Healthcare leaders across West Tennessee focusing on future challenges.
Challenges abound in the world of healthcare. While many of the issues are the same across the country, unfortunately, they seem to have a greater impact on hospitals in rural areas. Tennessee ranks second only to Texas in its rate of hospital closures. West Tennessee ranks first in the state for closures compared to East or Middle Tennessee. A multitude of factors contribute to that ranking. As we approach the New Year, West Tennessee Medical News asked four healthcare leaders across the region for their take on the current environment as well as what may lie ahead.
Regardless of location, healthcare providers are being asked to do more with less reimbursement. All four healthcare leaders agreed that keeping up with expensive technologies, and equipment, as well as recruiting and retaining qualified staff in rural areas will continue to be a challenge.
"Nationally and locally, I believe that we will continue to see pressure by private payers and governmental healthcare programs to drive cost down and reduce reimbursement to providers. I also believe that lack of access to care is going to continue to be a threat to the healthcare of our populations, due to lack of providers or lack of transportation or other social issues," said Amy Garner, chief compliance and communications officer for West Tennessee Healthcare, which operates seven hospitals across the region. "Geographically, patients have to drive farther distances to larger cities to see specialists. It is critical that we make sure that we are providing services in the communities where people live and work. This can be challenging because of the cost of providing services to smaller populations."
"Reimbursement is difficult for board members, a lot of management and staff to understand. Healthcare reimbursement is complicated," said Nick Lewis, administrator and CEO at Hardin County Medical Center in Savannah. "Every day the top leaders in our healthcare organizations struggle to ensure federal and state programs provide reasonable reimbursement with a well thought out methodology."
"We continue to have to look at ways to trim costs without harming our ability to care for our communities. Healthcare costs are continuing to rise and this will continue to place a significant burden on our healthcare systems. These costs continue to rise past the rate of inflation and the projections indicate that this trend is not going to go the other way any time soon," said Skipper Bondurant, administrator and CFO, Baptist Memorial Hospital - Union City. "The actuary at the Centers for Medicare and Medicaid Services estimates that aggregate healthcare spending in the United States will grow at an average annual rate of 5.8 percent from 2015 through 2025, or 1.3 percentage points higher than the expected annual increase in the gross domestic product. If this continues at this rate we will continue to see hospitals in our state struggle to stay open."
"Recruiting and retaining talented, patient-centered clinical staff is a very real challenge in West Tennessee. The number of people choosing to enter the nursing profession is not growing fast enough to meet the demands of the market, especially considering the number of nurses reaching retirement age. At Henry County Medical Center, we offer a sign-on bonus, tuition reimbursement, and student loan forgiveness in an effort to attract new nurses to our rural hospital," said Neely Ashby, CNO for Henry County Medical Center in Paris. "After successful recruitment, retaining those employees is the next hurdle we must tackle. To improve retention, we are working diligently within nursing administration to build comradery within our nursing units while promoting teamwork throughout the organization."
Facing these challenges means having a solid strategy and being innovative in those strategies. "Strategies evolve and do change over time and some of the ones we have used for years in healthcare still apply today, and some do not," said Bondurant. "One of those currently going through this cycle is healthcare acquisitions of existing practices. There is no question that healthcare systems have to own practices these days, but the main question is what kind of practices to own and how do you manage them efficiently."
"Healthcare has moved through a wave of changes," said Lewis. "Every few years, we need to retool ourselves to adapt to market demands. If you're not adapting to the market, you're not going to be in for the "long haul." I would caution rural providers in being the first adopters of any market forces in rural communities because of the potential downside risk."
"In my opinion there is no single strategy for the future and it takes a baseline of strategies that will evolve over time. This evolution is produced because of the very talented people in our organizations that consistently look at ways to improve. We cannot simple sit back and implement a strategy and say this will work for the long run and never seek ways to improve it," said Bondurant. "Here at Baptist, we call this way of thinking the Baptist Management System. We understand we have a solid core, but we use the Baptist Management System to test new ideas and concepts so that we can improve our processes and be better for our patients."
"There are strategies that make sense in rural areas where there are not as many choices or providers," said Garner. "One of the strategies that is working in rural areas is using telemedicine in behavioral health to connect patients in emergency departments with behavioral health professionals that may be miles away. I think this service will continue to expand to more specialties and locations in the future.
"I do think we in the rural setting have to get a little more creative about how we deliver healthcare, said Bondurant. "Here at Baptist Union City we are really investing in tel-health programs and have recently started tele-stroke, tele-infectious disease, and tele-eICU. These tele health programs allow us to take better care of our community through web-based protocols by connecting us with neurologists, infectious disease doctors, and intensivists. We normally would not be able to recruit these doctors here to Union City full time but with tele health we can have access to them at our finger tips. They can work with our on-site team to provide the care our patients need."
Collaboration is key say all four healthcare leaders. "It is extremely important to collaborate for the benefit of healthcare in West Tennessee, said Bondurant. "We are all in the business of taking care of patients and we are all in this boat together. The systems collaborate through our great Tennessee Hospital Association and our American Hospital Association. We have great leaders at both agencies who help support our efforts to advance the work of our hospitals and our efforts to care for the good citizens of Tennessee."
"Collaboration with other healthcare organizations and their leaders is imperative in this ever-changing world of healthcare," said Ashby. "The issues rural hospitals are facing are similar to those of most hospitals. Collaboration and networking are inexpensive ways to gain valuable information and insight into solving the challenges we face as leaders in healthcare."
"Working with other rural hospitals to provide needed services is very important for patients all over West Tennessee," said Garner. "Additionally, working with organizations like the Tennessee Hospital Association, the American Hospital Association, and the Rural Health Association of Tennessee are just a few of the ways we communicate with each other and raise issues collectively."
"Acting with a single voice is critical to prompting any change. Legislators seek consensus on issues. It provides our legislators with a sense of course correction on federal and state issues, if needed. We advocate through our state and national organizations such as the Tennessee Hospital Association, Hospital Alliance of Tennessee, Tennessee Rural Health Association, American Hospital Association and the National Rural Health Association," said Lewis. "My role is to be a voice which helps ensure true rural healthcare providers are represented when changes in federal and state programs are on the table for discussion. The issue of getting other rural healthcare leaders to come forth representing their organization is key to not only for their organization but Hardin Medical Center. Being active at the federal and state level with our legislators. They need and want our involvement."
"Rural healthcare is always going to be a need in the smaller communities across the nation. I know we have some of the most talented and dedicated people at Baptist Union City and in all the hospitals in West Tennessee, and for that reason I know the future is secure," said Lewis. "I believe healthcare is a calling, and that calling is the same in the rural setting as it is in the urban setting. We are all in this business to serve others and here at Baptist we get to live out our faith in service to our patients and in service to each other."
"The outlook for rural healthcare in West Tennessee is more important than ever for our hospital leaders, our employees, and citizens of our communities to get involved to ensure our lawmakers understand the important role rural hospitals have in our communities," said Ashby. "Rural hospitals are often the largest employers in the community, provide ease of access to emergency care, and allow for care to be received close to home. The work will not be easy, but with diligence, collaboration, and constant planning we can be successful in continuing to provide high-quality healthcare to the citizens of our rural communities."