Solving the challenges of rural hospitals
The bedrock of many small communities is the local hospital. It supports the economy and community spirit in so many ways.
Rural and critical access hospitals (CAH) face different operational challenges than their larger counterparts. Understanding the challenges of these organizations is the first step in providing solutions that fit their needs.
According to the American Hospital Association (AHA), nearly 20% of Americans live in rural areas. In nearly all cases, the hospital is the backbone of the community, often the largest employer to support the local economy and delivers crucial contributions to community services such as fire, law enforcement and public schools.
What’s more evident than the financial input from these organizations, however, is the impact to community culture. These hospitals help to cultivate a sense of family, pride and belonging.
Often, you’ll find generations working at rural hospitals. For instance, it wouldn’t be unusual to know a young candy-striper who worked her way up over 25 years and is now the Chief Information Officer (CIO) whose daughter is now a delivery nurse and whose nephew works in facilities management.
In rural communities, people aspire to grow up and work at the local hospital.
When you spend time in a rural hospital, you quickly understand how deeply the spirit of community is engrained. In addition, the patients ARE the community. The hospital is providing care to its staff’s mothers, daughters, sons and friends.
This great sense of community contrasts with the increasingly difficult challenges rural hospitals face. Among the most pressing challenges:
- Lower patient volumes and higher Medicare/Medicaid payer mix
- Aging infrastructure
- Geographic isolation far from populated areas with associated limits on resources and transportation access to timely, quality care
As a result of these challenges, many rural hospitals have decided to merge or affiliate with larger health systems in order to stay viable. The AHA cites 380 rural hospital mergers between 2005 and 2016, with some of those hospitals being acquired multiple times.
Unfortunately, the notion of a merger or affiliation often contradicts to the rural hospital’s mission to provide comprehensive care to the community while serving as an employment leader.
“Losing an employer of 150 people with good jobs is like losing a manufacturing plant. Hospitals are usually the largest or the second largest employer in a community. That’s something easy to lose sight of because we think of this from a health standpoint. But the effects are wide-ranging when a hospital closes.” – Mark Holmes, Director, Sheps Center for Health Services Research, UNC, as quoted in PBS.org article, “Rural hospitals rely on Medicaid to stay open, study shows” (Jan. 9, 2018)
A first-hand example
I recently spoke with a rural hospital CIO in northwest Ohio about these challenges. At the time we spoke, he was serving in multiple roles: CIO, CAO and CFO, while the organization was recruiting for those positions. This is a situation you see often in these settings.
He told me: “To lose the independence is to lose the culture. They (the acquiring health system) usually take away key service lines that aren’t profitable (obstetrics is number one), reduce or remove leadership roles, and outsource things that aren’t core competencies, like information technology or nutrition and food services. The result is that community members lose their jobs and patients have to travel out of the community to receive their care.”
This same CIO also responded to a 1 AM wake-up call requesting he come to the hospital to take an elderly patient home from the emergency department. The patient didn’t have transportation and the only cab driver in town was also a patient in the hospital at that time!
What is more unsettling than a community hospital being acquired is the possibility of it closing due to the continued financial challenges it faces. The Government Accountability Office reports that more than twice the number of hospitals closed between 2013 and 2017 than in the previous five-year period, indicating a worsening trend.
So, given the unique challenges of this market – and its steadfast commitment to culture and community – how can healthcare information technology help?
HIT can help best by supporting rural hospitals and communities with cost-effective innovations that reduce clinical and operational burdens, increase access for patients, and improve quality metrics leading to better patient throughput and care.
Below are just three ways to help hospital remain independent and thrive:
- A specifically designed set of solutions. Rural and community hospitals need fully integrated solutions for clinical as well as financial/administrative workflows at a price point that makes sense. With the savings, a rural hospital can invest in what matters most: Staffing and resources needed to provide the quality care and the community culture patients deserve.
- Tackling Social Determinants of Health and patient engagement: It’s critical to make it easy for patients to stay connected by removing social barriers that discourage interaction. As well, an integrated approach to patient engagement ensures patients and care teams are in sync.
- Removing geographic barriers: An integrated ride-sharing app, such as Allscripts Go, ensures patients get to their appointments regularly.
Small hospitals need a fully supported IT solution that delivers the clinical, financial and operational results they need at a price point they can afford.
- Williams, D. et al. (2018 August). Rural Hospital Mergers from 2005 through 2016. NC Rural Health Research Program. Retrieved from: http://www.shepscenter.unc.edu/download/17197/
- Government Accountability Office. (2018 August). Rural Hospital Closures: Number and Characteristics of Affected Hospitals and Contributing Factors. Report to Congressional Requestors. Retrieved from: https://www.gao.gov/assets/700/694125.pdf