Although all hospitals are affected by declining reimbursements, looming "meaningful use" requirements and physician shortages, rural hospitals are often hit the hardest. Brock Slabach, senior vice president for member services at the National Rural Health Association, discusses three challenges facing rural hospitals over the next 10 years.
1. Implementing an EMR. One of the most pressing challenges for a rural hospital is implementing an EMR in time to meet deadlines for meaningful use, Mr. Slabach says. Because many rural hospitals are struggling from decreased revenue and staff shortages, the million-dollar price tag on many EMR systems is more difficult to budget for. Mr. Slabach says that although some rural hospitals may opt not to implement an EMR because of financial and staffing obstacles, "those that don't transition to meaningful use are going to have a very difficult time, given everything coming down the pike [with healthcare reform]."
EMR implementation and support is also a challenge in rural hospitals because of a severe shortage of health information technology professionals. "HIT workers are in very short supply all over the country, not just in rural but in urban environments as well," Mr. Slabach says. "But when you look at rural environments, there is a huge workforce shortage for those trained and prepared to assist hospitals in achieving meaningful use. For example, nursing informatics officers are in such scarce supply already that the thought of being able to get one to a rural community is almost unimaginable." The workers in the most demand, clinical informatics specialists, are also the least likely to be attracted to a rural facility, Mr. Slabach says.
Because HIT workers are in short supply, they also demand higher salaries, which causes a problem for rural hospitals that are already strapped for cash, Mr. Slabach says. In order to overcome this problem, many rural hospitals are choosing to network with other local hospitals and providers, so one nursing informatics officer can work for five different hospitals instead of spending all his or her time in one facility.
2. Changes to the healthcare landscape resulting from health reform. Rural hospitals, as well as other healthcare organizations, have to look ahead to the changes that will come with health reform, including the move toward accountable care organizations, value-based purchasing and bundled payments. "Commercial payors are also going to be much more demanding in terms of wanting to see the value of the care provided," Mr. Slabach says. "The demand for having data at your fingertips and being able to demonstrate that data to third parties requires an advanced information system."
The increased focus on quality measures means that rural hospitals — many of which are already providing excellent care — must prove the quality of that care through data collected over time. This emphasis on quality means, again, that hospitals and hospital systems must move toward EMR implementation. "For those facilities that haven't migrated, it will be very problematic to produce that data in the necessary time frame going forward," Mr. Slabach says.
3. Financial deficits and workforce shortages. Mr. Slabach says the three major issues facing rural hospitals are all intimately connected. "Rural facilities are extremely fragile because they're the least likely to be able to afford the capital to do these projects, and they're most harshly impacted by workflow shortages," he says. He adds that the National Rural Health Association is working hard on an advocacy level to increase funding to rural hospitals and encourage physicians to take advantage of programs that incent providers to practice in rural areas.
The whole country will face a physician shortage over the next ten years, but none will be hit so hard as rural hospitals, which struggle to recruit physicians to their locations. Mr. Slabach says physicians and mid-level providers can be incented through loan repayment programs through the National Health Service Corps; it's just a matter of getting the word out and making those facilities attractive places to work.
Rural facilities will also struggle because their populations tend to be more vulnerable — older, sicker and more likely to get sick — and therefore often require more capital and staff for their care. "Rural health clinics and community health centers are often the only source of medical or social service care many patients in a rural community have," Mr. Slabach says. "The things that urban environments take for granted, like social services, community agency programs and disease management systems, aren't available in rural communities." In order to combat this problem, Mr. Slabach says hospitals will have to be proactive about increasing community education, performing needs assessments and deciding on creative programs and services that could address their populations' specific needs.
Read more about National Rural Health Association.
1. Implementing an EMR. One of the most pressing challenges for a rural hospital is implementing an EMR in time to meet deadlines for meaningful use, Mr. Slabach says. Because many rural hospitals are struggling from decreased revenue and staff shortages, the million-dollar price tag on many EMR systems is more difficult to budget for. Mr. Slabach says that although some rural hospitals may opt not to implement an EMR because of financial and staffing obstacles, "those that don't transition to meaningful use are going to have a very difficult time, given everything coming down the pike [with healthcare reform]."
EMR implementation and support is also a challenge in rural hospitals because of a severe shortage of health information technology professionals. "HIT workers are in very short supply all over the country, not just in rural but in urban environments as well," Mr. Slabach says. "But when you look at rural environments, there is a huge workforce shortage for those trained and prepared to assist hospitals in achieving meaningful use. For example, nursing informatics officers are in such scarce supply already that the thought of being able to get one to a rural community is almost unimaginable." The workers in the most demand, clinical informatics specialists, are also the least likely to be attracted to a rural facility, Mr. Slabach says.
Because HIT workers are in short supply, they also demand higher salaries, which causes a problem for rural hospitals that are already strapped for cash, Mr. Slabach says. In order to overcome this problem, many rural hospitals are choosing to network with other local hospitals and providers, so one nursing informatics officer can work for five different hospitals instead of spending all his or her time in one facility.
2. Changes to the healthcare landscape resulting from health reform. Rural hospitals, as well as other healthcare organizations, have to look ahead to the changes that will come with health reform, including the move toward accountable care organizations, value-based purchasing and bundled payments. "Commercial payors are also going to be much more demanding in terms of wanting to see the value of the care provided," Mr. Slabach says. "The demand for having data at your fingertips and being able to demonstrate that data to third parties requires an advanced information system."
The increased focus on quality measures means that rural hospitals — many of which are already providing excellent care — must prove the quality of that care through data collected over time. This emphasis on quality means, again, that hospitals and hospital systems must move toward EMR implementation. "For those facilities that haven't migrated, it will be very problematic to produce that data in the necessary time frame going forward," Mr. Slabach says.
3. Financial deficits and workforce shortages. Mr. Slabach says the three major issues facing rural hospitals are all intimately connected. "Rural facilities are extremely fragile because they're the least likely to be able to afford the capital to do these projects, and they're most harshly impacted by workflow shortages," he says. He adds that the National Rural Health Association is working hard on an advocacy level to increase funding to rural hospitals and encourage physicians to take advantage of programs that incent providers to practice in rural areas.
The whole country will face a physician shortage over the next ten years, but none will be hit so hard as rural hospitals, which struggle to recruit physicians to their locations. Mr. Slabach says physicians and mid-level providers can be incented through loan repayment programs through the National Health Service Corps; it's just a matter of getting the word out and making those facilities attractive places to work.
Rural facilities will also struggle because their populations tend to be more vulnerable — older, sicker and more likely to get sick — and therefore often require more capital and staff for their care. "Rural health clinics and community health centers are often the only source of medical or social service care many patients in a rural community have," Mr. Slabach says. "The things that urban environments take for granted, like social services, community agency programs and disease management systems, aren't available in rural communities." In order to combat this problem, Mr. Slabach says hospitals will have to be proactive about increasing community education, performing needs assessments and deciding on creative programs and services that could address their populations' specific needs.
Read more about National Rural Health Association.