Rural health care faces challenges ranging from financial stability to burnout and access to care, but speakers at this week’s American Hospital Association Rural Health Care Leadership Conference in Orlando, Fla., talked about how hospitals and health care professionals can advocate for change, work with community partners on solutions and embrace technology to improve the patient experience and their own daily workflow.
Dr. Joanne Conroy, CEO at Dartmouth Health in Lebanon, N.H., and chair-elect of the AHA Board of Trustees, said stressors in rural health care include a lack of primary care clinicians, delays getting prescriptions filled due to a shortage of pharmacy staff, long waits in the emergency department due to staffing issues, and a lack of nearby access to obstetric care.
If these problems, which are occurring across America but particularly in rural areas, are not addressed, Conroy said, adding just a few more hardships could destabilize rural health care.
Promoting financial stability is an important step forward, and working with lawmakers and other stakeholders to ensure reimbursements cover the costs of providing care is key.
“We know that on average we get paid 82 cents on the dollar for Medicare, far less certainly, for Medicaid,” Conroy said.
Increasing reimbursements and stopping excessive use of prior authorization by commercial insurers are minimum steps that are needed, Conroy added.
Burnout, workforce shortages go hand in hand
Provider burnout and workforce shortages are two big pain points for rural health care.
Dr. Geeta Nayyar, a rheumatologist and former chief medical officer at Salesforce, said burnout has taken the joy out of medicine for many nurses and physicians, leading to 1 in 5 health care workers leaving their jobs since 2020, and creating a shortage that is difficult to solve through recruitment.
Conroy said there are several reasons why it’s hard to recruit health care workers to rural areas, including the cost of housing and child care. Also, a rural lifestyle may not be what younger professionals are ready to embrace. “However, we have gotten to be very, very skillful at actually staying connected, so when they decide they want to begin families, they might consider coming back to our communities,” Conroy said.
Dartmouth Health works with local employers and started a housing fund to help physicians when they come to the community. The health system also works with Dartmouth College to make child care more affordable to young professionals. Conroy recruits nationally to bring in specialty care through emphasizing remote work and is trying to expand the number of clinicians who can provide telehealth care.
A digital approach to burnout, patient experience
Nayyar said burnout can be caused by bad technology and too much paperwork. A digital strategy for rural health care can reduce burnout, keep staff at rural hospitals and provide a better experience for patients so they continue to return for their health care needs, Nayyar said.
“The most important part to your digital strategy – or any strategy, for that matter – is going to be putting the patient first and doing the right thing with your colleagues in mind,” Nayyar said.
The physician and care team experience must be tied to the consumer experience in health care, Nayyar said. “No one is having a great consumer experience if the staff is burned out or too busy looking at a clipboard to actually look anybody in the eye.”
Patients are demanding more from their providers and have a choice of where to receive their care, including retail health care sites. They will switch to a provider that has more appealing services and can offer a better experience.
Nayyar said to consider how technology and even artificial intelligence can help – not with patient care but with creating a better visit. Nayyar suggested it can help improve patient portals and make office processes faster and more efficient.
Access is a big issue in rural health, and telehealth technology can help patients who face challenges getting to an office visit or finding a provider. Telehealth saves money and lives by reducing unnecessary ED visits and providing timely treatment of minor health care issues so ED visits are not needed, Nayyar said.
Interoperability is part of the solution. Providers should have access to patient data from other health care facilities to make visits more productive, helping ensure prompt diagnosis and treatment, and reducing repeat testing and patient frustration.
Building trust through online engagement
Nayyar said it also is important for providers to elevate their online engagement. Millions of people look to social media for health care information and often find misinformation, so having health care professionals online can help people get accurate answers to their questions.
Having a digital and social media presence also helps people find providers, get to know and like them, and learn to trust them and the health care system. Nayyar said most people trust their physician, but more than half of Americans do not trust the health care system.
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