By Arielle Zionts, KFF Health News

BOWMAN, N.D. — Retta Jacobi stepped onto a metal platform that lifted her to an entrance on the side of a custom-designed semitrailer. Once inside, she lay down on a platform that technicians slid into an MRI machine. Jacobi hoped the scan would help pinpoint the source of the pain in her shoulders.

The mobile MRI unit visits Southwest Healthcare Services, the hospital in Bowman, North Dakota, each Wednesday. Without it, the community’s 1,400 residents would have to drive 40 minutes to get to an MRI machine, an expensive piece of medical equipment the hospital couldn’t afford on its own.

Southwest Healthcare Services and 21 other independent, rural North Dakota hospitals are part of the Rough Rider Network, which used its members’ combined patient rolls to negotiate better prices for the mobile imaging truck.

Independent rural hospitals are increasingly joining what are called clinically integrated networks, collaborative groups that allow them to avoid selling out to larger health systems while sharing resources to save money and improve patient care. Many are motivated by the chance to combine their patient rolls for value-based care contracts, a growing reimbursement model in which insurers pay providers based on the quality of care they provide and the health outcomes of their patients.

Supporters of the networks are exploring whether funding from the $50 billion Rural Health Transformation Program — part of President Donald Trump’s recent tax and spending bill — can be used to help start or expand such organizations.

For independent, rural hospitals, the networks are an alternative to shutting down or reducing services, or to giving up local autonomy and joining a large hospital system.

“Anything that can help our rural hospitals and add services is awesome,” said Jacobi, who provides speech therapy to children in the local school district.

Since 2010, 153 rural hospitals in the U.S. have shuttered completely or stopped offering inpatient services, according to the Sheps Center for Health Services Research at the University of North Carolina. A far larger number, 441, merged with or were acquired by hospital systems between 2011 and 2021. That’s according to a report commissioned by the Coalition to Strengthen America’s Healthcare, an advocacy group comprising hospitals and health associations.

The Rough Rider Network provides negotiating leverage to its members, which serve about two-thirds of rural North Dakotans, said Dennis Goebel, CEO of the Bowman hospital.

Health care vendors “probably wouldn’t be talking to us if we’re by ourselves,” he said. “They’re not looking for the little, tiny crumbs. They want a big contract, and they’ll give you better pricing.”

Some rural networks share specialists who aren’t needed full time at any one hospital, according to the Commonwealth Fund, a nonprofit focused on improving the health care system. Some networks also invest in broadband, housing, and other community development projects that can help people stay healthy and access care.

Hospitals can pool staffers for a network-wide employee health insurance plan, said Nathan White, CEO of Cibolo Health, a company that helps launch and manage networks in rural areas. He said they can also enter shared contracts for telehealth, prescription drug programs, and other services.

White said he started Cibolo Health after a leader from an independent, rural North Dakota hospital asked him about collaborating with similar facilities. The Rough Rider Network launched in late 2023 with assistance from the company and $3.5 million from the North Dakota Legislature.

Since then, Cibolo Health has helped start networks in Minnesota, Nebraska, Montana, and Ohio. Once a sixth one opens in September, Cibolo-affiliated networks will represent more than 120 hospitals, with service areas covering 4.7 million people, White said.

The networks, which are nonprofits owned by the hospitals, pay an annual fee to Cibolo Health, a for-profit company, for management services. White said leaders from 10 other states are considering joining this model.

Similar networks have been around for more than 30 years but became more popular after the passage of the 2010 Affordable Care Act, according to a report by the Rand Corp., a research nonprofit.

Rural health care providers are increasingly interested in forming such networks, said Marnell Bradfield, executive director of the Community Care Alliance, a network of hospitals and independent primary care offices that launched in 2015 in rural western Colorado. About once a month, she said, she gets a call from health care leaders exploring similar networks and asking about her experience.

The Rand Corp. wrote in its 2020 paper that it didn’t find any academic studies that examined whether these networks do what its supporters claim — save money and improve patient care.

