After a blog I wrote last year on the future of independent community hospitals in a rapidly changing health care landscape, I heard from several readers with their thoughts on the challenges independents face, including Rachel Gonzales, CEO of Madison Memorial Hospital, a 69-bed hospital in Rexburg, Idaho. I wrote the blog, in part, to test the waters for a longer piece that will appear in the March edition of H&HN, which will frame some of the choices hospital administrators and trustees face in adapting to an evolving business climate, from independence to partnerships to new systems.


Gonzales sent me the following email, which succinctly lays out the challenges hospitals face in sorting out an unclear future:

"We are working hard on remaining viable, independently, as long as possible. I do not believe you can fully project what the future will hold when all of the variables have not been clearly defined. I believe success not only comes in efficiency but is built on relationships and an excellent product delivery. We have great relationships with our regional hospital as well as the closest university hospital. We have multiple informal partnerships and are exploring other levels of relationships."

After receiving the note, I reached out to Gonzales to learn more about the challenges facing her institution, which is located in southeastern Idaho. In many ways, Gonzales told me, Madison Memorial is very well-positioned for the future, with a growing population, a low uninsured patient base and economic growth linked to nearby Brigham Young University-Idaho. Still, the overall issues facing all health care executives — namely, the shift from volume- to value-based payment — are top of mind.

"All of our discussions are, how do we keep our foot in this basket while at the same time planning for the future?" Gonzales told me. "When you're feeling good, you're feeling the pressure in a different way."

While Medicare's shared savings ACO model isn't an option in southeastern Idaho because of minimum population requirements. Gonzales and leaders from several other nearby hospitals meet regularly on ways to collaborate going forward. The varied providers have a number of clinical and structural partnerships, and Madison Memorial in particular works with a range of providers, from a nearby critical access hospital to University Hospital in nearby Salt Lake City.

"We're doing our best on trying to coordinate and collaborate," Gonzales says. "Each player wants to maintain independence, but wants to work together."

All of the hospitals, Gonzales says, are looking to remain independent while meeting major patient care, IT and financial needs. And despite an unclear future, Gonzales says, the leaders are energized by the challenges they face.

"It's a challenging time for health care but it's an exciting time," Gonzales says. "It's about time health care leaders help define health care."

Look for my article on the future of independent community hospitals in the March edition of H&HN.