Becker's Hospital Review

20 THOUGHT LEADERSHIP continue blocking, tackling, and juggling service needs with volume, managing staffing and provider challenges, assessing the right operation models, and exploring partnerships and mergers. Finances are the key driver behind closures and financial challenges for rural hospitals, so the long- term answer is a drastic payment overhaul. In the meantime, the secret sauce for rural healthcare is more complex and several levers will need to be pulled both regulatory and operationally to sustain the future of rural healthcare. Rashid Syed. Managing Partner of North Houston Surgical Hospitals: In my opinion, the best approach towards improving rural healthcare is to segregate the patient care services from one large hospital system to nimbler healthcare facilities, making it more approachable and personable for both, the patients and the providers, by creating urgent care centers, surgery centers, specialty microhospitals for mild to moderate complexity elective and nonelective treatments and keeping larger hospitals for higher complexity, longer complicated treatments. It's about taking healthcare to the patients rather than patients in need seeking healthcare. Clinical Leaders Andy Anderson, MD. Chief Medical and Quality Officer of RWJBarnabas Health (West Orange, N.J.): Rural healthcare is essential to address the health and healthcare needs of patients and families who live in rural communities. My best idea to save rural healthcare is to provide robust virtual access (through telemedicine and remote patient monitoring devices) to triage and address acute care needs, to better manage chronic conditions, and to provide access to the best specialists to diagnose and treat complex medical conditions. William Morice, MD, PhD. CEO and President of Mayo Clinic Laboratories/ Mayo Collaborative Services (Rochester, Minn.): From my perspective, to save rural healthcare, one must tackle one of the greatest challenges facing rural hospitals and healthcare providers, which is maintaining sufficient patient volumes in their facilities while also developing next-generation tools and capabilities. ese tools and capabilities, such as at-home testing and digital diagnostics, will allow them to reach their patients in their homes spread across large areas. So, my idea is to invest in rural healthcare's ability to interact with patients remotely while also designing practice and social service models that bring them into facilities for care when needed. Done correctly, this will enable rural healthcare to sustain and grow their services while also increasing their reach and convenience for patients. Phil Schaefer. Senior Vice President, Ambulatory Services and Chief Care Network Development Officer of Southern Illinois Healthcare (Carbondale): For rural hospitals to survive, the economics of reimbursement must change along with the hospitals' approach to their cost structures. With almost all major payers having record profits in 2022 and with declining utilization and reimbursement, the current model of paying hospitals is not sustainable. Given this, it's imperative for rural hospitals to reevaluate their service portfolio and bend their cost curve downward. Steve Lipshultz, MD. Goodyear Professor and Chair, Department of Pediatrics of University at Buffalo Jacobs School of Medicine and Biomedical Sciences (Buffalo, N.Y.); Pediatric Chief-of- Service of Kaleida Health (Buffalo, N.Y.); President of UBMD Pediatrics (Buffalo, N.Y.): Improving rural healthcare finances is one of several key elements to sustaining rural healthcare and coming closer to a single standard of US healthcare. Below I list 14 areas where opportunities exist and are needed. Utilizing technology such as: 1. Telehealth; 2. EMRs; 3. Hub-and-spoke health system networking and infrastructures to allow most care in the local community but having the backup; 4. Ongoing physician and other healthcare provider and staff training; 5. Recruitment; 6. Retention, addressing; 7. Workforce shortages with pipeline programs and others; 8. QA/QI oversight and feedback as drivers of decisions based on the quality of care in rural places; 9. Enhanced rural public health; 10. Focused patient management on unique needs in rural settings; 11. Other necessary infrastructures to increase both revenues from payments and reimbursements and other efficiencies and outcomes are key; 12. e transition to value-based care will be very sensitive for rural healthcare with reduced reserves and with unique needs and solutions.; 13. Having a national agenda to reduce disparities by states for funders of rural healthcare around the U.S. will help level the playing field. e differences in reimbursements and uncompensated care for the same services around the U.S. widely vary based on local rules and regulations and (both state and federal) oen cause essential services in rural communities to no longer be sustained.; and 14. Adequate payments and better payment systems are needed with a level playing field. Anuj Vohra, DO. Chairman and Medical Director of the Department of Emergency Medicine of Charlotte Hungerford Hospital (Torrington, Conn.): My best idea to save rural healthcare is advancing access to care by means of telemedicine, home visits and increasing preventative care. Charles Emerman, MD. Chair, Emergency Medicine and Medical Director, Service Line of MetroHealth Medical Center (Cleveland, Ohio): Smaller rural hospitals would do well to form more robust clinical programs that leverage the resources of the larger urban hospitals. For example, we have trauma surgeons who take calls at two smaller rural hospitals. e local surgeons are happy not to take overnight ED calls. e trauma surgeons operate locally when appropriate and then transfer the more complex patients. It works out well for the patients, the local medical staff, and both systems. Andy Anderson, MD. Chief Medical and Quality Officer of RWJBarnabas Health Medical Group (West Orange, N.J.): Rural healthcare is essential to address the health and healthcare needs of patients and families who live in rural communities. My best idea to save rural healthcare is to provide robust virtual access (through telemedicine and remote patient monitoring devices) to triage and address acute care needs, manage chronic conditions better, and provide access to the best specialists to diagnose and treat complex medical conditions. Nisha Mehta, MD. Founder of Physician Side Gigs: Maintaining the quality of care in rural areas will become increasingly challenging as healthcare personnel shortages continue to amplify. Employers will need to place a real focus on retention and recruitment of clinicians, and systemically, threats to compensation by CMS and other payers need to be addressed. Medicare cuts are short sighted and will only exacerbate existing issues with access to care. n

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