“In theory, quality should improve with the alignment of health care organizations, but there is no evidence,” the report said. The paper also said such networks could end up increasing prices, something that can occur with traditional mergers and acquisitions.

Bradfield and White said they have the evidence, at least for their organizations.

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Community Care Alliance members have reduced their insurance costs while improving patient outcomes, such as reducing their need for inpatient and emergency care, Bradfield said.

White said data from a pilot program between Caret Health, a care coordination company, and SMP Health-St. Kateri, one of Rough Rider’s hospitals, showed the program helped a significant number of patients catch up with preventive care.

Gabby Wilkie, finance director at the St. Kateri hospital, in Rolla near the Canadian border, said Caret Health staff called and texted patients who were behind on annual physicals, cancer screenings, vaccinations, and other visits. She said staffers explained to patients why this preventive care is important for their health before setting up a three-way call with St. Kateri staff to schedule an appointment. White said it took an average of 11 outreach attempts before patients came in for any visits.

“To be honest, we didn’t have the resources to reach out,” Wilkie said.

She said St. Kateri would have spent an estimated $300,000 to do that kind of outreach for 1,000 patients. Meanwhile, she said, the hospital estimates it will earn more than $100,000 when that many patients come in for their preventive care. Cibolo Health and the Rough Rider Network both contribute to the cost of the Caret Health service, which is now rolling out to other network hospitals.

Goebel said joining a network to remain independent is also beneficial for the economy of rural areas, where hospitals are often major employers. He said health systems sometimes cut services and staff at rural hospitals they acquire.

Jacobi is taking medication and doing physical therapy after a doctor examined her MRI results. If that doesn’t work, she may need to make a five-hour round trip to Bismarck to get an ultrasound-guided steroid shot. Jacobi was thankful she could get a diagnosis and treatment advice without having to travel far for the MRI.

“Anytime we can maintain more local control, it’s a good thing for our small towns,” she said.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By CALEIGH WELLS and BRITTANY PETERSON

LITTLETON, Colo. (AP) — When Lena Astilli first bought her home outside of Denver, she had no interest in matching the wall-to-wall green lawns that dominated her block. She wanted native plants — the kind she remembered and loved as a child in New Mexico, that require far less water and have far more to offer insects and birds that are in decline.

“A monoculture of Kentucky bluegrass is not helping anybody,” Astilli said. After checking several nurseries before finding one that had what she wanted, she has slowly been reintroducing those native plants to her yard.

Though Astilli was replacing grass just last month, it remains ubiquitous in American yards. It’s a tradition that began more than two centuries ago with the landed gentry copying the landscaping of Europe’s wealthy, and grass now dominates as the familiar planting outside everything from single-family homes to apartment complexes to office parks and retail malls.

“In the absence of simple directions and guidance about what to do with their landscape, they default to lawn because it’s easy,” said Mark Richardson, executive director of the Ecological Landscape Alliance, a nonprofit that promotes sustainable landscaping.

Yet that grass is problematic in deserts and any place with limited water, such as the American West, where it won’t do well without irrigation. As climate change makes the world hotter and triggers more extreme weather, including drought, thirsty expanses of groomed emerald are taxing freshwater supplies that are already under stress.

Enter xeriscaping — landscaping aimed at vastly reducing the need for irrigation, including by using native or drought-tolerant plants. (A utility here, Denver Water, says it coined the term in 1981 by combining “landscape” with the Greek word “xeros,” which means dry, to encourage reduced water use.)

Reasons to think about ripping up that lawn

Homeowner Lena Astilli cuts holes in a weed barrier atop her dead grass where native seedlings will be planted Thursday, Aug. 28, 2025, in Littleton, Colo. (AP Photo/Brittany Peterson)

The average U.S. family uses 320 gallons of water every day, according to the Environmental Protection Agency. Nearly a third of that is devoted to outdoor water use. It’s even more for people with thirsty plants in dry places.

“Potable water is going to become harder and harder to come by,” said Richardson. “Lawn reduction is a fantastic way to limit the use of water in the landscape.”

