll come once a month and have a clinic for endocrinology and take care of all the diabetics and things like.

So I think those, the pool gets bigger for some of the resources and it's just a matter of us now kind of adjusting to that and, and getting that going as opposed to, you know, when I got to the up in 2000, you know, if somebody had something, if you were over 55 and you had something complex, you went to Mayo's or you went way down Saint, you never thought about doing anything local because it was local. And I think Marsh Fields's Cancer Center, I think will be a huge game changer, I think for the up. Cancer is one of the number one out migration programs in the up, when you look at the data from Blue Cross or c m s or whatever, it just goes, whether it's Cancer Center of America, just that, whatever. And some of it's really marketing, but actually a lot of it will be skills.

And I think when when Iron Mountain got its new radiation therapy machine, last year, it was the cutting edge, the highest, the, the best machine in the Midwest. And it was just because their turn in the system when they ordered it, all these bells and whistles came on. But it also enhanced a lot of the services they could do, where before the old radiation therapy machine that they might have had or some of the other ones had, you know, did a good job, but you couldn't do a lot of gynecology work. They were just damaged too much. So

David Haynes:

What does it, what does it mean, excuse me, what does it mean then? I, I, I guess they, what we've always heard over the years is that rural people are used to driving <laugh>. They go to, for instance, they go to Green Bay from the up for Costco or whatever. So to go to, to go to Escano or to Iron Mountain, if you live in Marquette or Alger County or somewhere doesn't really restrict up health consumers. Is that accurate? I mean that they will move around more

Dennis Smith:

Historically. I think they would. I think what they would like to do now is for now that they're getting in a little bit more complexes, stay closer to home if possible mm-hmm. <Affirmative>, so like again, the Iron Mountain thing, they'll be able to do hundreds of more procedures that they never were able to do before. And specifically gynecological stuff, you know, where before you couldn't do that and because it was too damaging, or maybe it had to be done at Marquette and maybe it couldn't be done in the up at all. And that opens a whole door to other women's health services that they would have or that Marquette would have. And I think, you know, historically when you go back 25 years, if a woman had breast cancer and she was gonna have breast surgery, they had the surgery, they had the biopsy, they had the surgery, then they, later things healed.

They did the reconstruction. Well, now the state of the art is you have it all done at once. Mm-Hmm. <affirmative>, you go into a place and you know, they get the biopsy, they get the surgery, all the reconstruction's done at the same time, the woman has to go through one traumatic surgery as opposed to a series of two or three or four. So that's really kind of more cutting edge. And so people were driving to Grand Rapids or green Bay or something for those types of things. And now those skillsets are, are really kind of devolving in the, in the up. And that's a better service for them. Less time off the job, less time away from their families, you know bigger, faster turnaround. So I think a lot of those are there. 

David Haynes:

So will we see, will we see a, a trend where physicians will move around to various regional centers as, as opposed to par as opposed to patients that doctor in Iron Mountain will go to Escanaba or or does it mean that people will have to drive to where the specialists are?

Dennis Smith:

I think it's gonna be a little of both. Okay. I think if you look back in 1960s and seventies, when Marquette general was the central thing, they sent their doctors all over the up. They had like 18 clinics all around the up. When you look at Marsh Field's philosophy, they have a very similar philosophy in that they'll have these clinics all over the place, but they will send their specialists somewhere for X number of days at a time, you know, to see the patients in that area. And then if they have to have something more skill set, they'll bring them into maybe back to Marquette or back to Marshfield or back to wherever. And I think and what you see in some of these hospitals, especially in Michigan medicine, I mean they've been very clear in their vision as they've gone out and acquired other facilities, is they don't, they're not acquiring those things to bring all those patients back to Ann Arbor.

I mean, they will tell you point blank, they got more than enough patients than they wanna deal with. They want the more complex stuff. So they're more than willing to go to Midland and invest more there to put more skillsets in Midland or to s Saint Marie or somewhere else. Same thing with Marshfield. They're more than willing to go and invest more things like in Iron Mountain. So you have more skillsets there. You have more endocrinologists, more, more rheumatologists, things like that where people can go and stay local and get all those stuff. I think that's changed from the way it was maybe 25, 30 years ago when you had the Spoken hub thing where all the specialists in one area and everybody's, their feet are into that process. I think now the goal really is to have more home services, more home, more in-home hospital type stuff.

You have more people, the specialists going to certain areas for longer periods of time and doing various clinics and things like that. And you go back to the eight 1980s and 1990s, those clinics would come to Marquette and they would be, they would bring them up from either the old Butterworth and Grand Rapid. So they would bring 'em from Ann Arbor or whatever, and they might have a pediatric cardiology program all for tho that person would be there for five days or a neurologist will be there for five days. Well, now that'll be more than normal, I think, where some of these larger systems will have specialists in certain areas and then if the volume is there, they'll be there permanently. Right. So dermatology is a great example in that you can have a lot of dermatology in certain areas, but if you don't have the volume, then they're going to need to travel. Whether they have a, a clinic and maybe in, in Muning, or maybe they have one in Newberry and they have one else. So they have maybe, maybe one week during, in Marquette all week, and then the next week they're traveling to their own five spaces. So it's kind of complex. I think the other thing that's, that's, that makes this expansion of larger healthcare systems coming to the up and expanding their footprint is they all have an insurance arm.

David Haynes:

Mm-Hmm.

