By Mitchell Clark, Cerner
By now, many have likely heard the data around rural hospital closures within the last decade: Since 2010, there have been more than 80. If we look back to 2005, the number of closures increases to more than 120. Additionally, there are currently more than 650 additional rural facilities around the country that are at risk of closing.
Challenges facing rural health care organizations
Rural health care organizations face a unique set of challenges as they operate in an unstable environment year to year. It is all too common for these hospitals to lose funding annually and still face the expectation of meeting new demands or exceed previous performance with less resources.
Budget crunches aren’t atypical in health care, so what else makes operating a hospital in rural America so challenging? Several factors contribute to this trend of hardships and closures, including the correlation with a state’s decision of whether to expand Medicaid, decreased demand for inpatient services and even an inability to recover from the recession.
Age of both the patient population and hospital staff and physicians are also a factor. There has been an increasing trend of residents relocating to urban areas, particularly college-educated millennials. Even though many hospital staff and physicians work beyond retirement age, the decreasing population limits the backfill pool of the aging workforce. This is amplified by the struggle to recruit new talent to rural communities.
Effects of rural hospital closures on the community
With a dwindling population, the remaining rural community residents tend to be those that are less likely to uproot, such as the elderly, the less affluent and those with a chronic illness. This is the portion of the population that needs the services of rural hospitals the most, but are at risk of losing them.
A closure means that those living in the community will face limited options and are forced to travel longer distances for care. They may end up foregoing care due to their inability to make or keep appointments. Closures hurt the local economy, result in lost revenues for the county and local businesses and losing a major pillar in the community.
How health IT can help rural hospitals
As rural hospitals figure out how to do more with less, there needs to be a way to leverage available resources. While rural hospitals view technology as one of their greatest limitations and challenges, it can also be the key that opens doors for their hospital and community.
Rural health care providers deserve to have reliable, seamlessly integrated technology across all the departments they support. However, lacking a large IT department or extensive budget, many rural health care organizations simply don’t have the resources or expertise to seek out new avenues of opportunity or fully understand what they currently have.
One of the biggest challenges facing rural hospitals that are seeking change is knowing where to start. Optimizing the organization to increase revenues and decrease costs can often be hard to envision, and sometimes, a little guidance is needed to identify improvement efforts.
Immediate opportunities for rural hospitals
For rural health care organizations looking to make immediate changes, there are several opportunities to improve and address current issues within the next 12-18 months. At a high level, looking at how the day-to-day flows across the hospital and identifying pain points will allow leadership to create an action plan on how to address the issues.
One of the biggest problem areas is running disparate technology systems or, in some cases, still relying on paper documentation for portions of their workflow across departments and care settings. These piecemeal platforms that were created due to cost limitations or as a stop gap, not for long-term sustainability and growth.
Opting for a single, integrated platform
Consolidating systems into a single integrated platform should help limit the disconnect and confusion for the care team as they provide patient care. It would also empower them to have the right data at the right time to provide the best possible care based on a clear and holistic understanding of the patient.
Leveraging data analytics
Another opportunity is to analyze the data their system provides to make more proactive decisions. The system should help leadership identify revenue-increasing areas of opportunity as well as ways to decrease spend. We have clients, including critical access hospitals, who have created data committees to review areas for improvement and have made a significant impact on their hospital’s performance.
Expanding outpatient services
The last near-term opportunity is the shift to performing more outpatient services. While this is less technology-driven, leadership can use data analytics to identify the opportunities for expansion. An integrated system across inpatient and outpatient will help track the patient across the entire continuum of care.
By shifting services traditionally handled on the inpatient side, rural hospitals can provide the patient population with high-value health services such as wellness and prevention, chronic disease management and urgent care in a convenient location, and at a lower cost to them and the patient. This helps them increase volume across their patient population while also freeing up hospital resources.
Long-range opportunities for rural hospitals
It’s hard to predict what the future of health care will hold in the future, but there are substantial opportunities for leadership to better position their organizations for what may come. These longer-range goals focused on 18+ months are more laborious and likely require new technology, but they can have a tremendous positive impact.
Leveraging a data analytics program for population health
Developing a deeper, richer analytics program, either as a standalone or as part of a broader population health strategy, will allow a rural hospital to make more informed decisions and elevate hospital operations. We have had clients harness the power of data rich analytics to evaluate the feasibility of creating new lines of business; they’ve been able to look at the data and know exactly how long it would take for that venture to be profitable.
Additionally, we have clients who have created initiatives to monitor and track annual wellness visits and remind community members when they fall behind. This helps keep the patient population healthy, and brings in revenue from the visits and subsequent services that get scheduled.
How virtual health can help rural hospitals
Virtual health is a major opportunity in rural health given the remote location of some patients and the limited number of physicians. For virtual health to work, an in-depth strategy surrounding the technology and potential partnerships needs to be built out to provide a comprehensive offering.
Partnering with other rural hospitals
Leveraging a partnering hospital, such as a teaching facility, could allow the organization to offer services to the community that it would not otherwise be able to provide due to physician or specialist availability or financial viability (given the limited need in a small community).
Upgrading to a modern, interoperable enterprise-wide system
Finally, for rural hospitals that are on an antiquated system for their primary technology provider(s), then leadership should strongly consider upgrading or switching systems to something more modernized. Given the rate at which both technology and health care change, an updated system will improve a hospital’s operational efficiencies.
There are countless examples of rural hospitals that have found success through transformation. For example, Pagosa Springs Medical Center (PSMC) shared advice on how they recently attained HIMSS Analytics Stage 7 on the EMR Adoption Model (EMRAM). With only 11 beds and located in rural Colorado, PSMC is the smallest independent acute facility to achieve this designation. Stage 7 is the highest level of implementation and utilization of information and technology applications, and only 6.5 percent of hospitals in the U.S. achieve. This example illustrates that an organization’s size is not a defining factor, but rather a commitment to change and a willingness to be bold.
More AEHIA News Volume 2, No. 3:
- ONC’s Don Rucker, Other IT Leaders to Discuss Interoperability at Advocacy Summit– Bradley Simonich, CHIME
- New Member Benefit – Cooperative Member Services – Rebecca Scholten, CHIME Technologies, Inc.
- Data Growth and Cloud Migration – Ashu Singraur, Contineo Health
Looking to contribute to the AEHIApplications Newsletter? Email your contributions to firstname.lastname@example.org.