key: cord-1053213-8qzsxx9r
authors: Howard, Steven; Counte, Michael; Mikes, James; Dybdal, Landon; Linomaz, Jacob
title: Rural Health Care Delivery Organizations and COVID‐19: Major Challenges and Implications for Health Care Management Education and Training
date: 2020-07-09
journal: J Rural Health
DOI: 10.1111/jrh.12495
sha: 9c4937c11b8f98c53eb8649364eb7b6d4c74805d
doc_id: 1053213
cord_uid: 8qzsxx9r

nan

The COVID-19 pandemic has taken a dramatic toll on hospitals worldwide, but few are feeling the pressure as acutely as America's rural hospitals. They have struggled to compete in an environment of rapid hospital consolidation and have comparatively fewer and fewer resources than the health systems growing around them. Many have Critical Access Hospital (CAH) status, and CAHassociated cost-based reimbursement has helped sustain them, as have volumes of positive-margin elective procedures. However, as the pandemic forced a hiatus on elective procedures, rural hospitals and health centers were put at even greater risk for closure. 1 In 2019, 18 rural hospitals closed, and 10 more were shuttered during the height of the pandemic in the first half of 2020. 2 New data show 453 rural health facilities at risk of closure in the near future. 3 This comes at a time when rural hospitals' services are most needed.

This article is protected by copyright. All rights reserved. 2

The evidence is clearer than ever that new health policies are needed to boost rural hospitals' ability to become more self-sustaining. For years, rural providers have struggled with the everincreasing burden of caring for one of our country's most rapidly growing vulnerable populationsthe elderly-a group most at risk for COVID-19. 4 Federal and state governments must give special attention to supporting rural providers, not only during the pandemic crisis, but also in their transition to a -new normal‖ post pandemic. Recent research has brought to the forefront the problems we already recognized in rural health care: financial resource constraints; dependence on long, just-intime supply chains; challenges from out-migration of positive-margin services to larger urban hospitals; and limited resources for rapid training and incorporating new research and best practices.

Not only is the pandemic stretching each of these aspects to the breaking point, it has also caused provider organizations to curtail or completely eliminate the use of clinical students and residents. 5 This could have far-reaching impacts on clinical education and exacerbate the already-forecasted provider shortages. The health care administration workforce is critically essential, both during the pandemic and in the future. Alas, there has been very little mention in the press or scholarly literature about the serious risks of interrupting health administration education. One of the most significant policies state and federal governments can implement is helping rural hospitals build their capacity.

The leaders of our rural hospitals are competent-they are simply resource-constrained. We need new ways of helping them deepen the management, quality improvement, and operational excellence competencies of their management, staff, and boards of directors. How can we build more proactive connections of rural hospitals to university health management programs to grow in this area? And, what must health administration education programs do to align their programs with the unique needs of rural health care providers?

Contemporary rural hospitals and outpatient centers are clearly facing a very turbulent external health care environment and an uncertain future. This turbulence has in turn led to major socioeconomic changes within American society and in local markets as well. As discussed earlier, it is particularly problematic for rural health care organizations, because the effects of external stressors such as Administration that has helped support capacity building at rural health care facilities.

Although not related to COVID 19, the growing comprehensive Value Based Payment reimbursement system developed by the Centers for Medicare & Medicaid Services (CMS) also will continue to have major impacts on health care delivery in rural areas. This was the emphasis of a 2018 MEDHOST publication. 6 The authors conclude that for rural health care providers to be successful, 5 interrelated issues must be addressed:

1. They need to clearly understand the concept of value-based payment (VBP) 7 and use costeffective technology and analytics to track and continually improve services (patient experience, clinical practice profiles, and outcomes).

2. The cost of IT services must be reduced by using technologies specifically developed for use in smaller health care organizations.

3. Rural health care providers need to ensure that their IT system(s) are interoperable and strongly support all managers and clinical staff who need to monitor utilization trends and Rural health facility executives and clinical leaders have a -full plate‖ of challenges. In addition, we need to address the lack of financial resources and multi-function responsibilities of rural managers as obstacles to obtaining traditional management training. This may be the right time to strengthen relationships between rural health care delivery organizations and academic health care management education programs. The academic programs are always seeking experiential training opportunities (virtual and/or residential) for their students, and rural health care represents an attractive opportunity to make an impact. Advanced graduate students and faculty can create effective virtual and/or face-to-face management development programs for managers and clinical staff on specific topics of interest (eg, advances in health informatics, special topics in financial management such as standards-based cost accounting, and basic and advanced methods to assess quality and improve performance in rural health care organizations).

The result of implementing the above recommendations would be to further strengthen the capability of rural hospital executives, managers, and clinical leaders amidst a very turbulent health care environment. If this effort is fully supported by national and regional hospital associations and funding agencies, rural health organizations can be more sustainable over the long term. Patients, clinicians and managers of rural health care delivery organizations deserve no less.

This article is protected by copyright. All rights reserved.

Response to COVID-19 Lags in Rural Communities. To the Point (blog), Commwealth Fund

Sheps Center for Health Services Research. 172 Rural Hospital Closures

The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability

Rural Healthcare Center Preparation and Readiness Response to Threat of COVID-19

Rural health networks and care coordination: health care innovation in frontier communities to improve patient outcomes and reduce health care costs

Rural Hospital Software & Information Technology: Strategies for Success. MEDHOST Minute Blog

The Hospital Value-Based Purchasing (VBP) Program