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by Mitchell Clark
Published on May 30, 2018

Rural hospitals are often the lifeblood of their communities – which makes their closures noteworthy. By now, many have likely heard the data around rural hospital closures within the last decade: Since 2010, there have been more than 80. But if we push the timeline back just five years to 2005, the number of such 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 is also often a major factor. There has been an increasing trend of residents relocating to urban areas, particularly with college-educated millennials. Even though many hospital staff and physicians work beyond typical retirement age, the decreasing population also limits the potential backfill pool of the aging workforce. This exodus in the community is then amplified by the struggle to recruit new talent away from population-dense metro areas 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 that face 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.

So, what is the real-life impact of these closures? These rural hospitals touch a very large portion of the community that goes far beyond the care that is provided. A closure not only means that those living in the community will face increasingly limited options, they will also be forced to travel longer distances for care. They made end up foregoing care due to their inability to make or keep appointments. Closures also mean a significant blow to the local economy, with several employees out of a job, lost revenues for the county and other 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 any rural hospitals view technology as one of the greatest limitations and challenges they face in today’s landscape, it could 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 and utilize 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 get the ball rolling when it comes to improvement efforts.  

Depending on an organization’s appetite to grow, there are varying extents of how technology can be used in both near term and long-range goals. The sections below go over some of these opportunities in greater detail. 

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 or areas of friction will allow leadership to put together an action plan on how to address these issues.

One of the biggest problem areas for many organizations today is running disparate technology systems or, in some cases, still relying on paper documentation for portions of their workflow across various departments and care settings. These piecemeal platforms that were often created due to cost limitations or as a stop gap were not built 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 for hospitals today is to start analyzing the data their system provides to make more proactive decisions. The system should be able to help leadership identify revenue-increasing areas of opportunity as well as where to decrease spend to improve the bottom line. We have clients, including those at critical access hospitals, who have created data committees that meet and review these areas for improvement and have made a significant impact on their hospital’s performance.

Expanding outpatient services 

The last near-term opportunity that I want to focus on is the shift to performing more outpatient services. While this action alone is less technology-driven, leadership can use data analytics to help identify the biggest 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 not only provide the patient population with high-value health services such as wellness and prevention, chronic disease management and urgent care in a convenient location, but they’re also able to do it at a lower cost to them and the patient. This should also help them increase volume across the more price-sensitive portion of 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 really hold in the next 3-5 years and beyond, but that doesn’t mean there aren’t substantial opportunities for leadership to better position their organizations for what may come. These longer-range goals focused on 18+ months out are going to be more laborious and likely require acquiring new technology, but they can have a tremendous positive impact. 

Leveraging a data analytics program for population health

Developing out a deeper, richer analytics program, either as a standalone or as part of a broader population health strategy, will allow a rural health care organization 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 for their hospital; they’ve been able to look at the data and know exactly how long it would take for that venture to be profitable. 

We have also had clients that have created initiatives to monitor and track annual wellness visits and remind community members when they fall behind. This not only helps keep the patient population healthy, but also brings in revenue from the visits and any subsequent services that get scheduled.

How virtual health can help rural hospitals 

Virtual health is another 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 will need 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 that is not considered part of the go-forward strategy 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, these updated systems will only 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). At 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 something only about 6.5 percent of hospitals in the U.S. has achieved. 
PSMC’s example illustrates that an organization’s size is not its defining factor. All a successful transformation takes is a commitment to change and a willingness to be bold. 

Cerner CommunityWorks has been delivering cloud-based EHR technology paired with managed services since 2009, empowering rural health care organizations to keep up with the ever-changing health care landscape. Learn more here.
 

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