Question

What are three recommendations that impact the culture of rural hospitals that is driving results for access, quality, and cost-effectiveness?

Answer 1

1) Matching Needs Of Your Population To Value-based Payment -

The needs of your patient population are constantly changing and are often hard to determine. The hospital’s Community Health Needs Assessment (CHNA) or similar assessment can provide valuable insight as to the service desires and needs of your service area. Hospitals need first to determine what services they can provide, versus which services they can identify for other entities to provide. Hospitals will want to focus on providing those services they can provide in a high quality and cost effective manner due to the future financial rewards for improving value. This will lead to encouraging other health care providers to offer those services for which they do not have the expertise to provide or are unable to provide in a cost effective manner. Under the value-based payment methodology, providers will need to avoid the temptation of attempting to provide all services needed by the patient, regardless of the cost. This will create special challenges for providing services that frequently have low demand, but are still critical to the health of the community.

Matching the needs of the population will also require providers to begin to access more data relating to patient utilization trends. This will allow the provider to begin developing strategies to improve coordination of care, reduce resource utilization and improve quality. The following steps should be considered when focusing in this area:

• Access data to determine needs of the populations
• Assess services that can be rendered by the hospital effectively and efficiently
• Identify necessary external health care providers that could provide complementary service lines
• Begin a process of analyzing utilization data to identify opportunities to improve coordination of care, reduce cost and improve quality

2) Development and Maintenance of Provider Relationships -

One key strategy to maintain volumes of services in the future will be to increase the number of patients being served versus the number of services to be provided to each patient. Successful hospitals will be those that develop strong relationships with primary care providers rendering services to patients in their service area and identify the patient care needs of that population. In general, patients do not choose the hospital they use for services. More often, it is the physician or mid-level provider that refers their patients to the providers of hospital services. Under most value-based reimbursement methodologies, the primary care provider will be the individual that has greatest control on where patients will receive services. For this reason, hospitals need to develop and implement strategies to not only engage with primary care providers, but to develop an aligned vision with these providers.

The process of alignment with physicians can be challenging, due to a lack of consistent incentives and motives in the past. However, it is imperative that hospitals reach out to physicians to create a shared vision and strategic plan. This will include involving physicians more in decision making and governance, improving communication, establishing mutual accountability and assisting these providers in becoming more clinically and financially successful. Working together, rural hospital administrators and physicians will be able to better explore strategies to reduce resource utilization and improve overall quality of care. Those that strengthen these hospital-physician relationships will be well prepared to move into a value-based reimbursement methodology. The following steps should be considered when focusing in this area:

• Identify key providers in the market area
• Develop strategies to deepen relationships and engage identified providers
• Provide input in decision making
• Include in governance o Improve physician-hospital communication
• Establish mutual accountability
• Improve physician, clinical and financial performance
• Establish a monitoring system to gauge the strength of these relationships, and take action as appropriate

3) Understanding Your Market Today and Tomorrow -

While preparing today for the transition tomorrow, it will be necessary to understand the market today. However, for long term strategic planning it is also important to understand the market of the future. The market assessment of today includes demographics of the service area, including age, sex, nationality, education, health status, income, population dispersion in the service area, incident rates of disease, etc. Providers also need to understand the demand for services by service line in their market, their market capture for these services and their competition. This information is crucial in developing programming and marketing strategies to address patient demand for services, attract patients to the organization, and determine where patients go to receive services when not coming to the local facility.

Preparing for the future is more difficult and is often ignored. This requires facilities to access analytical models that can predict changes in local demographics over a period time, typically 5-10 years. These analytical models may be available through local governmental entities, institutions of higher learning or external vendors. In addition to providing predictions on local demographics, there are models than can also provide information on future volume trends. This information can identify inpatient versus outpatient trends as well as trends by medical condition. The information can be used to assist providers in their strategic planning to help prevent the organization from continuing to invest in services or enter markets that are anticipated to diminish in the near future.

The following steps should be considered when focusing in this area:

• Gather current demographics for the market to determine current needs and demands
• Obtain projected changes in demographics over next 5-10 years to include population and service demands
• Determine anticipated changing needs in the market during next 5-10 years to determine service line gaps and service lines that may become obsolete
• Develop strategies to address potential gaps and obsolescence