It Doesn’t All Have to Be Doom and Gloom for Rural Hospitals – A Blueprint for Improving Cost Structures

While I do believe there are multiple reasons not to count rural healthcare out (which I will get into below), I also do not want to paint a picture that ignores the reality many of the country’s rural health systems, hospitals and communities face. The truth is, we have seen an unnerving number of hospitals close (at least 146 since 2005) and/or stop offering critical services, such as labor and delivery (100 since 2020). And those numbers are predicted to grow, with more than 700 hospitals across the U.S., at risk of closure. 

As a practicing cardiologist earlier in my career in rural Texas, I saw first-hand the challenges facing these organizations. We couldn’t attract or keep critical staff; we couldn’t treat a large number of patients who entered our ED (often as a result of the aforementioned staffing issues); the quality of care delivered – and the speed – was far from consistent. It was excruciating to see these kinds of problems that negatively impacted peoples’ lives, often worsening patient outcomes.

Based on that experience 15 years ago, I began to see opportunities to address the problems faced by so many rural hospitals, improve patient outcomes and an organization’s bottom line. 

Today, we are at an inflection point: we have already lost so many rural hospitals and risk losing even more. But we are also living in a moment of great advances in technology and innovation that allows us to find new ways to address challenges. There are new opportunities being uncovered that give me hope that we can find ways to address many of the long-standing problems facing rural hospitals.  

One reason for having this conversation now is because hospitals and health systems must start thinking about their use of the Rural Health Fund, $50 billion in federal funding for a new “rural health transformation program,” that was included in the budget reconciliation bill. With a blueprint that outlines some proven strategies to improve cost structures, hospital executives can begin to make data-driven decisions about the best way forward for their organizations and communities.

Take inventory of models of care 

One size does not fit all when it comes to addressing America’s rural healthcare crisis, so it’s important to start by identifying where an organization is in order to know where to begin. The answers to the right questions can help set the direction.    

• How many patients does your organization transfer each year?
• Are those patients being transferred for specific specialties, such as neurology and/or cardiology?
• If we had access to a specialist provider that addresses the reasons for those transfers, could we keep and treat those patients?
• How much revenue would that help us retain?
• What specialty acute care do we offer and do we need to expand those services in order to serve our community’s evolving needs? Would that care need to be part-time, full-time?

• Are we offering care virtually, hybrid, or in-person only? What do those patient volumes look like and what has been the impact?
• How are we caring for patients across the continuum and coordinating care into the outpatient setting post-discharge? Is it connected or disjointed?
• What would the impact on our patient experience be if we could allow more patients to get the care they need close to home – without having to transfer?

If an organization does not have a system in place to collect and analyze this (and similar) data, it’s important to start there. Create the infrastructure and processes necessary to accumulate and examine metrics that will paint a comprehensive picture of an organization’s unique opportunities and challenges.  

Identify innovative solutions that address gaps

Since we are facing a shortage of providers across roles and specialties – and that’s expected to get worse in the future – we need to get creative with the ways we connect clinicians and patients, and consider the role technology will inevitably play. From urgent care to the emergency room and inpatient/outpatient hospital settings, the right solutions can both improve patient outcomes and a hospital’s bottom line. 

AI-enabled urgent care can reduce ER burden and drive revenue 

For health systems, an effective urgent care strategy can shift care upstream, build a referral pipeline, and introduce non-acute patients in the community to the system. It also can relieve overburdened emergency departments and primary care providers. But, in order to achieve true business-driving results, health systems must deploy a technology-enabled model that delivers measurable ROI, such as: significant reduction in door-to-door visit times; increase in patient satisfaction; improved diagnostic accuracy; reduction in costs, such as real estate and staff; and an achievable “break-even” financial model. 

With the current fragmented healthcare system, the ability for health systems – especially in rural communities – to offer services across a patient’s care journey is no longer optional; it’s imperative. By reimagining how that care is delivered, systems can both improve patient access to quality care and the bottom line. 

Acute specialty telemedicine can reduce transfers and improve operational efficiency

Rural hospitals and health systems are struggling to keep or find specialty providers to administer in-person care. The impact of that is felt by the people living in those communities; they must go without necessary care, drive more than 45 minutes to get the care they need, or be transferred to a hospital far away from their home and loved ones. That means care is often delayed, which can have a significant impact on outcomes. 

On the other hand, when a hospital is able to provide virtual specialty care on-site and keep those patients within their walls, the results go beyond improved patient outcomes. By introducing these programs for inpatient care, hospitals can retain higher-complexity patients, thus reducing both transfers and avoiding revenue loss.

AI scribe technology can strengthen billing accuracy, improve patient care and reduce burnout

AI scribe technology offers rural hospitals a practical way to ease the growing strain on their providers while enhancing patient care. By automating clinical documentation, scribes reduce the time physicians and nurses spend entering notes, freeing them to focus more on patients, which can improve accuracy and consistency in medical records as well as help mitigate burnout. For hospitals under pressure to do more with less, AI scribes can support financial sustainability and a healthier, more satisfied clinical workforce.

The problems facing rural hospitals and health systems are real, and we need to make sure we are addressing them across the healthcare system. While we continue to work on them as a country, there are opportunities to improve an organization’s cost structure with innovative and creative solutions based on exciting technological advancements available today. 

Photo: Courtney Hale, Getty Images

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