Improving Rural Public Health = Rural Healthcare System Strengthening

Rural hospitals are under financial attack.  “Do more with less” seems to be the mantra which, in turn, contributes to rural hospital closures nationwide.   Operating a lean hospital sounds good until it jeopardizes the level and quality of care.  This short discussion explores an alternative that is designed to increase rural facility income; leading to improved healthcare delivery.

The concept is simple. Improve the health of the community through public health interventions and demonstrating this improvement to payers. After community health improvements are realized, as supported by collected data, the facility will generate additional revenue from third party payers, ranging from 3 to 5%.

The initial program goal is to identify and prioritize public health projects based on the unique and individual needs of the community, facility and insurers. Such customization ensures that the most critical community health problems become targets for improvement.

Targets for improvement are selected based on community need, ability to effect change, input from payers and expected effects on the community health as a whole. The ability to have a wide range of interventions is critical as this allows selecting the right intervention for the right job. From increasing physical catchment areas to bringing healthcare into patient homes, we can produce a healthier community.

The tools used to select community health interventions include public health data, disease incidence and prevalence, morbidity and mortality, healthcare utilization rates, geography and GIS, community-based research, projections of health, expenditures and patient flow.

Executing on the plan can be summarized as follows:

  1. Participation – Facility, community and insurer(s) agree to participate
  2. Analysis – Conduct community health analysis
  3. Selection – Select key determinants of health to change
  4. Interventions and Launch – Determine interventions and launch programs
  5. Monitor and Collect – Monitor and collect project data
  6. Report – Report to Insurers and stakeholders

Success = Healthier Communities, Cost Containment and Increased Reimbursements!

What would increased reimbursement mean to an average critical access hospital?  Let’s use an example of $16,000,000 in annual revenue with 40% of its reimbursements coming from private payers, or $6,400,000 from private sources:

3% increase represents $192,000 per year

4% increase represents $256,000 per year

5% increase represents $320,000 per year

In addition to increased reimbursement, this program should provide the opportunity to introduce new service lines.  These include:

  1. Community Paramedicine
  2. Telemedicine
  3. Semi-Permanent Clinics

One critical aspect is that each new service line must be financially independent. While they are not required to make large profits, they must be structured to be autonomous.

In summary, the Hospital benefits by:

  • Establishing new service lines
  • Delivering Care in new catchment areas
  • Improving community standing
  • Healthier population
  • Increased Reimbursements

The Community benefits due to:

  • Customized healthcare delivery
  • Improved outcomes including health, wellness and longevity
  • Increased interaction with hospital
  • Increased interactions with insurance groups

A specific program to launch this program has been developed by Dr. Erik McLaughlin, MD, MPH.  He is an American Board-Certified physician and has completed a Fellowship in Rural and Remote Medicine with Advanced Specialist Training in Emergency Medicine in Australia.  Dr. McLaughlin earned his Master’s in Public Health from Tulane University and completed Family Medicine training in Chicago.  He has worked on six continents, directed regional medical service areas and focused his career on the provision of rural and remote healthcare.

If this topic is of interest to you, please join Dr. McLaughlin during the AzHHA Roundtable Discussions.  He will be leading a discussion on rural healthcare challenges and solutions.

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