What is to be done about Rural Healthcare?
today, rural healthcare at a breaking point.
My name is bill Russell. I'm a former CIO for a 16 hospital system and create, or this week health, a set of channels dedicated to keeping health it staff current. And engaged. We want to thank our show sponsors. We're investing in developing the next generation of health leaders, short test and artist site two great companies. Check them out at this week. health.com/today.
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And we also appreciate your help in helping us to raise money for Alex's Lemonade stand. All right. Today we're gonna be talking about rural healthcare, and there's a great article.
Dartmouth Health, c e o. Rural Healthcare is at a breaking point. Dr. Joanne Conroy is CEO and president of Dartmouth Health based in Lebanon, New Hampshire, which is rural. She is the chair-elect of the American Hospital Association's Board of Trustees and will chair the board starting in 2024.
And here's what she had to say. American healthcare wasn't a crisis before the pandemic, however, On what we are now seeing, especially in rural hospitals and health systems, the worst may be yet to come. Our rural hospitals and healthcare systems continue to lose money. Many think the pandemic is over, that we are out of the woods and can get back to normal.
Current data shows that new cases and hospitalizations and deaths from Covid continue to decline, but there's still a threat, an early flu season,
and high rates of R S V infection among our children late last year. Added strain on healthcare. In addition to the increased demand caused by the triple demic, we have ongoing workforce challenges, inflation and supply chain issues
that may cause even more economic stress than the first three years of the pandemic, and the challenge is even more significant. For rural facilities last fall report from the American Hospital Association showed that 136 rural hospitals closed from 2010 to 20 21 19. In 2020 alone. Texas Hospital Association has warned that one in 10 hospitals in the state is at risk of closure with nearly half.
Of the state's hospitals projecting negative operating margins. Uh, let's see. Let's go down a little bit. Hospitals rely on these post-acute care facilities, so she goes into the challenge of staffing and she said the staffing isn't only for the hospitals, it's also the post-acute care facilities, and this is what she has to say.
Hospitals rely on those post-acute care facilities for safe patient discharge. When they no longer need hospital level care, and here in New Hampshire, 30% of the state's limited number of post-acute care beds are closed because of staffing. At my hospital alone, we average 350 to 400 denials of requests for critical transfers each month.
We are fully staffing every bed we have, but on average we have 75 patients ready to be discharged back with no post-acute care setting that will accept. This situation is far worse in rural areas where the workforce shortages are greater and the options are fewer compared to urban centers. So again, this, the shortage, we have to have a, a larger lens on the shortage.
It's not just the hospitals, it's not just the ambulatory settings. It is technicians, it is nurses, it is, , doctors, it is, staffing in those post-acute care, , facilities as. All right. She goes on so much for being out of the woods. All hospitals, but especially those in rural communities like mine, have been developing innovative solutions to address those critical needs.
In 2014 years before Covid was known to most of us, Dartmouth Health created a Workforce Readiness Institute to help fill our needs. For Allied health positions like pharmacy techs, surgical techs, medical assistants, and phlebotomists, we have strengthened our relationship with the nursing program at New Hampshire based Colby Sawyer College, making significant investments in winding our pipeline for new nurses.
And last month we introduced our center for advancing rural health equity, partnering with communities and community organizations to address social determinants of health, giving our communities mainly rural, a stronger foundation of wellbeing to better navigate this at future public health crisis, however much more needs to be done to strengthen our healthcare infrastructure. You all experience the symptoms of systems under. When you can now find a primary care provider, you have to wait more than eight hours to get prescriptions filled. You stay in the emergency room for hours for a bed to become available in hospitals, or you have to delay getting necessary surgery because of operating room closures.
We're gonna come back to this list. By the way, when our community's experienced natural, natural disasters, we lament the shortcomings of our infrastructure, proposed ways to make it more durable and resilient, and then ultimately dolittle or. However, this storm battering healthcare is different. We simply do not have the luxury of crossing our fingers and hoping the best next time.
Our inactivity has real-time implications for patients who are parents, children's, and neighbors. All right, now she goes on to solutions that she's proposing. . These unprecedented times also present an opportunity to re. The training models for physicians and other healthcare professionals.
We still train our physicians as we did a hundred years ago. And modernizing our approaches could help us train providers faster and more efficiently. And we've heard this from a lot of people. We heard this from Dr. Klasko. We've heard this from leaders across the board that, , we have to look at how we're training new clinicians in the field and what it means to practice at the top of their license anyway.
We'll go on in its final days, the hundred 17th Congress passed legislation that extends among other things, programs and financial support that will benefit hospitals and service providers in rural areas, as well as telehealth benefits for Medicare beneficiaries. First expanding during covid that proves so valuable to patients and providers everywhere.
These are steps, although small ones in the right direction. Okay, so the government is subsidizing rural health.
