25 Population Health Challenges & Opportunities for Small Hospitals

While small and rural hospitals face many challenges in managing population health, they also have opportunities for success through close ties with the community and partnerships with other organizations, according to a report by the American Hospital Association's Health Research & Educational Trust and Hospitals in Pursuit of Excellence.

"The Role of Small and Rural Hospitals and Care Systems in Effective Population Health Partnerships" lists 17 challenges and eight opportunities for small and rural hospitals managing population health:

Challenges

Population demographics and health
1. Twenty-three percent of the U.S. population lives in a rural area.
2. Nearly 20 percent of the rural population is over the age of 65.
3. Poverty is common in rural areas, with 16.6 percent of the rural population living in poverty.
4. Almost half of rural residents report at least one major chronic illness.
5. Patients must travel farther for medical care.
6. Patient engagement in medical care is lower due to societal factors.

Financial pressure
7. Nearly half of rural hospitals have 25 or fewer beds.
8. Rural hospitals make up half of the total number of hospitals but represent 12 percent of spending on hospital care.
9. Fifty-six percent of gross revenue for rural hospitals comes from outpatient services.
10. Nearly 60 percent of revenues are from Medicare and Medicaid.
11. Medicare and Medicaid are the primary payers, covering 31 percent of the rural population.
12. Twenty-five percent of rural residents under the age of 25 are uninsured.

Inadequate infrastructure and data
13. Small and rural hospitals and care systems lag behind urban health centers in demonstrating meaningful use for health information technology.
14. Integrated technology and informatics capabilities often lack the ability to measure population health status.

Lack of scale and limited staffing
15. Limited scale presents challenges in becoming an accountable care organization or organizing a patient-centered medical home.
16. Their location and size make recruiting skilled and experienced healthcare workers more difficult.
17. Without sufficient volume for certain medical procedures, rural hospitals are unable to meet certain quality standards or have adequate and accurate data, which can affect reimbursement.

Opportunities

Strong community and patient relationships
1. Being one of the largest employers in their community creates a stronger brand and perception.
2. Residents have a limited number of healthcare options, resulting in long-term relationships.
3. Hospitals use community residents for their workforce, increasing employment.
4. Working with urban health centers and larger health systems, small and rural hospitals offset costs and gaps in resources.

Integration of services
5. Small and rural hospitals are increasing their use of electronic tools and technology, including telemedicine.
6. Small and rural hospitals are partnering with other local health providers for care delivery (home health, prevention and post-acute care).

Federal financial assistance

7. Becoming a critical access hospital provides opportunity for additional funding.
8. Graduate medical education redistribution of unused residency slots gives priority to rural training tracks.

More Articles on Population Health Management:

AHA's Population Health Partnership Checklist
Scripps, SCL Health: Why Hospitals Are Moving to Hospice, Home Health

7 Steps to Population Health

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