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The three counties (shown in gray on map, metro area is black) - which comprise the St. Cloud service area for long-term care reimbursement - want to be included in the metro rate schedule, which would provide over $130,000 in extra funds to the two long-term care facilities in Paynesville: the Koronis Manor, operated by the Paynesville Area Health Care System, and the Good Samaritan Care Center, operated by the Good Samaritan Society.

Fifteen long-term care facilities from the three counties have united to lobby for the metro designation. A key to the campaign, according to PAHCS CEO Willie LaCroix, is getting all the facilities to agree that they either all get the designation or none get it. Paynesville's situation in competing for health care staff will only get worse if St. Cloud facilities get metro rates but we continue to get rural rates, LaCroix added.

Getting designated as a metro county would mean a $2.31 daily rate increase at the Koronis Manor, which translates into $45,000 extra per year. The Good Samaritan's daily rate would increase by $5.68, which would provide $85,000 yearly.

In all, the metro designation would provide $2.4 million extra annually to the 15 facilities. Of that, $800,000 would come from the state government and $1.6 million from the federal government.

"We are a great candidate for that because we're already considered metro by the federal government," said Jay Ophoven, director of nursing at the Good Samaritan. Ophoven is serving on the six-person steering committee that is directing this lobbying campaign.

The long-term care facilities will point to these factors in lobbying for the metro designation: that Benton, Sherburne, and Stearns counties will become federally-designated metropolitan areas based on the 2000 Census; that Benton, Sher-burne, and Stearns counties are more "metropolitan" than some of the areas that received the designation in 2001 (portions of Itasca and St. Louis counties and the city of Breckenridge, in particular); and that St. Cloud area wages are influenced by wages in the Twin Cities.

With nursing, in particular, in short supply, facilities that get better reimbursement rates can offer higher wages to attract workers from facilities that receive less reimbursement and thus can afford only lower wages. "We're competing for labor with all these places," said LaCroix.

Whether the coming improvements on Highway 23 through Richmond decrease driving time to St. Cloud or I-94, it should make it safer and less stressful to commute, said LaCroix. This means that long-term care facilities will compete even more for nurses and staff.

The Good Samaritan Care Center and the Hilltop Good Samaritan Center in Watkins both received a rate increase from the state after the 2001 legislative session, when the state effectively eliminated the lowest reimbursement rate: deep rural. The Good Samaritan got a $2.03 per patient per day increase in 2001, which for 40 beds for 365 days in the year means an extra $30,000 in revenue. Hilltop in Watkins got twice as much in 2001, said Ophoven.

PAHCS is negotiating with the Good Samaritan Society to purchase both their Paynesville and Watkins facilities. Hilltop in Watkins is located in Meeker County, a couple blocks from the county line, and would not benefit from the metro designation.

The Koronis Manor, as a skilled facility, was already reimbursed above the state average and got nothing extra in 2001, besides a small percentage increase for wages.

Nurses at PAHCS - whether in acute care, clinic, or long-term care - are all paid by education level and experience, not by building, said LaCroix. This has kept departments from fighting internally over wages and has meant Manor wages have been higher than other long-term care facilities in the area, but this has only been done by subsidizing those wages through gains from PAHCS's profitable departments.

The 15 long-term care facilities have agreed to hire a lobbyist to work toward getting the metro designation for the three counties in the 2002 session. They have budgeted $15,000 to be spent. The lobbyist will collect it depending on how far the bill advances, getting the whole amount only if it becomes state law.

"It's a short session, and they don't want to spend money, so it's going to be an uphill battle," said Ophoven.

The change also may be opposed by both metro facilities and counties that border Benton, Sherburne, and Stearns, who may feel they will be at a competitive disadvantage if facilities in these three counties get an increase but they do not.

The facilities have also contacted legislators in the three-county area. LaCroix said that local legislators Sen. Michelle Fischbach (R-Paynesville) and Rep. Doug Stang (R-Cold Spring) have been very supportive of health care in the past.