Doing More with Less: Biggest Challenges for Rural Healthcare

Posted on Fri, Oct 16, 2015
Doing More with Less: Biggest Challenges for Rural Healthcare

Bill Yarbrough, CEO
EmCare Physician Services

After nearly a quarter of a century of working with rural and community hospitals (most that report volumes of less than 15,000 a year), I have personally seen more hospitals in financial distress in the last several years than I have at any other time. I believe these struggles will be short-term, but that does remain to be seen due to the unknowns resulting from the Affordable Care Act’s (ACA) benefits to these types of hospitals. The biggest challenges for rural hospitals may be continuing to operate until these ACA results shake out. But for rural hospitals struggling in the current healthcare climate and waiting for the positive results of reform, there are things that can be done now.

Going it Alone
Rural hospitals not affiliated with a healthcare system may experience the greatest difficulties. Rural and community hospitals have a critical mission to the communities they serve and are often the only point of care for people in their areas. So when rural hospitals close, their communities suffer. One issue that rural and community hospitals can find challenging is trying to match resources and services with the larger metropolitan hospitals or healthcare systems. But many times, affiliating with these larger groups can help both parties – I’ve worked with such affiliations and they have strongly trended over the last ten years or so. It’s a mutually beneficial relationship - the system gains a presence in a new area while the rural facility gains resources, staffing, expertise and stability. There are a number of innovative arrangements where the relationship doesn't necessarily mandate a system of ownership or necessitate a changing of culture, but the parties simply share resources. There are also several of these agreements dealing solely with specialty care. When a hospital lacks care that a neighboring hospital has, the two can sometimes complement each other in terms of helping communities that are in close proximity.

Perhaps the greatest benefit for a larger hospital or system that agrees to partner with a rural hospital is the achievement of greater efficiency. In terms of HCAHPS scores or patient satisfaction metrics, I see a lot of rural and community hospitals scoring more favorably than their larger counterparts. This tends to indicate that rural and community hospitals have learned to do more with less, often through excellent Lean programs or other streamlined methodologies. That means that the larger for-profit systems and facilities as well as tertiary care hospitals are able to tap into their smaller affiliates for their effective efficiencies and modalities.

Meeting the Recruitment Challenge
Recruiting challenges aren’t limited to rural facilities. Recruiting for large 100,000 volume facilities can be just as challenging. Recruiting is actually EmCare’s bread and butter. Over the past 12 months we started up a number of new groups. Many times we had less than 60 days notice. Usually we have about 90 days, and in many cases we build those groups from scratch. We were able to staff these new practices in rural settings within a very short time frame. So rural recruiting can be done quickly, efficiently and very effectively.

One of the challenges of recruiting to smaller facilities is accessing potential hires. Our culture in general has gotten away from print and mail recruiting. Being able to communicate electronically and through social media and through networks and referrals are critical areas for recruiting. By embracing the newer virtual solutions, it becomes obvious that there are plenty of physicians who really want to affiliate with a quality organization and who want to work in a sustainable practice environment.

In my experience, in order to attract a physician to practice in a rural or community setting, hospitals should strive to be innovative in their packages and focus on promoting quality of life. There are so many beautiful communities around the country that are idyllic and wonderful, not only for raising a family, but also as professional practice opportunities. When you're talking specifically about rural administrators trying to attract somebody to come in and practice medicine, it's about putting the best selling points of the community out there in your recruiting materials. Physicians are looking for great practice opportunities, particularly if they're looking in a smaller community. They're looking for a more intimate practice experience and they want to practice long-term in these types of communities. So playing up the unique and quaint aspects of these wonderful locations can be a very successful tactic for recruiting.

I’ve seen facilities partner with their local chambers of commerce, put potential hires in touch with a great realtor and emphasize how much further their dollars can go in their market. These types of methods can go a long way when candidates come in to interview – the recruits feel welcome, they see how they could be embraced as part of the community.

After nearly 25 years of recruiting for rural hospitals, I am seeing the next generation of physician leadership emerge. One of the things that is personally fulfilling is watching the great energy and leadership brought by physicians that come out of residency programs. They are excited and stepping up and are going above and beyond to be part of the next great wave of physician leaders. The ability to step into a leadership opportunity can be a draw to smaller areas.

Adapting to Survive
Change for change sake isn't a good thing. In my experience, the most effective approach to positive change occurs when hospitals take a long hard look at themselves – or engage an objective, outside perspective – to identify what is currently negatively impacting that hospital.

One way to adapt is to offer specialty services. Patients like to stay close to their families, but if they need care that is not available at their local hospital, they will have to be transferred. No one is saying every rural hospital should have a neurologist, but by making sure there is a range of medical services - including surgery, outpatient surgery and certain specialty care - more patients could stay in the community rather than traveling a hundred miles away from their families. That improves the quality of care and satisfaction of care for everybody. It also enhances the reputation of the hospital.

Somebody once told me that you can either be an aircraft carrier or a speedboat, meaning that there are changes, whether in business or in life, that can be turned around more quickly than others. There are some major advantages to being a speedboat. Smaller vessels have the advantage of being able to change and adapt to evolving environments more quickly, as opposed to being part of a massive system where adaptations can roll out slowly. The key is to turn in the right direction.

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