Contact: Katie Johnson
Dr. Rapp Road commemorative road sign dedicated at Prairie Ridge Healthcare
(Elbow Lake, MN) With a population of just under 6,000 people, Grant County is fortunate to have a nationally recognized critical access hospital in Elbow Lake, its County Seat. There is also a clinic there and one in each of four neighboring communities. It’s no exaggeration to say the continuous presence of excellent rural healthcare in Grant County for the last half century is thanks in large part to one man, Dr. Larry Rapp. This article seeks to capture his story and his reflections on nearly 50 years of service to the local medical community.
In 1972, a group of leaders in Elbow Lake banded together to recruit more medical help for their community. At the time there were a total of six doctors in all of Grant County, so they put together a package meant to attract an additional doctor for their town of 1500. “I had a lot of debt after finishing my training which meant Elbow Lake’s incentive was really appealing. I thought I would stay for a while and then move on – maybe get advanced training in cardiology. But I loved it in Elbow Lake. The people; the scope of practice; a place to raise the kids. Fifty years later, here I am, still in Elbow Lake.”
Dr. Rapp started work joining doctors Dahl and Brown in their practice. Over the next 48 years, sometimes in solo practice; sometimes with short term help from the U of M; sometimes from other physicians who were living in town for a few years, Dr. Rapp saw vast changes in health care. He was on the front line for all those changes:
In the beginning, the only imaging technology was x-ray but that progressed to having ultrasound, PET scan, Cat scan and MRI; large, open incisions for surgery advanced to small incisions using a scope, image-guided surgeries, and robotic surgeries; the use of ether as an anesthetic evolved to multiple, sophisticated anesthetics; a single antibiotic, penicillin, advanced to over one hundred antibiotics; cardiac care and stroke care, limited to the use of observation, oxygen and pain medicine moved forward to diagnostic procedures, elegant medications, stents, the use of mesh and rapid transport to a tertiary center.
Patient payments in goods or services, i.e., sweet corn, chicken, fish, and baked goods, lawn mowing, car service, etc., graduated to paper billing, and finally computer invoices; a portable phone used for on-call communication was a box so big it barely fit into the front seat of a golf cart that progressed to today’s cell phone which fits into his pocket. In addition to serving the local area and sometimes the entirety of Grant County and the out-state needs, he oversaw the pharmacy, lab, x-ray, and physical therapy departments; assumed the Medical Director role for area nursing homes, opened satellite clinics in Ashby , and was the county coroner for 35 years. With his abiding interest in education shining through, Dr. Rapp enjoyed training nurse practitioners, physician assistants, medical students, and anyone on staff who expressed an interest in learning. In the 90’s, he was an early champion for the use of telemedicine, making connections with the University of U of M and other facilities. This proved to be unsustainable because there was not the necessary computer infrastructure nor the financing to support it.
The training of an osteopathic doctor has an emphasis on holistic wellness - mind, body, spirit - for individuals, their families, and their communities and the perspective that a physician always cares for people, not patients. These were his guiding principles for the duration of his career. As the current Prairie Ridge value statement says: We operate with a “People are precious” mindset.
The Elbow Lake Hospital had opened as a district hospital in 1961 and later, in 1976, became a county hospital. The hospital had a sound building with all the important departments for the makings of a good hospital. “The hospital saved expenses by not employing any doctors; when a patient needed to be admitted, they simply called the patient’s doctor to come to the hospital,” said Rapp. As health care systems changed during the 1980’s with the Prospective Payment System, doctors began adding x-ray and lab equipment to their own clinics. Ultimately, this would put doctors in competition with hospitals and by 1993, the Elbow Lake hospital was in financial trouble.
The Grant County Commissioners, serving as the Board of Directors, faced a difficult decision and ultimately recommended closing the hospital. After some soul searching and a willingness to do whatever it would take to keep the hospital open, Dr. Rapp proposed folding his clinic into the hospital under a 501C3 structure to form a vertical, integrated health care system. The new name became Grant County Health Center. Rapp said “We believed that by alleviating the competition between doctors and hospitals, we could improve the bottom line.” The transition with Dr. Rapp as CEO was bumpy, but eventually, with a bank loan and some creative thinking, he was able to forge a successful management system.
