Industry Insights

Introducing the Rising Voices for Rural Health

March 2018

In early 2018, the National Rural Health Association (NRHA) announced the selection of two BKD personnel to represent rural health policy on its Rural Health Congress (the Congress).

According to the NRHA, “The Rural Health Congress is the policy-making body of the NRHA. The Rural Health Congress determines the association’s positions on public policy …”

NRHA Selections

Partner Deborah Whitley in our Waco, Texas, office was selected as one of the proud BKDers to sit on the Congress, effective December 1, 2018. Deborah spends significant time working with rural providers and delivering critical advice regarding operational and financial matters.

As the rural plight becomes more complex and uncertain, Deborah finds value in taking time to discuss issues and approaches affecting rural leaders nationwide. In fact, this past year she co-authored “Rural Perspectives from Texans on Capitol Hill” with Region 7 executive of the American Hospital Association and former president and CEO of Texas Organization of Rural & Community Hospitals David Pearson. Deborah used the opportunity to share her widespread knowledge and experience.

Managing Director Steve Parde in our Kansas City, Missouri, office was the other honored BKDer to be selected as a member of the Congress. Steve has been a frequent presenter at the NRHA’s Critical Access Hospital Conference, presenting on a variety of strategic, operational and reimbursement topics.

Raising Their Voices for Rural Health

Deborah and Steve recently sat down to answer a few questions about their experience and what they expect to encounter as members of the Congress.

Q:  What’s your experience helping providers with current rural health policy issues?

Deborah:  In my 23 years working in the health care industry, I’ve been involved in many of the operational implications regarding regulatory changes and how they affect hospital facilities and beneficiaries. I’ve spent countless hours helping rural and community hospitals improve their overall Medicare and Medicaid reimbursement. I’ve also worked in specialized reimbursement areas such as electronic health record funding, disproportionate share payments, volume adjustments, departmental financial projections, special coding, billing and pricing processes and reviews in both inpatient and outpatient areas of hospitals. 

Steve:  My experience in dealing with current rural health policy issues is based on the foundation of knowledge I’ve built over the past 18 years assisting rural health care providers with strategic, operational, financial management and third-party reimbursement issues. As health care policies change, I’ve helped my rural health care clients navigate the regulatory changes by consulting on important reimbursement issues and strategizing on complex reimbursement challenges to provide them with viable solutions.

Q:  What are your views regarding health care delivery in rural areas?

Deborah:  Reimbursement regulations are ever-changing and affect the rural providers’ operational processes. All payor types follow similar guidance to that of Medicare regarding their effects on providers. While rural America makes the transition to value-based payments, rural hospitals must address new processes to help achieve sustainability now more than ever. Rural providers need more accurate guidance through the complex reimbursement process changes, and because low volume has always been a contributing factor to their increased financial pressure, the shift from volume to quality heightens their challenges. Consistent application of rules and regulations for all providers is almost impossible. There needs to be a distinct application of rules for certain rural providers that continues to address both the low-volume challenges and higher marginal costs of providing services to protect rural health care in the future.

Steve:  The health care industry will continue to focus on quality, value and outcomes. Rural health care will be no different as the shift to patient-centered payment models continues to grow and be expected in the industry. Rural hospitals will continue to be challenged as they tend to be looked at as the sole (or major) health care provider in the community and often serve a higher percentage of Medicare and Medicaid patients. This makes rural hospitals much more vulnerable to policy changes and reimbursement cuts. It’s important for health care policy makers to understand the financial fragility and operational challenges many rural hospitals face as health care policies are being made.

Q:  With the constant and alarming news of rural hospital closures across our nation, what financial, operational or strategic advice can you offer rural leaders to ease their woes?

Deborah:  We’ve talked to our rural hospital leadership about the help that’s out there for them if they’re willing to accept changes to their current financial and operational patterns. While there may need to be adjustments in departmental cost structures or drastic commitment to improvements in revenue cycle or collection processes, a rural hospital has the long-term footprint in the community that keeps it going. We may see many strategic plans that may be altered, but they aren’t terminated when there’s a strong commitment for survival.

Steve:  Be diligent and persistent in your efforts to find every opportunity to receive the appropriate reimbursement for the services the hospital is providing. Health care has been—and will continue to be—in a constant state of change. As with all change, there will be challenges and opportunities. It will take strong leadership and financial discipline to meet the financial, operational and regulatory challenges faced by many rural hospitals. We recommend rural hospitals look at themselves in the mirror and critically evaluate whether they’re operating on all cylinders in each area. This evaluation is a dose of “preventive medicine,” as it gives rural hospitals the opportunity to identify areas in which they aren’t operating on all cylinders and implement processes to do so. We recognize access to patient care in rural communities is critically dependent on the financial viability of the rural hospital, which is one of the cornerstones of the rural community.

Have more questions? Email them to Deborah or Steve.

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