Reinvigorating rural health

Declining populations, physician shortages and high unemployment rates are among the many elements contributing to the significant challenges faced by rural healthcare organizations. While these providers face struggles, they are an integral part of the healthcare ecosystem. Advances in telehealth adoption and emerging business models are bringing new opportunities to these critical institutions.

In a discussion with Modern Healthcare Custom Media, two industry leaders offered their perspectives on how rural healthcare leaders can prepare their organizations for the future, and shared best practices for success in this unique environment.

Panelists:

Mitchell Berenson is president and CEO of Community Infusion Solutions. Berenson, a more than 20-year healthcare industry veteran, specializes in the development and evaluation of infusion services. He holds three patents for remote-monitoring devices and is an expert in value-based care.

Jim Kendrick is president and CEO of Community Hospital Corporation. As a national leader in advancing community hospitals, Kendrick has more than 20 years of executive experience in not-for-profit and for-profit healthcare. Kendrick was a Modern Healthcare Up & Comer in 2010 and joined CHC in 2017.

MB: COVID safety and security issues have driven patients to look closer to home for their healthcare decisions. Since COVID, outpatient infusion services referred to our partner rural hospitals have increased by over 20 percent. Referring urban hospitals shared that patients specifically requested follow-up care to the local provider to limit exposure and risk. Patient compliance demanded an increase in hospital/patient transparency to ensure patient safety.

JK: Government support was helpful for hospitals, but understanding of permissible fund use and reporting timelines remain unclear. The government funds also make it difficult to assess a hospital’s true financial position. Many that were struggling before the pandemic now have improved financials that may give leaders a false sense of security. The government funds temporarily stopped the bleeding, but many of the same issues remain. Leaders need clarity.

MB: Our partner hospitals rely on us to provide and assign an active case manager, to develop a strong patient relationship and ensure patient compliance and satisfaction. The primary measure we utilize for quality assurance is infusion compliance rates—every patient, every infusion, every time—and we’re proud our rates far exceed the industry average. We also incorporate a patient satisfaction survey to ensure we provide a positive experience.

JK: The pandemic emphasized the importance of clinical quality and safety for all hospitals. Community hospitals are using a back-to-the-basics approach with an emphasis on continual improvement to make gains. Leaders should take action by broadly communicating the measures, data and progress to all staff to identify strengths and areas for improvement. Next, encourage staff to contribute ideas. The ultimate goal is real improvement – not just a score.

MB: Technology has changed the trajectory of patient outcomes. Remote infusion monitoring, for example, lets us know that something is preventing successful patient outcomes on Day 3 instead of Day 300. That allows us to adjust and customize ongoing care. Similarly, high-tech infusion drug therapies—once only available at urban hospitals—are now available everywhere, even in rural areas. We recommend looking for partners who can access new technologies instead of building and managing it internally.

JK: It is key to remember that the goal of technology is to help meet your business objectives. That means strategic goals should drive technology purchasing decisions. Looking through that lens, our focus is on clinical informatics and improving efficiencies in clinical workflow that also accelerate the revenue cycle. Any technology that isn’t evaluated properly has the risk of increasing costs, posing security risks and decreasing efficiency.

MB: Most rural providers are challenged with reimbursement issues due to lack of volume, making it difficult to achieve economies of scale. However, data reports reveal that service outmigration is more significant than volume. In fact, IV infusion is the No. 1 outmigrating service line for U.S. rural hospitals. The good news: these services can be recaptured and net revenue—the life blood of a rural hospital can be earned, at times up to $100,000 a month or more.

JK: Rural hospitals have been struggling with reimbursement for many years, so this isn’t a new issue for our clients. Hospitals can’t control the changes, but they can manage their costs to align with expected revenue. We monitor several data points to gain a big-picture perspective and adjust accordingly. Examples include aggregate volume, provider utilization trends, operating ratios, productivity, liquidity ratios and patient revenue indicators.

MB: One thing COVID has taught us is that the healthcare market is rich with innovation. However, when it comes down to seeking out new partnerships to help the bottom line, there are really only two elements to consider: 1) does the partnership improve healthcare value in 30-90 days, not years; and 2) does it drive new, sustainable revenue. Both of these elements are why we’ve leaned in on IV infusion services—because we can and will impact both.

JK: Strategic partnerships are key for community hospitals to consider. There are many options besides mergers and acquisitions, including affiliations that allow a smaller hospital to leverage a partner’s resources, facilities and physicians. Management relationships are another option that can provide economies of scale. Pursuing a partnership can sustain a hospital and support expanded services, depending on community need.

MB: With any chronic illness, the onus is on us to guide the patient. At a service line level, a best practice is managing the patient experience and barriers to care. Case managers can speak at the patient’s level and connect the players to manage patient expectations and distress. Transportation is also a social determinant impacting whether a patient gets healthcare—especially for daily/monthly services, like infusion—and should be assessed.

JK: Rural residents are more likely to experience certain socioeconomic factors that negatively affect health. To address this challenge, small hospitals often team up with other local community organizations. Among our partners, one successful hospital partnered with the local fire department to provide home healthcare visits for patients who lack transportation. Another hospital teamed with a local food pantry to deliver produce, immunizations and health screenings to isolated residents.

MB: With the ongoing clinical staffing shortage, the solution for years has been to contract out these resources. The catch: It's very difficult to secure that staffing, particularly in rural areas. The solution, we believe, is partnering with service providers where the staffing is built in. It’s one of the key reasons our company provides a turnkey service—we’ve seen it be a game-changer for so many rural providers.

JK: Although rural hospitals face recruitment challenges, leaders can improve their ability to attract and retain quality candidates by strengthening their hospital’s reputation. The best way to begin is for leaders to get involved in schools, organizations and activities. These connections help increase awareness of hospital services and provide a pipeline for future talent. Efforts to improve the community also make it more attractive to recruits.