Trending in Rural Healthcare: Three Ways to Stay Competitive

Posted on February 24, 2015


The rural healthcare system has changed dramatically over the past decade due to the implementation of the Affordable Care Act. However, overall resources still remain relatively inadequate. Many rural hospitals continue to experience shortages of physicians, reimbursements, financial strains and new information technology requirements. In fact, nearly 50 rural hospitals have closed their doors since 2010. But is it all doom and gloom? Not if we stay ahead of these three trends:

TREND 1: Telemedicine, EMR and digital clinics

We have to embrace technology. We can no longer deny it, especially since telemedicine - the use of telecommunications technologies to support long distance healthcare - has become more common and isn't going away. It helps tackle the problem of physician shortages by connecting patients and providers over long distances, as well as increasing your patients' access to specialty care.

Telemedicine is also a great use for extended therapy; patients can do sessions from their home, using video game consoles and telecommunications with therapists, hopefully saving more money than they would if they went into clinics.

Electronic medical records were mandated by a 2009 federal law, but many rural hospitals have still not gotten on board. Electronic medical and health records are not only easier to organize and understand, but they also allow different doctors' offices and clinics to collaborate on patients' care and better understand their patients' medical histories, especially those with chronic illness. Not to mention, this kind of technology helps rural hospitals attract more physicians.

A third digital trend is the digital health clinic, which increases access to care while reducing costs. This allows patients in rural areas who don't have access to specialists, or those who can't leave their home, to get the treatment or advice they need.

TREND 2: Prevention, education and outcomes

Generally speaking, rural hospitals care for an older, sicker, less educated, less-affluent and more overweight population. That can pose many challenges when it comes to the shift of reimbursements from fee-for-service toward pay-per-performance.

As healthcare becomes increasingly outcome-based, evidence and definitions for high-quality outcomes will be in high demand. We'll also see pressure to deliver better outcomes at lower cost. Rural healthcare providers must acknowledge and confront this challenge by emphasizing prevention.

TREND 3: Mergers, acquisitions and collaborations

We're seeing this across the board in Wisconsin. And the strategy for many of the mergers and partnerships is to negotiate now, from a position of strength, rather than waiting for market pressures to force a move. In order for rural hospitals to survive in the changing climate, we must focus on the development of innovative delivery models that promote integrated, quality healthcare within budgetary constraints. Resource sharing, integration, and joint venture arrangements with regional partners can yield benefits without surrendering independence.

What can you do today to stay on top of the trends?

1. Keep track of market share to determine how many patients are leaving town for care.

2. Use surveys and/or focus groups to understand your weaknesses so you can improve your community perception.

3. Develop messaging strategies based on your strengths.

Want to discuss any of these trends in more detail? Send me an email or give me a call at 920-544-8102.

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How to Meet the Demand for Primary Care

Posted on February 10, 2015


Under the Affordable Care Act (ACA), primary care has taken center stage - and for good reason. Reorienting hospitals and clinics toward primary care is a fundamental step in making healthcare more accessible and affordable. It can decrease ER visits, reduce hospitalizations and even lower mortality rates.

But as the number of PCPs continues to shrink, the demand for primary care continues to rise. That begs the multi-million dollar question: How can rural hospitals keep pace?

The answer is far from simple. In fact, there is no "one" answer. All hospitals, especially rural hospitals fighting to compete with bigger healthcare systems, will need to take multiple steps to help offset the increased demand for primary care services. That brings us back to the question of, "How?"

I'll sum it up in one brief but critical statement: By turning their focus on prevention, patient education, diagnosing and managing chronic diseases, as well as alternative approaches to delivering care. Here are some examples:

  • Offer virtual learning opportunities and build out your website to include risk evaluation surveys and general health information sources.
  • Implement web-based screening and treatment reminders.
  • Create and promote programs that teach self-screening.
  • Develop a medical home program that coordinates patient care across all settings. Primary care physicians could manage a team of non-physician practitioners; an advanced-practice nurse could conduct follow-up visits with patients with chronic diseases, like diabetes.
  • Create a health action team that includes leaders from all sectors of the community to discuss local health issues. ThedaCare's Community Health Action Team (CHAT) is a good example.
  • Consider the role of transitional care nurses (TCNs). A TCN is generally an advanced practice nurse with a master's degree in nursing. After a patient is released from the hospital, the TCN:
    • Conducts weekly home visits for a certain period of time and is available to the patient seven days a week via phone.
    • Accompanies the patient to the first post-discharge physician visit.
    • Helps patients and caregivers successfully manage the patient's care at home.
    • One evidence summary shows a 30-50% reduction in rehospitalizations, and net savings in healthcare expenditures of approximately $4,000 per patient, within 5-12 months after patient discharge.

It's not a matter of "if" these and other steps need to be taken by CAHs. It's a matter of "when." And that answer can be summed up in one word: "Now."

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