The leaders of Dartmouth Health, MaineHealth and the University of Vermont Health Network outline the perilous road for rural health systems.
While hardly any hospitals are having an easy time these days, rural health systems are facing profound difficulties.
“In rural America, the challenges are a little more difficult to navigate,” says Joanne Conroy, CEO and president of Dartmouth Health.
Conroy and two other healthcare leaders - Andrew Mueller, CEO of MaineHealth, and Sunny Eappen, president and CEO of The University of Vermont Health Network - participated in a panel discussion Monday afternoon about rural hospitals and their difficult headwinds.
Rural hospitals were struggling well before the COVID-19 pandemic, but they are now looking at a tougher road. In a recent op-ed, Conroy wrote that rural health systems are reaching a breaking point as they continue to lose money.
Hospitals in rural areas are having problems recruiting and retaining workers. “Our workforce shortage has not gone away,” Conroy says.
The UVW Health Network, which serves Vermont and northern New York, is dealing with more than a dearth of doctors, Eappen says.
“It’s not just the medical college,” he says. “It's the school of nursing. We need respiratory techs, we need folks that are working in food service. We need everything quite frankly.”
(You can watch the roundtable in its entirety in this video from Dartmouth Health. The story continues below.)
‘Can’t close our beds’
Rural hospitals account for 35% of the nation’s hospitals, and many are barely staying afloat, according to a report by the American Hospital Association. More than 600 rural hospitals are at risk of closing in the near future, according to the Center for Healthcare Quality & Payment Reform.
Mueller said about two-third of MaineHealth’s costs are going to salaries and wages. The worker shortage is exacerbated by a significant number of retirements, while younger people are still getting their training and aren’t yet in the workforce, he said.
Rural health systems also continue to rely on more contract labor for nursing, which adds to expenses and also frustrates staff nurses who are making less money, the leaders said.
While rural hospitals are dealing with a persistent shortage of workers, Conroy says they don’t have an option that some systems have utilized: reducing the number of beds.
“We can't close our beds because we're the safety net for New Hampshire, Maine and Vermont,” Conroy says. “And people depend on us to keep our beds open for the high acuity patient that they cannot care for in their smaller facility.”
On top of higher labor expenses, rural hospitals, and hospitals everywhere, are struggling with inflation and are paying higher costs for drugs and other supplies. But as Conroy says, “We're not in a position to actually pass that on to a consumer or an insurance company.”
“All of those pressures are kind of coming to roost at once,” she says. “So I like to say healthcare is kind of a rough business right now.”
The impact of housing costs
Higher housing costs pose a hurdle to attracting some talent, the leaders said.
Even in rural areas of New England, housing prices are influenced by the relative proximity to Boston, Connecticut and New York.
“Housing I think has become a universal challenge everywhere,” Mueller says. “I think all of us can talk about the stories of nurses and physicians who've ultimately rescinded job offers that they had originally accepted, simply for lack of finding a suitable place to be able to afford to live.”
Conroy echoed the impact of the lack of housing in rural New England.
“It's really rough in rural America where we don't have public transportation, and we don't have adequate housing, believe it or not, to actually get people to actually come and settle and create that stickiness so they'll stay in our communities,” she says.
The hospital executives talked about the need to train more young physicians in rural areas. When people train in rural areas, they are more likely to stay in those communities.
“So we have a huge obligation to continue to train the next generation of caregivers, not just at the academic center, but also in the rural communities,” Mueller says.
Health systems need to look at ways to help young clinicians with housing costs or loan assistance.
“Once they’ve tasted it, they like the life that’s out here,” Eappen says. “It’s up to us to make it easy as possible.”
A need for creativity
Noting the difficulty in recruiting workers to rural facilities, Eappen says health systems need to adopt different approaches to scheduling.
“I think we have to be a little more creative,” Eappen says. “The 40 hours a week, maybe it needs to be 32 hours a week. Maybe the hours need to be more flexible and adaptable. I think as an industry we've been more rigid. And I think we're going to have to be more creative, almost the Uber of how we deliver care.”
Health systems should look at ways to make it easier for people to take shifts on short notice, he adds. If a nurse’s spouse is home from work unexpectedly, the nurse should be able to easily pick up a shift that’s available. “I think we need to be more dynamic in the way that we think about it,” he says.
Health systems also need to be more willing to adopt technology that will allow patients to access the system more easily, such as scheduling appointments, Eappen says. “We've been very slow to adapt everything, from scheduling on your own,” he says. “Can you schedule your own appointment or get a radiology exam that gets ordered? Can I look at the schedule that's out there and choose the place that I want to go when I want to go?”
“We can make restaurant reservations and airline industry reservations easily,” he adds. “We need to do that.”
Rural health systems must embrace virtual care, especially for residents in small communities that describe their trip to the hospital in hours, not miles.
Telehealth offers much-needed access for behavioral health in particular.
“Compliance is better,” Eappen says. “People actually show up more often. They don’t have to worry about buses or trains or getting there on time or worrying about their kids. You can do it from home.”
Conroy also stressed the importance of taking research and clinical trials beyond the academic medical centers and into rural areas,
“We want patients to be able to access the research that will actually change their care as close as possible to their homes,” she says.