His group isn’t keen on grass even in areas like the Northeast or Midwest, where drought and water use aren’t as problematic as in the West. Less lawn means fewer pesticides and fertilizers washing into rivers. More native plants mean more rest stops and nesting grounds for pollinators like birds, butterflies and bees, which have faced serious population declines in recent decades.

“We can bring nature back into our urban and suburban areas,” said Haven Kiers, associate professor of landscape architecture at University of California-Davis. “Improving biodiversity, creating habitat is going to be a huge thing for the environment.”

It’s also better for the people using the yard, Kiers said.

“So many studies show that spending time in nature and gardening, all of this is really good for you,” Kiers said. “When they’re doing that, they’re not talking about mowing the lawn.”

Taking the first steps

A person plants a native seedling in a crevice garden Thursday, Aug. 28, 2025, in Littleton, Colo. (AP Photo/Brittany Peterson)

Kiers says the only thing more intimidating than an expanse of lawn is an expanse of unplanted dirt. Her top recommendation: take it slowly. It also mitigates the cost, because she said paying someone to do it all at once can cost tens of thousands of dollars.

If you’ve got beds along the outside of the house, expand them. If you’ve got a path leading to the front door, put shrubs or flowers on either side of it. If you don’t have shade, plant a tree, and if you’ve got a tree already, create a bed around it. All of these steps reduce the lawn space.

There are also financial incentives and rebates in several states to make the transformation more affordable. Sometimes they’re offered by a city, county, state, water agency or local conservation organizations, so searching for the programs available with the municipalities and companies near you is a good place to start.

Looking for landscaping ideas? “If you want to see good examples of horticultural at its finest, visit a public garden,” Richardson said. Kiers recommended finding a master gardener or a community garden volunteer, because they’ll often provide expertise free of charge.

What’s in Lena’s yard?

Greg Gorskiy plants a crevice garden Thursday, Aug. 28, 2025, in Littleton, Colo. (AP Photo/Brittany Peterson)

Astilli, the Littleton homeowner, remade her backyard with native plants a few years ago — goldenrod, sunflowers, rudbeckia, purple poppy mallow, Rocky Mountain bee plant and more. Some green lawn remains for her dog and child to romp.

Late this summer, she was getting her hands dirty converting the front yard to xeriscaping. With the help of Restorative Landscape Design and its owner, Eryn Murphy, Astilli was replacing grass with plants like bee balm, evening primrose, scarlet gilia, prairie dropseed and tall thimbleweed.

In a break from the work, Murphy reeled off a few of the different possible looks for low-water landscaping: a gravel garden with perennials, lush prairie, a crevice or rock garden with tiny plants growing in the stone features, a cactus garden.

“Really the sky is the limit in terms of your creativity and your aesthetic,” she said. “It’s just about using plants that are supposed to be here.”

Murphy said an ever-drier West due to climate change will require people to “do something” as lawns become less and less viable.

“Water is going to keep getting more expensive, your lawn is going to stop looking good. You’re going to have to open your eyes and say, what could I do that’s different and better?”

The Associated Press’ climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

Pawns of Hamas

It is extremely saddening to see the trauma that continues in Gaza as shown on the front page of the Thursday, Sept. 18, edition. The people are pawns used by Hamas to generate strife.  If the terrorist organization that is Hamas cared one bit about the suffering it has bestowed on the civilian population they would free the hostages.

Tom Bates, St. Paul

 

Meet neighbors? Good. But clean up after slobs?

I am responding to the letter on Sunday Sept. 14 about neighbors organizing to clean up streets.

I think he has a great idea to get out and meet your neighbors.

However, I don’t think we should have to have clean-up clubs. I think people need to be responsible for their own trash.

It’s disgusting to see bottles and cans floating in our lakes and rivers. McDonalds bags full of trash tossed whereever you happen to be when you finish your happy meal. Your old couch does not go in the ditch. Your old sink and toilet don’t belong in a park.

Dispose of your junk yourself. Then people would have time to meet their neighbors instead of picking up garbage.

