I love our rural communities. You don’t have to convince them to work together. The people are smart, work hard, and know the value of a dollar. And they can smell a skunk a mile away.
“The only constant is change” is probably the best description of our ‘new normal’ in healthcare. Decreasing inpatient volumes, hospital layoffs, declining reimbursements, mergers and affiliations. Who saw this coming? Clearly, incremental improvements to old processes is no longer “leadership.” I think our rural health system has some distinct advantages that we can learn from.
Rural communities are used to pulling together out of necessity. The local Critical Access Hospital (CAH) already supplies some of the best paying and most stable jobs in town. More importantly, it’s home. My father-in-law had to drive 25 miles to get to his CAH; trying to convince him to go 50 miles the other direction for that ‘big city’ hospital was a waste of time.
So a quality, post-discharge, patient care plan is a plausible goal. Formalizing the integration is work, but not unrealistic. Start with something simple, like HIPPA. Who needs to know what to achieve this quality patient care plan. Suddenly you’ve identified the players and defined the responsibilities. And, since it’s rural, everybody has a right to participate. Federally qualified health centers (FQHCs), rural health clinics (RHCs), community health centers (CHCs), DENTISTS (personal bias), WIC clinics, skilled nursing homes, home health agencies, faith-based organizations, and Telehealth (since most CAHs can’t provide 24×7 pharmacy services).
A review process is important for quality assurance and continuous performance improvement, which will lead to ‘discussions’ about costs and reimbursements. But there’s already one CAH/FQHC collaboration success story (Sakakawea Medical Center and Coal Country Community Health Center in N.D.), so it can be accomplished!
And once those ‘yokels’ make it work, then what’s our excuse?