PHOENIX— If there's one thing I've learned in my 20-plus years as a journalist it's this: listen to the experts. Or did my Mom tell me that? Either way, it's a valuable lesson.


For instance, the old newspaper reporter in me was all set to write a blog focused on the Advanced Payment ACO Program, which is aimed at testing the ACO concept in rural settings and among physician-owned organizations, but when I asked rural administrators and trustees what the highlight was of day one at the 25th Rural Health Care Leadership Conference, a number of them immediately mentioned the opening keynote address by Bridget Duffy, M.D., CEO of ExperiaHealth. Before joining the San Francisco-based company, Duffy was chief experience officer at the Cleveland Clinic. Her message today: hospitals need to focus on creating an exceptional patient experience. Central to that, she says, is for all staff at the hospital to show compassion or empathy for patients. It's something that is lacking throughout health care, she says. It's also something my colleague Bill Santamour has been writing about recently in H&HN Daily.

Importantly, Duffy says that hospitals can't actually focus on the patient experience until they get a handle on creating an exceptional work environment for their own employees, which is something Haydn Bush pointed out in the December cover story in H&HN. Duffy gave an impassioned plea to the more than 560 attendees to really focus on the "human experience of care" and make worker and patient experience a top organizational priority.

Now, that's not to say that folks weren't interested in the afternoon's panel discussion on the impact health reform will have on rural providers. Clinton MacKinney, M.D., from the Rural Policy Research Institute at the University of Iowa, gave an overview of the Advanced Payment ACO Program, an initiative coming out of the Centers for Medicare and Medicaid Innovation. Under the program, which will open for applications in the spring, providers will get an upfront payment of $250,000 to start an ACO, an upfront variable payment of $36 per prospectively assigned beneficiary and an upfront monthly payment of $8 per month per prospectively assigned beneficiary.

The concept certainly captured the attention of attendees, but there was a healthy dose of skepticism about whether rural hospitals have the resources or time to not only apply for the program, but actually set up an ACO if they're accepted.

Whether it was Duffy speaking about the patient experience or MacKinney on ACOs or governance guru Jamie Orlikoff, the common refrain yesterday was "innovation." Change is coming rapidly and providers need to embrace that, adapt their strategic plans to the new value-based model and innovate, or get left behind, speaker after speaker said.

And, honestly, the pace of change has some rural administrators a bit nervous. I sat with a handful of them during a break yesterday and they're all wondering if their 12-bed or 25-bed hospital will be able to participate in an ACO. They worry about hiring docs and building out IT systems. Will the critical access hospital program's cost-plus reimbursement model remain intact?

We may not get answers to all of those questions this week, but we are getting a healthy dose of examples of how rural hospitals are thriving despite these uncertainties. Charlotte Burns, CEO of Hardin Medical Center in Savannah, Tenn., for instance, talked about how her hospital has embarked on an ambitious campaign to improve patient safety. This following programs to institute Lean management techniques and improve the patient experience.

We'll have more coverage of the Rural Health Care Leadership Conference in tomorrow's edition of H&HN Daily.