15,000 feet above Arizona and climbing— Well, I've got about three hours of flying time to reflect on this year's Rural Health Care Leadership Conference, which ended early Wednesday afternoon. That, plus there's no movie and I'm taking a short break from reading a great book — Unbroken by Laura Hillenbrand. It's a fascinating story about Louie Zamperini, a troubled youth who turned into a highly successful marathon runner. His quest for greatness — Olympic gold and breaking the four-minute mile — was interrupted by a stint as a bombardier in World War II. The story gets even more compelling: his plane crashed into the Pacific. Zamperini and his crew were stuck on a lousy raft, surrounded by rough seas and killer sharks. They rowed to the safety of a distant island, which just happened to be a Japanese military base. I'm only about one-fourth of the way through the book (Zamperini's plane hasn't crashed yet), but my wife says that it is one of the most heroic tales she's ever read.

I hadn't really thought about it until now, but Zamperini's story, told beautifully by Hillenbrand (who wrote another of my favorites, Seabiscuit) could prove as somewhat of a parable for rural health care leaders. Forget the particulars of his story — that he was a hoodlum who could run fast, but eventually straightened his life out. No, the parallels, I think are this: a leader (Zamperini's brother), sensing that things weren't going in the right direction, created an environment where Louie could thrive and eventually become a high performer. Louie realized his self-worth and reached for the top.

OK, am I stretching it a bit? Maybe it's the altitude; I think we just hit 30,000 feet. At any rate, you get where I'm going, right? The message we heard all week in Phoenix was that hospital execs and trustees need to create an environment where they, their staff and the organization can aim higher and achieve greatness. A lot of my reporting from sunny Phoenix focused on these broad themes.

While this message certainly resonated with the crowd, there was also a fair amount of chatter about the day-to-day realities of running a rural hospital in this changing and challenging environment. Perhaps more than their urban counterparts, rural hospitals face a lot of unknowns: how — even, will — they fit into the ACO world? Will budget cutters set their sights on altering the cost-plus reimbursement for critical access hospitals?

True to form though, the execs I talked to were focused on tackling these challenges head on. I shared a cab to the airport with the COO of a critical access hospital in Minnesota (journalism 101 mistake on my part: I forgot to ask if I could use her name in my blog). I asked if she was concerned about cost-plus reimbursement going away. Sort of, she said. It's not clear if there's enough political momentum to do away with the reimbursement scheme just yet, but then she told me this: "We are operating as if it is going away and trying to become as efficient as possible."

That's similar to the message that Ira Moscovice, director, Upper Midwest Rural Health Research Center and a professor of health policy at the University of Minnesota, gave during his presentation on bundled payments Wednesday morning. He said that rural hospitals need to show that they can provide high-quality care and do so efficiently. He noted that nearly one-third of rurals still don't provide data to Hospital Compare. That's a mistake, he suggested. "Why should I partner with you if you don't show your quality data?" he asked. And as we move toward bundled payments and accountable care, partnerships will become critically important.

Finally, I had the opportunity this week to talk with Tom Morris, associate administrator for rural health policy, Health Resources and Services Administration. We discussed the transition from volume to value-based reimbursement, the importance of rurals to report quality data and an upcoming IOM research initiative looking at telemedicine. Take a look:

Well, looks like my battery is running low. Time to sign off and get back to Zamperini's remarkable story.

Matthew Weinstock is senior editor of Hospitals & Health Networks. He can be reached at mweinstock@healthforum.com.