Although rural hospitals are increasingly tasked with reinventing themselves, the pathways to such reincarnation are not always well-lit. Participants at this year’s Rural Health Care Leadership Conference — more than 600 strong — sought to change that by coming together to share best practices for addressing the challenge of adapting to new models of care.

As health care futurist Ian Morrison described, rural hospitals must contend with the same, ever-changing struggles that the rest of the health world does: the transition from fee-for-service to a value-based pay model; the need to partner with other organizations to build economies of scale; and Medicaid expansion, to name just a few. These issues, though, are only magnified for rural hospitals.

Morrison likened a rural hospital’s market share to an ice cream cone shared by two dogs — the rural hospital being the smaller animal, which ultimately loses the cone to its more dominant counterpart. “[Rural hospitals] have all the autonomy of an ACO, but none of the physiology,” he explained.

The threats to independence were certainly top of mind for attendees. Keith Mueller, professor of health management and policy at the University of Iowa, echoed sentiments of many speakers, suggesting that there’s a need at both local and national levels to create strategies specifically aimed at helping rural hospitals to make the leap to new payment models.

“One of our biggest problems is deciding about partnership,” said Linnette Davidson, a nurse and trustee at the 20-bed critical access Bigfork Valley Hospital in Minnesota. “The problem is, when big systems partner with small rural hospitals, the rural hospitals can lose their influence and their power to make their own decisions and take care of people in the way that we know is best.”

To preserve their independence, Mueller said, rural hospitals must first focus on health to ready themselves for payments inevitably becoming tied to value. This should be done through an interconnected approach, Mueller said — one that includes merging governance practices, bundling payments and collaborating on programs that address a culture of health.

“The interconnectedness of programs ought to be easier when the scale is smaller,” Mueller advised.

Morrison urged rural health care stakeholders to explore all the resources at their disposal, including those in the government, private sector and community.

“Those of you who have the burden or opportunity of leadership really can make a difference in these communities,” he said.

Robert Schmitt, CEO, Gibson (Ill.) Area Hospital, said that rural hospitals often aren’t given enough credit for the advances they have already made.

“Rural hospitals are a lot further down the population health and ACO spectrum than I think a lot of people give us credit for,” he said. “We’re already doing a lot of those same things, just on a smaller scale.”