The landscape changed again in 2005 when the hospital became a Critical Access Hospital (CAH). That was a “real game changer,” according to Dr. Rapp. The CAH designation allowed the hospital to be compensated not based on productivity but on the cost of providing rural care which improved the bottom line.
The timing of the transition to a CAH hospital turned out to be fortunate. “My wife Mary was a major part of the management team at the hospital. She became ill with cancer and died in the spring of 2007. I told the board I could not continue as CEO while dealing with my loss and continuing my practice.” Dr. Rapp said. This opened the door to a relationship with Lake Region Healthcare (LRH) in Fergus Falls, who was able to provide management services to the system which was then called ELEAH Medical Center (The name took the first letter of each town with a clinic – Elbow Lake, Evansville, Ashby and Hoffman.) All the ELEAH providers except Drs. Rapp and Stock became employees of the Fergus Falls Medical Group. LRH would eventually expand its management services. Morris joined the list of locations in 2007. Another name change occurred in 2010 when ELEAH became Prairie Ridge. In 2017 another satellite clinic was opened in Herman.
Rapp knows better than most that delivering quality healthcare in rural communities is challenging. “Elbow Lake is fortunate to have a beautiful hospital and clinic building. The partnership we were able to forge with LRH allowed us to continue delivering health care and cost-effective operation, to have robust electronic medical records, and strong telemedicine capabilities.” Recruiting and retaining healthcare workers is also important, especially Nurse Practitioners and Physician Assistants on the health care team, Rapp believes. He was instrumental in the U of M’s fledging collaborative Nurse Practitioner project in the 1990’s and later in training medical students from the U of M’s Rural Physician Associate Program.
Over the past eight years, Dr. Rapp initially stepped away from weekend call, then night call, then ER care, and after gradually decreasing the number of his clinics, he officially retired March 31, 2020.
Reflecting on the pandemic, Rapp believes it was a wakeup call to scale up public health services and the country’s disaster readiness workforce, equipment and supplies. “We were not ready for this pandemic, and surely there will be more pandemics to follow.” He thinks COVID-19 has accelerated telemedicine, put pressure on the health care insurance industry, started us rethinking long term health care (nursing homes and assisted living,) and allowed non-physicians in rural areas, like nurse practitioners and physician assistants to play a bigger role.
What’s next for Dr. Rapp? “Retirement has been a major life transition for me. My retirement coincidentally occurred within the same 30 days as the beginning of the quarantine for COVID-19 and my marriage to Rita, my second wife. The pandemic has been a real challenge. Rita and I look forward to the future when we feel free to move about for more contact with family and friends and safe opportunities for activities, events, and travel.” As a pilot, he looks forward to providing Angel Flights for people who need transportation to distant medical centers.
In honor of his retirement, Prairie Ridge Healthcare officially named the circle drive in front of the hospital “Dr. Rapp Road” this summer, commemorating his contributions to the health care system in Elbow Lake and Grant County. “It’s a legacy I certainly appreciate,” Rapp said. “It has been my privilege and honor to have been part of healthcare in Elbow Lake. Because COVID-19 closed the hospital and clinic except for emergencies during my last weeks of work, there was not an opportunity for a proper good-bye to my patients. The affection I feel for my patients and those whose lives touched mine during my career is immeasurable. Some of my fondest memories are working all these years with wonderful staff at the hospital and clinic. Also, the pleasure of working with my family, my brother Keith, my son Greg and my late wife Mary. To have my entire career in one place, Elbow Lake, was a privilege for me and my family.”
With 50 years’ worth of roots and friendships that kept Dr. Rapp in Elbow Lake far beyond his original intent to stay a few years, he said he wants to thank everyone who has been part of the journey with him. “Besides providing health care, my interest has been in creating a health care system in Elbow Lake that is sustainable. The process is sometimes messy, but I think we can all be proud of the end product.”