Penni Hergert, Maplewood

 

Burden crooks before they get worse

Thursday’s front-page reported: “Consensus on gun proposal elusive.”

I wonder why?

When I was a youth, a few years ago, Minnesota had a simple statute that stated it is “illegal to discharge a firearm on or upon any Minnesota street or highway” as it was publicly stated. Subsequent modifications have burdened that simple statement with scenarios, caveats and definitions with the result that the state legislation now contains a million words of gibberish — with efforts to add more. Municipalities have added their own ordinances barring the discharge of a firearm within their boundaries without a permit.

Yet, all of this is apparently being ignored by those charged with prosecution because recent articles on these pages have reported shooting followed by no charges filed.

Illegal firearms use is at the bottom of the crime food chain. It is the street-level entry into that world. And it is too often being ignored by prosecutors as a minimal or “not worth the effort” crime. Wouldn’t common sense indicate that we stop something at its source? And why wouldn’t further charges be added to any obviously applicable charges? It’s time to always burden the criminal with everything possible before they graduate to bigger things.

Art Thell, West St. Paul

 

The good old days?

Wow, “Make America Great Again” could mean, bring back the “old days of America” without all of those “bad childhood vaccines.”

Yes, in the old days when I started my pediatric training and then private pediatric practice, we didn’t have all those shots to prevent pneumonias and brain infections. Hah, I was doing “spinal taps” (needles into the spinal cord spaces) to detect early brain infections etc., at least four times a month. Those were deadly diseases. Wow, then the “Hib” and “Pneumococcal” vaccines came out and “POOF” those diseases literally disappeared.

Now we have Robert F. Kennedy Jr., our new Secretary of Health and Human Services, declaring all of those vaccines are dangerous and should be voluntary for parents to use. Hmmmm, I guess he has some research that proves epidemics causing deaths are a myth, and the measles vaccine causes all of those autism cases, and therefore can’t really trust those doctors who only want to make money?

I’m surprised he hasn’t declared tap water as poisonous. I put some kids in the hospital for drinking only water for several days when they got sick and their blood-sodium levels dropped to near deadly levels causing their heart rhythms to stop.

So, I guess it is time to bring back the measles, chickenpox, brain infections etc., etc., just like the old days.  Well, the measles cases are now coming back and expect a few more deaths. Yes, we are making America “Great Again” and of course expect to see many more deaths and thousands of more infections, which apparently are better for the country than the vaccines?

Mark Nupen, Anoka.
The writer is a retired pediatrician.

 

Lock up the people who pull the trigger

Very shortly after the horrific murder of Minnesota sate Rep. Melissa Hortman and her husband, Gov. Tim Walz moved swiftly to ensure the safety of all state politicians by closing a majority of the doors into the State Capitol, installing metal detectors on the three remaining doors left as public access and exploring methods to ensure the safety of elected officials. With the equally horrific murder of two children and the wounding of 20 others attending church in South Minneapolis, Gov. Walz calls for a ban on assault “style” weapons. During the 2024 legislative session, a bill was introduced to place School Resource Officers (SROs) in public and private schools. The bill was rejected by the Democratic majority.

An assault weapons ban would take months to pass and perhaps years to demonstrate a realistic effect on the possession of assault “style” weapons. Considering this fact, the Hortman murders were carried out by one individual armed with a semi-automatic pistol containing 17 rounds of ammunition. Many of the Minneapolis “shootouts” involve handguns with a capacity of 30 to 50 rounds of ammunition, capable of firing all 30 rounds in less than five seconds.

We don’t need new laws or a ban on assault “style” weapons; we need the long-term incarceration of those people who “pull” the trigger.

Jim Feckey, Mendota Heights

 

‘You have to be carefully taught’

In the words of the song from “South Pacific,” “You have to be carefully taught.” Babies enter the world quite ready to love everybody. It is only when they start interacting with “society” that they begin to be concerned about “the other.” On Sept. 3 we saw the Annunciation community demonstrate how they taught their children to take care of each other.

