Small rural hospitals across Montana are getting a new identity as primary care facilities, or MAFs (medical assistance facilities).
The state Legislature, responding to rural hospital closings, created MAFs in 1987, with the first facilities opening in 1989. Currently, 10 MAFs operate throughout the state, with another three applications under consideration. Each MAF has an emergency room, an outpatient clinic, a few inpatient beds, and operates a nursing home and often other health-related community services.
Staffed by nurse practitioners or physician assistants, with an on-site supervising physician, MAFs serve residents of small, isolated communities, generally with populations under 1,000. "This is a frontier health access project," says Keith McCarty, director of the MAF project for the Montana Hospital Research and Education Foundation in Helena. Frontier counties are defined as those with fewer than six persons per square mile.
McCarty says these facilities are very important to the viability of the communities in which they're located. In many towns, McCarty says, the largest employers are the schools, churches and hospitals. The loss of any institution would be a big blow psychologically, he says.
Walter Busch, administrator of Roosevelt Memorial Medical Center in Culbertson, agrees. "There are two reasons why a rural hospital needs to exist: one is access to health care and the other is economic viability of the community." Busch says Roosevelt, with its 90 employees, is "far and away the largest employer in the community." A typical MAF site, Culbertson is a town of fewer than 800 located in Roosevelt County, which has about 10,000 residents. In addition to primary care, Roosevelt has 44 nursing home beds, operates a home health agency, a rural health clinic, ambulance and community van services, and the Meals on Wheels and WIC programs.
Roosevelt also takes advantage of Montana's Telemedicine Network, to which five MAFs are currently connected, for diagnosis and consultation with specialists. Busch relates an example of the importance of that telemedicine connection: A woman who was prepared to drive 300 miles in a snowstorm to Billings to have a sick child examined stopped at Roosevelt first. A network consultation with a physician at Deaconess Hospital in Billings resulted in diagnosis and medication, and the woman avoided the trip.
Busch adds that the network is also a valuable community resource. Educational and training opportunities are available to Roosevelt staff; in addition, organizational meetings for Girl Scouts, bankers and other groups have been held over the network.
—Kathy Cobb
