PHOENIX — As rural hospitals shoulder increasing regulatory burdens, the demands of consumerism and the consequences of aging populations — among other responsibilities — they are perhaps under more pressure than ever to provide essential health services to their communities while fighting to survive. But a panel on the second day of the 30th annual Rural Health Care Leadership Conference delved into creative ways rural hospitals have been able to do just that.

The panel, which was moderated by American Hospital Association President and CEO Rick Pollack and comprised Randy Oostra, president and CEO of ProMedica in Toledo, Ohio, and an AHA board member; Ray Montgomery, president and CEO of Unity Health in Searcy, Ark.; and Christina Campos, administrator at Guadalupe County Hospital in Santa Rosa, N.M., brought to light the findings of the AHA Task Force on Ensuring Access in Vulnerable Communities report, which offers nine payment and delivery model options to address the needs of a range of institutions struggling with this issue. (You can see the full report here.)

“While rural communities grapple with the challenges of protecting access, they will need tools to help them determine which services should be maintained globally and delivery system options that allow them to do that,” Pollack said. “And our report provides vulnerable rural communities and the hospitals that serve them with a menu of options and strategies.”

vulnerable-communities-panel-rural-2017For hospitals that struggle with attracting and retaining talent in their often-isolated communities (which sometimes have flagging economies, too), Campos suggested advocating for states to allow nurse practitioners to practice to the full extent of their licenses, which would enable hospitals to better optimize their staffs. Or, if things got really dire, she said jokingly: “You know [the singles site] We’re going to have” (From left: Pollack, Oostra, Montgomery and Campos.)

Campos, Oostra and Montgomery praised the advantages of telemedicine and virtual care as another way to maximize treatment, as well as to care for remote populations. In response, audience members asked why hospitals aren’t often reimbursed fairly for these services — in some cases, billing codes don’t even exist for certain tele-treatments. The AHA has provided the Trump administration with a list of asks for regulatory relief, Pollack said, and “certainly breaking down barriers to telemedicine is on that list.”

Just as attracting staff was on rural hospital leaders' minds, so was attracting patients. Consumerism was a common theme at the conference, and as Pollack said earlier in the day: “In the next 60 seconds, I could hail an Uber; I could book a dinner reservation for two; and I could have Amazon deliver flowers to my wife via drone. That’s the backdrop against which our patients will measure their hospital experiences as consumers in the future.”

In addition to discussing other tangible examples of how rural hospitals are finding ways to succeed — including partnering with integrated delivery systems, targeting the social determinants of illness and listening closely to one’s community — the conversation moved into talk of regulations, as audience members were curious about the consequences for rural health care of changes to or repeal of the Affordable Care Act. While “there are always unintended consequences,” Pollack said, “we are doing whatever we can do to make sure the whole discussion around repeal, replace, repair is done in a thoughtful way."