I read once about a country in Europe in which empathy was part of the school curriculum from kindergarten to graduation. The children are taught at school, never mind what is happening at home, to honor and respect each other. I suggest that empathy can and should be taught in our schools. We need to change the culture around the “them vs. us” attitude so many people seem to cling to.

Also we need to insist that schools have mental health counseling available at all times. These individuals and teachers can spot the “loners,” the children who have a hard time cooperating, who need to feel included and noticed. Most school shooters seem to be kids who felt excluded, not noticed, isolated.

I am all for banning guns, background checks, etc., but teaching children to love and care for each other, and that kindness is better than bullying, may show better results in ending the gun culture we currently experience

Evelyn V. Lawyer, St. Paul

 

More departments of war

Self-proclaimed “peace president” Donald Trump wants to change the name of the Department of Defense to the Department of War. But why stop there? Since policies and actions taken by other federal departments seem to have turned away from their intended missions, no longer protecting our Earth and health, for example, why not create more accurate names for those, too? Maybe the Department of War on Environmental Protection, or the Department of War on Health and Human Services, and on and on …

Steve Masson, St. Paul

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What we have now isn’t working

The police are tired of arresting the same “bad guys” over and over.  We have far too much plea bargaining, too many legal loopholes, weak laws and soft consequences. So many times we read “that is all that the law allows.”

Solution: Our legislators must change the incarceration guidelines.

Eliminate much of the plea bargaining and bail. This would mean that the “bad guys” would be incarcerated before their trials and not on the streets.

We have lost our moral compass. There will never be a perfect system, but obviously what we have now is not working. Tough love is needed or things will only get worse.

John Heller, North St. Paul

 

It’s not carbon-free

Amidst all the chaos in the country, I want to draw people’s attention to a bill on the docket that seems to me to be a potential bipartisan betrayal of Minnesotans. The bill wants to redefine biomass, “renewable” natural gas, and trash burning as “carbon free” when they simply and factually release more carbon than coal or natural gas. That would be placing straightforward lies on our books for the sake of appeasing corporations. People who don’t stand to profit from this deception generally accept that “carbon capture” and so called “lifecycle” carbon concepts are misleading half-measures at best, and dangerous at worse.

Call me cynical, but I can’t help connecting this and recent initiatives to try to attract AI data centers into Minnesota. Each center can easily use the same amount of power as all of Minneapolis if they’re not depleting the groundwater well dry. We’re already seeing that, where they’ve been built before. I’m not excited about the idea of drought or $600 electricity bills, and the thought that attracting these centers will “create jobs” is painfully shortsighted.

Firstly, because it’s in support of an industry that openly advertises itself as a way to lower wages and lay people off. And secondly — surely I’m not the only one who remembers the dot-com boom and bust? It seems like Minnesotans could end up with low jobs, a carbon-pumping power grid, and no way of enacting the very popular climate goals we were promised and that we fought for.

Teri Blauersouth, St. Paul

My favorite planet, besides the one I live on, is on the rise in the low eastern sky during evening twilight. It’s Saturn and you can’t miss it.

It’s the brightest star-like object in that part of the sky. This weekend, Saturn reaches its closest approach to Earth for 2025, just under 795 million miles away, which is close for Saturn. Astronomers call this opposition. Not only is the separation in space between Earth and Saturn at a minimum but the sun and Saturn are at opposite ends of the sky, with Earth in the middle. That’s why they call it opposition. Because the sun and Saturn are at opposite ends of the sky, Saturn is available all night long, rising in the east at sunset and setting in the west at sunrise. Opposition happens every 378 days as Saturn and Earth travel in their respective orbits around the sun.

Why 378 days? That’s because in the one year that it takes our Earth to orbit the sun, Saturn moves only about 1/29th of its orbital distance around our home star. It has a much larger and slower orbit than Earth, so it takes the Earth about two more weeks to come between Saturn and the sun once again.

