Jared_Chanski Jared Chanski, executive vice president of Preferred Management Company, recently joined the HealthShare board of trustees. He oversees operations for a number of rural hospitals in Texas and Oklahoma. He shared his thoughts on the challenges facing leaders of small community hospitals in rural Texas.

1. What are the complexities of managing a community of rural hospitals with their own unique needs and challenges?

Perhaps the biggest challenge is maintaining financial stability in an ever – and rapidly -- changing reimbursement climate. While concerns regarding reimbursement are certainly not unique to rural hospitals, the dominance of uninsured, underinsured, Medicaid and Medicare patients in our small communities makes our rural hospitals even more vulnerable. Medicare beneficiaries comprise as many as 28 percent of our service area county residents, who rely heavily on our hospitals and clinics for the provision of preventive, routine and lifesaving care. They also benefit from the Medicare Swing Bed program which allows our hospitals to provide skilled nursing care close to home and family. Continued targeting of Medicare reimbursement for Swing Beds and Critical Access Hospitals as federal budget cut opportunities will be potentially devastating to our hospitals, patients and communities.

                Additionally, small populations combined with geographic isolation means our facilities are relatively low volume facilities. As a result, fixed expenses combined with minimum staffing levels make it very difficult to manage our flex expenses. 

                We respect the need for standards to maintain the quality and consistency of our health care system. However, changes to existing and introduction of new regulations can be very difficult for small hospitals to manage. Candidly, this is another reason why the services of Preferred are so valued by our communities since we retain and share across our system the experience, expertise and resources necessary to address these regulations. It can be frustrating, however, to recognize the number of administrative staff added over the years that are not involved in direct patient care.

                In the same vein, the mounting burden of quality reporting measures at the state and federal levels is increasing exponentially. These require time to abstract, tabulate and transmit further adding to the workload of clinical personnel in the absence of full-time on-site quality coordinators.

2. Do you see any variation in needs do your hospitals handle from community to community?

Our partner communities have distinctive personalities largely driven by size and location. Just like the geography of Texas ranges from the pine trees in the east to the mountains and basins of the west, each community has a unique culture, values, struggles and needs. 

3. What priorities and issues do rural and critical access hospitals face when it comes to your workforce?

As many as 35 counties in Texas do not have a physician. Physicians in small communities work in our clinics and hospitals, and take round-the-clock call for our emergency rooms. The rural workload combined with a national shortage of physicians and advanced practice providers makes it very difficult to recruit and retain these professionals. Counties who lose their physicians risk losing their hospitals.

                It can be equally difficult to recruit qualified professional staff for our hospitals and clinics due to geographical isolation and a lack of local amenities. Because our staff treats a diverse array of patients and conditions in all practice settings, they need to be especially well-versed in clinical care. Administrative support staff must also wear multiple hats and have limited delegation opportunities.

                We are continually looking for options that maintain quality of care, availability of emergency medical services, while relieving the practice burden of these providers. This begins with competitive salaries and benefits, and more recently includes a major focus on technology and telemedicine as alternative staffing for our emergency departments maintaining a high level of care as the sole safety net medical providers for our communities.

THA HealthShare Solutions magazine