CEO Report: Focusing on Rural Health in Michigan
Posted on February 08, 2018
I returned yesterday from the annual American Hospital Association Rural Health Care Leadership Conference, where more than 800 rural clinicians, trustees and executives gathered to share the latest insights on emerging trends, best practices, and key public policy matters being debated in state capitols and Washington, DC. Hot topics included the opioid epidemic that is consuming rural communities across the nation, Medicare payment reform, the precarious future of the 340B program, and much more.
In both the formal presentations and the informal dialogue, two things stood out from this event. First, there is a stark and growing difference in the viability of rural hospitals in Medicaid expansion states like Michigan and those in states that have not expanded Medicaid. While we were fighting hard to successfully launch the Healthy Michigan Plan – which at last count now covers some 673,000 Michiganders – other states were fighting to prevent the adoption of a similar program. For those in the latter category, the unabated growth in uncompensated care has simply been too much to overcome for facilities that were already struggling financially. Rural hospital closures are becoming a reality.
But perhaps even more poignant is the recognition that “business as usual” is no longer a viable strategy for rural health. There is tangible energy around the rural Accountable Care Organization concept; in fact, this concept is alive and well in Michigan, with a number of our rural members now engaged. Many rural providers are also aligning with a Clinically Integrated Network model. And still more have fully merged with a multihospital system that includes at least one major referral hospital and all that comes with it. In Michigan, a rapidly growing percentage of our rural hospitals now fall into this category. And finally, it is clear that technology has advanced to the point where the biggest roadblocks to more robust utilization of telehealth in rural communities – desperately needed in certain specialties, such as mental health – are no longer the technical shortfalls, but rather the legal and regulatory barriers. That is exciting and frustrating all at the same time. (On that note, our own U.S. Sen. Gary Peters was praised for his co-sponsorship of S.787, the Telehealth Innovation and Improvement Act of 2017.)
According to the latest U.S. census, rural Americans are notably older and sicker than their urban and suburban counterparts. And the evidence suggests that rural America has not benefitted from the economic recovery to the same extent as other regions; in other words, most of the job creation has occurred outside of rural communities. While rural areas currently cover 97 percent of the nation’s land, they are home to only 19.3 percent of the total population. Demographers believe that we are moving toward a future state in which an even higher concentration of the population will be located in nonrural settings. All of this to say that rural healthcare will continue to have unique challenges going forward.
The truth is that I have always had a special place in my heart for rural Michigan and for our rural members. Years ago, I had the privilege of staffing the MHA Council on Small or Rural Hospitals and working directly on the development and implementation of Michigan’s Critical Access Hospital (CAH) program. I also had the privilege of serving on the board of trustees at Charlevoix Area Hospital, one of 36 MHA members that have become certified as CAHs. Some of the smartest and most effective leaders I have encountered have come from the ranks of our rural membership. In addition to holding the title of CEO, many of these leaders wear multiple hats in their organization: chief nurse officer, chief of government affairs, chief of public relations, or all of the above. Their margin for error is thinner: the loss of a single specialist physician could be devastating to the organization and the community, a single bad patient outcome could skew their quality data, and so on. In a small town, there is nowhere to hide when the hospital is experiencing challenges of any kind. This is especially true when the hospital is the largest employer in the community, which is very often the case in rural Michigan.
The MHA is proud of the work we have done together with our rural members to advance healthcare in Michigan. Over time, the list of funding and public policy matters that we have successfully addressed is long and impressive. And yesterday, as part of his executive budget recommendation for the coming state fiscal year, Gov. Rick Snyder announced his continued support for the Obstetrics Stabilization pool (which primarily benefits our rural members), as well as a funding increase for the Small or Rural Access Pool. Both pools were initially created – and subsequently protected – by the MHA and our members working together to effectively articulate a real need. Our Council on Small or Rural Hospitals, currently chaired by Marc Augsberger, CEO of McLaren Caro Region, and staffed by Bill Jackson, MHA CFO, continues to assist the association as we seek to add maximum value to our rural membership.
I have often recited the mantra “we are all in this together.” It has multiple meanings. Within organizations, silos can stifle the ability to work collaboratively to address issues. We must work together. Within communities, every one of us will be a patient at some point. We must work together. And within the MHA membership, rural and urban providers alike are charged with ensuring that all of our residents – regardless of ZIP code – have access to high-quality, affordable healthcare. We must work together, in terms of both our advocacy in the public policy arena and in our operations and shared learning.
With that in mind, I urge you to consider registering for the MHA’s upcoming Breakthrough conference. Like this week’s AHA conference, this is a terrific opportunity to learn from expert faculty and to network and exchange ideas with your colleagues throughout the state. I hope to see you there.
Posted in: MHA Rounds