Saturn is by far my favorite planetary telescope target. It’s been that way since I was a kid. I’ll never forget seeing Saturn through a telescope for the first time in the early ’70s at the Woodlake Nature Center in Richfield. That was a game-changer for me as I plunged into the hobby of backyard astronomy! Even through a small telescope, you can see Saturn’s ring system. That was a real thrill for me way back when and still is now. I’m now blessed to own larger telescopes, which really put my view of Saturn over the top. Even more fun for me is being able to show Saturn off to the hundreds of folks at my stargazing programs over the years, especially the kids. I never get tired of hearing reactions like “sweet,” “awesome,” “incredible,” “holy ____,” and much more! If you’ve never seen Saturn through a telescope, now is the time.

While Saturn is still one of the best telescope treasures, it’s been a bit of a bummer the last year or so. That’s because its beautiful but very thin ring system is temporarily on edge from our vantage point on Earth. This occurs every 14 years because of the alignment of Saturn and Earth in their respective orbits around the sun. The good news is that the angle of the very thin ring system will begin to open up after this year and continue to improve over the next several years. Don’t let that discourage you, because Saturn’s still one of the best telescope treasures of the night sky. Also, make sure to stay up as late as possible to view Saturn, so it has a chance to climb higher in the sky and escape the blurring effects of Earth’s atmosphere near the horizon. Start by viewing with low-magnification eyepieces and work your way up. When you’re viewing Saturn or any other planet through a telescope, it’s important to discipline yourself to take long, continuous views. Your eye needs to adjust to the level of light coming into your eyepiece. You also want to catch pockets of less turbulent air for better views of Saturn. As with a lot of things in life, you’ll be rewarded for patience and persistence!

Like all the planets in the outer solar system, Saturn is primarily composed of a ball of hydrogen and helium gas, with other trace gases present. It’s approximately 75,000 miles, way larger than Earth’s 8,000 miles. Its hallmark, though, is its incredible, intricate ring system that spans over 175,000 miles in diameter, which is more than half the distance between Earth and its moon.

Amazingly, the ring system is less than 50 feet thick on average and is made up of billions and billions of mainly ice particles ranging in size from crystals to the size of your house. Most likely, the ice is the pulverized remains of one or two of Saturn’s ice moons that were ripped apart by the planet’s tremendous tidal forces. Eventually, the ring system will dissipate millions of years from now.

Along with Saturn’s ring system, it’s also possible to see some of Saturn’s moons, even with a small telescope. The moons resemble tiny stars surrounding the planet. The brightest and biggest is Titan, over 3,200 miles in diameter. That’s larger than the planet Mercury. Enceladus, one of Saturn’s much smaller moons, is a strong candidate for possible life under its surface. The Cassini spacecraft during its 13 years orbiting Saturn detected geysers of water shooting out of Enceladus before it purposely plunged into Saturn at the end of its very successful mission.

Enjoy the rise of Saturn this autumn! Every night, it’ll start out higher and higher in the southeastern skies as evening darkness sets in.

Starwatch programs

Monday, Sept. 22, 7:30-9:30 p.m., River Bend Nature Center in Faribault, Minn. For more information and reservations, call Faribault Parks and Recreation at 507-334-2064 or visit www.ci.faribault.mn.us/219/City-Enrichment-Programs.

Tuesday, Sept. 23, 7:30-9:30 p.m., Paperjack School in New Richmond, Wis. For information and reservations, call 715-243-7421 or visit newrichmond.ce.eleyo.com/ce.

Thursday, Sept. 25, 7:30-9:30 p.m., in Northfield. For information and location call 507-664-3649 or visit northfieldschools.org/communityeducation.

Friday, Sept. 26, 8-10 p.m., Big Marine Park Reserve near Marine on St. Croix. For information and reservations, call 651-430-8200 or visit www.co.washington.mn.us/index.aspx?NID=532.

Mike Lynch is an amateur astronomer and retired broadcast meteorologist for WCCO Radio in Minneapolis/St. Paul. He is the author of “Stars: a Month by Month Tour of the Constellations,” published by Adventure Publications and available at bookstores and adventurepublications.net. Mike is available for private star parties. You can contact him at mikewlynch@comcast.net.

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