Uncertainty is the new normal for rural hospitals. Finding ways to see through that uncertainty and move forward successfully brought trustees and executives to the American Hospital Association’s Rural Health Care Leadership Conference last month.
Policy and governance were the themes at the Feb. 5-8 conference, which attracted health care leaders from across the country to the Arizona Grand Resort & Spa up against South Mountain on the edge of Phoenix.
(Photo by Mary Knopp – Randall Photography)
The more than 800 conference-goers representing 250 hospitals and health systems heard speakers and attended workshops on topics including leadership, workforce, clinical and financial performance, partnerships, and the new Medicare Access and CHIP Reauthorization Act physician payment system.
“One of the reasons that we’re here is to find out if we’re on the right track in a lot of what we’re doing,” said Jim McHale, board vice president of Central Peninsula Hospital in Soldotna, Alaska, a nearly three-hour drive from Anchorage.
In the desert in Arizona, there were a lot of opportunities to do just that, especially for trustees.
“We have to get really good at pivoting,” said Dottie Schindlinger, executive vice president of BoardEffect in Philadelphia, during a session on generative governance on the conference’s third day. “That requires a lot of smarts on the part of our boards.”
Learning and networking
Governance issues were a focus in Phoenix, with workshops and discussions on best practices for boards, community engagement, the trend toward providing governance support staff, the board’s role in safety and quality, and succession planning.
Conference speakers stressed that boards need to play a larger role in rural health care organizations than many traditionally have, as new care models take hold and value-based payment methods become more common.
“The world is changing so that we’re not just on hospital boards anymore. We’re going to be overseeing care systems,” said Pamela Knecht, president of Accord Limited in Chicago, who led a Sunday workshop with about 100 participants, mostly rural hospital trustees, on the conference’s opening day.
Participants in the sessions, many of which were standing room only — or sitting-on-the-floor room only — heard opinions on the nitty-gritty of governance: procedures, board-management relations, self-evaluation and meeting agendas.
The conference, in its 30th year, gave trustees, executives, physicians and nurses from rural hospitals, health systems, and public health and community organizations a chance to learn the latest on legislation and policy. Most of the attendees wanted to hear about what they might expect from the new administration in Washington: the future of the Affordable Care Act and of regulations.
“We understand the stakes are really high,” said Maryjane Wurth, executive vice president and chief operating officer of the AHA, at a federal update session.
AHA President and CEO Rick Pollack moderated a panel on access to care on the conference’s second day.
“While rural communities grapple with the challenges of protecting access, they will need tools to help them determine which services should be maintained globally and delivery system options that allow them to do that,” said Pollack (pictured/photo by Mary Knopp – Randall Photography).
The panel laid out the findings of the AHA Task Force on Ensuring Access in Vulnerable Communities and described the work rural hospitals do to provide essential services.
AHA staffers urged participants to reach out to their legislators to make sure hospitals’ concerns are addressed.
“Let me tell you, as a lobbyist, your voice is infinitely stronger and more important, and members [of Congress] listen to you far more than they listen to any lobbyist,” said Sarah Macchiarola, AHA senior associate director for federal relations.
Immediately after the task force report on the conference’s second day, a group including 80 or so trustees learned how they can help guide discussions about access back home.
“In order to transition to these new care models, you’re going to need acceptance and buy-in from the community,” said Priya Bathija, AHA senior associate director for policy, who moderated the session.
From the board’s perspective, it’s important to ask: “Is this improving access? Is this affordable? How am I going to pitch this to the community?” said panelist Bobbie McGrath, board vice chair at Holton (Kan.) Community Hospital, a 12-bed critical access hospital.
Collaboration and partnerships were recurring themes at the conference. The growing push toward population health management and clinical integration make cooperation a necessity for rural hospitals, which often lack resources to provide coordinated care on their own.
One hospital that found solutions to this problem is Mackinac Straits Health System in St. Ignace, Mich. Among other initiatives, the hospital partnered with the Sault Ste. Marie Tribe of Chippewa Indians on population health, helping earn Rodney Nelson, Mackinac Straits’ president and CEO, the AHA’s Rural Hospital Leadership Award, which was presented in Phoenix.
There were any number of other creative strategies board members could hear about as they moved from room to room. Executives described rural accountable care organizations: the Illinois Rural Community Care Organization, the Wilderness Health collaborative in Minnesota and the Community Care Partnership of Maine. A session on MACRA drew capacity crowds two days in a row, while technology and consumerism were hot topics.
“In the next 60 seconds, I could hail an Uber; I could book a dinner reservation for two; and I could have Amazon deliver flowers to my wife via drone. That’s the backdrop against which our patients will measure their hospital experiences as consumers in the future,” Pollack said.
While hospitals need to rethink their services to reflect a changing patient population and its needs, boards need to rethink their internal composition in the same way, conference speakers said. The consensus was that not only is increased diversity — in gender, background and, especially, age —essential for health system boards, but so is a broad and up-to-date mix of professional expertise and skills.
For rural hospitals, that doesn’t have to be impossible. “You’d be surprised at how many people are willing to serve on the board of a not-for-profit health system even when they don’t live in that community,” Knecht said.
Physicians are among those who need to be drawn into the strategic process, participants said, while attracting and retaining medical staff in rural communities remains top of mind for rural health care leaders.
“Some of their issues are that they’re struggling, Joseph Roberts, M.D., a board member at Lumberton, N.C.-based Southeastern Health, said of many rural doctors. “They’re working very hard and trying to maintain their business.”
The road ahead
An overarching concern at the conference was the increasing pressure rural hospitals face to provide essential services while coping with new financial, regulatory and clinical demands. And all of this needs to be done in a transforming health care landscape that is more and more focused on value-based care and the health of populations — including behavioral health and the social determinants of illness.
“The storm is hitting at a particularly challenging time,” health care strategist Jamie Orlikoff (pictured/photo by Brian Frankie) said during a general session on the conference’s third day. Later in his speech, Orlikoff, president of Orlikoff & Associates consultancy in Chicago, told his audience: “We’re at a crossroads. We’re at a disruptive point in the history of hospitals.”
What can be done, said Orlikoff, is to focus on affordability, consumer engagement, and physician alignment and performance, along with improved governance and leadership. “Our value proposition is not being realized,” he said. “It’s up to us to do something about it.”
While concepts such as integration, nimbleness, culture and outcomes were parsed in the desert air, the rural health care leaders assembled in Phoenix had a straightforward but not-always-easy lesson they could take home.
“It’s your job to make yourself relevant to your community,” Orlikoff said.
Contributing: Genevieve Diesing
Brian Frankie is a copy editor at Trustee. Genevieve Diesing is digital editor at Trustee.