Dennis Smith:

<Affirmative>. So when you look at it from that perspective there eventually there'll be more competition I think for health insurance in the up, which will help employers. And most of our employers are 25 employers are smaller. And so maybe you'll have that. I mean, the whole thing with Sparrow is that they have p p so right now Michigan Medicine has a little piece of that. Eventually they'll have it all and they can really run that if they want to all the way up into the suit.

David Haynes:

Will we see that, will we see a Marshfield or D and our others putting clinics together in a Marquette or in a Houghton will that happened or where there's an already a system, they won't do that kind of competition?

Dennis Smith:

No, I think they will and I don't think that they'll view it so much as competition as, as if they can provide a service that's not there.

David Haynes:

Okay.

Dennis Smith:

You know, let's just say that our, our physician population in the up is aging. Right. And so we're getting more and more younger people in. Well if there's an area, let's say it's, it's area X and they, they're having more family practice folks retire and move on, then there's gonna be a void. They might do that. They put a clinic in there. I can see all of them putting clinics in Marquette.

David Haynes:

Okay. All of 'em. Sort of, sort of like the people in up talking about how hard it is who have diabetes to find an endocrinologist. Yep. I hear them all the time. So that would sort of be this model too. It would be mm-hmm. <Affirmative> specialty like that would say, okay, well there's not enough in all these communities, but you can come here at Iron Mountain or you or we're gonna be in Mar or Houghton with our end chronology team. Is that what we're sort of gonna see in rural healthcare?

Dennis Smith:

I think so, and I think it'll be, you might, in some of the areas that are small enough, you might have just a specialty clinic week and then you have a variety of specialists there. Okay.

Dennis Smith:

Something that's larger, like maybe Iron Mountain or Marquette, you may have them there for half the time. Yeah. I mean, realistically you and I might hire somebody, put 'em in Marquette two weeks, put 'em in Iron Mountain, two weeks. Right. And they can go back and forth. You see that a lot in dermatology. You see that lot in some of the others. 

David Haynes:

Sure. So it would be, that would be a trend for healthcare across the country, I assume for rural healthcare. Yes. Yes. I think this is the way, cuz everyone's talking about the crisis facing rural areas and healthcare.

Dennis Smith:

I think whatever you see in the up, you'll see in the thumb, you'll see in some of the other more rural areas you'll see in Montana, Idaho, the Dakotas, things like that.

David Haynes:

What are the two or three largest threats, problems, concerns facing rural healthcare in Michigan? What, what thing, what is it, what we just talked about? Are there other things that worry hospitals and insurance plans?

Dennis Smith:

I think probably the number one threat really is getting providers mm-hmm. <Affirmative>, you know, and there's the there's really kind of the, the, the philosophical change between when you're dealing with, with rural healthcare, you need to kind of expand your thought process. And so having a board certified internal medicine person in a very small community just doesn't work. But you could have a nurse practitioner or a PA there working with an internal medicine or family practice doctor in a, in a bigger team approach to do this kind of stuff. Because if you don't, then you're not gonna have that service there at all. And then they're gonna be driving 35, 40 miles to get their annual physical or whatever. So I think that supplying to me is a huge thing for the, for the broader aspect.

David Haynes:

I, one of the interesting things another healthcare expert told me is he said, you know, it's an interesting phenomenon. It, somebody goes to a big healthcare system, a Mayo or somewhere else and they see a PA at for 45 minutes and they see the doctor for 10 minutes. It's, it's perfectly fine. And when they try to do that in their home, small town practice, people go, wait a minute, I want to see my doctor. Right. Perfectly comfortable with it. Going to a big city center, is that sort of a, is that just totally off or is that correct?

Dennis Smith:

No, I think that's correct and I, my personal bias is is that there are probably, it's probably an age related issue. I think people my age might think that, you know, I grew up seeing my doctor, I wanna see a doctor and I don't know who you are, but you either have NP or PA after your name, so you can't be as good as them. Yeah. And, and the reality is they're probably as better if, if as good if not better. You know, cuz they're seeing more volumes. And I think when you have that team approach, then you have Dr. Hayes is seeing the more complex things and, and PA Smith is seeing all the running noses, all the earaches, all the things like that, that really take up a lot of time and clog up the system. So I think you do see that, and I think, but you'll see people that are forties and then and less in their fifties and less, much more global in their vision on stuff. And they just wanna get in and out. You have a lot of people, 30 under, they don't even care about the, have their own primary care physician. They'll go to these little walk-in things or they'll pay a hundred bucks a month to have, IM gonna access, they just wanna have healthcare when they want it.

David Haynes:

And

Dennis Smith:

They want, they're already looking long term at, okay, I need to do this, I need to do that, I need to, whatever.

David Haynes:

Yeah. They, they, they go, look, I don't necessarily need one physician to be my healthcare provider. If I can get in to see somebody, gimme a quick diagnosis, yep. I can get some treatment or I gotta be told I gotta go see a specialist. I think that's a, that's a, well, Dennis, thank you. It's been educational as usual with you. You're such a font of knowledge on this. I really appreciate it. And all of our listeners do this is, this is I think very helpful. There's so many questions out there. I would, yes. Of all the topics we get healthcare questions texted to us and things, it's about healthcare. It's just people just, and it is very complex to figure out. But thank you very much for doing this. And I hope we can do it again.

Dennis Smith:

I'll do it anytime. Thanks. I really enjoyed it, David. Thanks so much.

David Haynes:

Thanks my friend. Bye-Bye.

Dennis Smith:

Yep. Bye-Bye.