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The biggest challenges facing rural hospitals

Rural hospital executives discuss past, present and future struggles and opportunities

Over the past few years and as we move into the future, many rural and critical access hospitals throughout the country have continued to struggle when it comes to rising costs of care and decreased reimbursements, as well as the recruitment and retention of high-quality clinicians and staff, among other challenges.

However, Bob Wallace, service line director of outreach at Centura Health in Englewood, Colo., says he "tends to be an optimist" and believes there are also a number of promising opportunities for rural hospitals, especially when it comes to shared services and the potential for some regionalization with small, community hospitals.

"Rural hospitals can bring tremendous value to healthcare systems and can provide the right care at the right place locally. That's going to make them attractive to larger systems, especially when larger systems are looking at the potential expansions of ACOs," said Wallace, who works with rural communities and rural and critical access hospitals across the state to help them support keeping quality healthcare local.

Despite Wallace's optimism, there's no denying the ongoing issue of recruitment and retention of quality employees.

"Primary care physicians are tough to come by," he said. "It's tough to not only find a general surgeon but one that is willing to move their family to a small agricultural community. That's always going to be a problem, but the other piece is retention and making sure that the folks out there will stay there and enjoy the life of that community."

Chris Fox, CEO of Avantas, a leading provider of strategic labor management technology, services and strategies for the healthcare industry based in Omaha, Nebr., said while retention and recruitment of quality staff and maintaining necessary resources at rural hospitals can be challenging, small hospitals can band together to save on costs and resources.

"Smaller, rural hospitals can share resources internally or across regions if they choose to," said Fox. "It can be an opportunity to align resources and staffing groups."

Jackie Larson, senior vice president at Avantas, added that automation tools can be of great use to rural hospitals, especially when it comes to balancing staff members and utilizing resources in the best ways.

"The tools can be used to leverage the amount of staff a facility may need at a particular time. Labor is the biggest cost center and can be one of the hardest to predict," she said. "A rural hospital can use the tools to proactively align labor and plan ahead for variations."

Jay Jolly, CEO of Goodland Regional Medical Center in Goodland, Kan., mentioned that it's imperative that rural hospitals continually reach out to their communities when it comes to the types of services they offer and how they can be used.

"Keeping services in the front of the community so they are aware of what we do and remember to use our services if they can is extremely important," he said. "Whatever changes health reform continues to bring, it'll be increasingly important to be out in the community educating people about the changes and how it affects care right here at home."

Regardless of the challenges or opportunities facing rural hospitals in the future, Wallace understands the important role these institutions play in small communities.

"The concern with a lot of us in rural healthcare is that while there are people in Washington from rural areas that know how important these hospitals are to those communities, there's a majority that don't, and they don't realize that typically rural hospitals are the largest employers in the small counties and typically they have the biggest economic impact in the community," he said. "These hospitals have the opportunity for the most influence within a small population to affect the healthcare of that community positively if it's done right. Just because you choose to live in a rural community doesn't mean you should get second-class healthcare."

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