The American Hospital Association continues to advocate. For solutions, including lifting the cap on Medicare funded physician residencies, boosting support for nursing schools and faculty, providing scholarships and loan forgiveness, and expediting visas for all highly trained foreign healthcare workers.
These are important initiatives and help from measures like these cannot get here soon enough. The pandemic and the issues created and magnified are not in our rear view mirror. They're still right on top of us, and we need solutions to keep rural healthcare systems solvent and working. We and our patients cannot wait. Okay, so there are some solutions for you reimagine how we do, , medical training.
, continue to have the government subsidize some aspects of rural healthcare. And then, , some of the other things like lifting the cap on, , Medicare funded residencies, and, allowing, , visas and scholarships, loan forgiveness, , all good solutions. and, potentially, alleviating some of the challenge that we have today.
I am not to disagree with any of these, proposals. In fact, I agree with, , Just about all of them. , but as I'm looking at this, I'm wondering is are we extending a model that is potentially not serving our rural communities? Well, it is serving our rural communities, don't get me wrong. And anytime there is change, there is a certain amount of chaos that gets introduced into the system and we cannot have chaos in this environment.
So you have to buffer the change to ensure that there is not chaos, but is there a better model for deliver? healthcare in rural communities that is just over this hill, if you will, that we don't see clearly yet
so for example, if we throw out acute care at this point, because acute care is a challenge. That has to be handled locally. But if we throw out, , acute care,
How much primary care can be delivered remotely. Prescriptions we already know can be delivered remotely and we have a, a lot of technology that is starting to step into that gap that could potentially deliver a really high level of health, healthcare, and really relationally based healthcare to that community.
So now, if that's just, if we take acute care out of the equation, if we put acute care back into the equation, it gets more complicated for sure. I'm not disagreeing with that, and we have to look at that, very carefully.
And what does it look like to deliver acute care in those settings? and how are we going to do that moving forward? But what I am saying is if you subsidize the existing model too much, then you prolong the life of an existing model that potentially there's a better model on the other side of it.
All right, let's go back to this list. And the reason I like looking at this list is this is a very good list of what the challenges that people in our communities are facing. as they come into our healthcare systems today, right? Let's see. You all experience the symptoms of a system under stress when you can't find a primary care provider.
All right, so that's one of the problems that exists in a lot of health systems that exist here. Where I live, we struggle to get a primary care appointment before three to four months. and because that first visit is pretty extensive, you have to have a physical and a workup and a bunch of other things.
It's three to four months to get into see your primary care provider. We don't have enough of them. How are we going to, address that? And I'm not bringing this up to solve this problem. I'm bringing this up to say this is a problem. This is a problem that is being experienced in your health system today.
. And it is pretty common. And the answer isn't to just print more primary care providers. The question is, how do we do this more efficiently? How do we give a couple hours back to our primary care providers across the board, either with technology? Or with processes, procedures, alleviating some of the, , documentation burden, whatever it happens to be, giving primary care, , providers some time back.
That's what administrators should be focused on to alleviate this problem. , you have to wait more than eight hours to get prescriptions filled. There are a lot of companies that are coming into this prescriptions, space. And if you're waiting eight hours to get your prescription filled, you might as well have it delivered by Amazon the next day.
I'm not promoting Amazon. There's other, , express Scripts and others out there. I'm just saying, there are alternatives to waiting eight hours to get your prescription filled. Uh, you stay in the emergency room for hours. , for a bed to become available in a hospital and you have to lay delay getting necessary surgery, and this gets back to what you was talking about at, , the post-acute care facilities.
But it's not only that, , that is an easy thing to look at and say, well, we can't solve that problem. But some of the other problems are, , the discharge process and some of the hospitals. As we look at that and realize that, it's waiting on a single signature to let that patient go, and we can't get that signature cuz we can't track that person down for 4, 5, 6 hours.
So we just, we took that bed for six hours when, if we had a much better process for discharging a patient. That we would've opened that bet up five hours earlier. And so we have to look at those areas, the, the things we can solve, the things that are within our grasp, both from a technology perspective and from a process perspective, and tackle those things to the ground. So again, great article. Really appreciate Dr. Joanne Conroy, , writing this article and talking about this. In fact, I'm gonna reach out to her and see if we can't get her on the show and do an interview about this topic. , I believe this is gonna be one of the things that becomes extremely, , acute.
over the next couple of years as we start to see, , more and more rural healthcare facilities close down, communities are going to be extremely upset about those facilities closing down. And it's going to be incumbent upon all of us to seek out solutions, regardless if we are an urban center or a rural center.
I think a lot of care is going to be consolidated. And still delivered in those wide geographies, but consolidated amongst, a fewer number of health systems.,,,,,,,,,,,,,,,
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