Rural hospitals confront many of the same issues as their urban counterparts, while facing other concerns unique to their regions and communities. And usually with much less cushion on the bottom line.
How would you describe the current staffing situation at rural hospitals from your perspective?
Alan Morgan: Workforce remains the top issue. In one aspect, it has gotten better with regard to traveling nurses. The temporary staffing issue and concerns we had with the greatly inflated salary requirements for traveling nurses during COVID surges—that has abated. So that’s good news from a finance standpoint. The challenge is that overall staff costs remain high across the board.
Larry Van Der Wege: It’s hard to categorize, because it’s all relative. I’ve heard of places where it’s worse. I’ve also heard of places where it’s better. Our hospital has challenges, especially when it comes to nursing recruitment, both in our inpatient and emergency department, as well as our clinic. Even in other areas—maintenance, business office—any and all positions are difficult to fill at different times. It’s precarious, that’s for sure.
Outside of staffing, what are some other critical operational challenges facing rural providers?
Alan Morgan: There’s just a general sense of unease about what the next six months to a year are going to look like for hospital finances. The pandemic-related federal assistance has run dry. Prior to the pandemic, almost half the nation’s rural hospitals were operating in the red, so those structural financial concerns certainly remain. And let’s not neglect another major concern in rural areas: behavioral health.
Larry Van Der Wege: Along with workforce shortages, it’s the inflationary costs of those employees. We’re increasing pay scales as much as possible to try to retain the wonderful staff that we have, but also to recruit others. It’s all across the board, not just in nursing. Inflation is also showing up in supplies and all the other services. But reimbursement isn’t keeping up.
What do you think about the Rural Emergency Hospital model from the Centers for Medicare and Medicaid Services? Rural hospitals could give up their inpatient beds in exchange for more reimbursement.
Alan Morgan: If done properly, it could be a substantial lifeline and a very critical solution for many rural communities. But then again, it might not. So many questions will remain unanswered until we see the final rules. To me, this is déjà vu for what happened with the critical access hospital program. It would be the first new provider type in 20 years, so there’s a lot of excitement around that.
Larry Van Der Wege: The reality is that some rural communities just don’t have the volumes to support continuation of acute inpatient beds. They still need all the other services to keep a community healthy and viable: primary-care physicians, physician assistants, nurse practitioners, lab, radiology, an emergency department, urgent care and a robust EMS. I applaud CMS for trying to be responsive and provide another off-ramp for these communities.