ReInventing the Rural Hospitals Revenue Model from the Pandemic: Rural Hospitals Telehealth

On today’s podcast show we’re going to be talking about Reinventing the Rural Hospitals Revenue Model during COVID and Telehealth in rural areas, brought to you by One Touch Telehealth. We have a great guest with us today.

Ashley Williams is the CEO of Innova Emergency Medical Associates and has over twenty years of healthcare experience.  She was recently named a Woman to Watch by ColoradoBiz magazine for her contributions to the Colorado economy.

Rural hospitals around the country have just been overwhelmed with trying to keep their employees safe during the pandemic while dealing with an increase in high acuity patients. Besides, they have seen a major reduction in people coming into the ER for low acuity needs and rural hospitals are still seeing a reduction in elective and outpatient surgeries.

On today’s show we’re going to be talking about really what can rural hospital executives do to combat this with operational efficiencies and new revenue opportunities to help them stay afloat during these tough times.

 In what ways are you seeing emergency departments or hospitals get creative during this financial stress?

The census has dropped and continues to kind of stay there. We anticipated that the census would increase, but it hasn’t. We’re still seeing a decrease of about 35% at some of the places and some are hit every more than others. That is being mitigated a little bit by higher acuity and critical care. So the people that we’re seeing are a lot sicker, right. But honestly, most are focusing on cutting expenses which means staff, unfortunately.  

We’re seeing, a lot of hours being cut and positions being cut. As far as ways to increase revenue, what we’ve seen is a lot of pop-up clinics. Clinics such as vaccine clinics, respiratory clinics, things like that. Rural hospital executives are having to come up with creative ways to bring people in, but segment out the COVID patients to keep the population safe.  Another thing we’re seeing is executives bringing in specialty services, things that they didn’t do before. And so for instance, we have one rural hospital where they’re bringing gastroenterologists to come to do scopes a few times a week, and that’s not something that they ever did before, but it’s a new revenue stream for them. And then, telehealth is a big thing. People are heavily relying on that as well.

 How can rural hospitals utilize telehealth to increase efficiencies or new revenue opportunities to support their local community and fight closure?

The latest US Government Accountability Office said that 25% of rural hospitals are in financial distress and on the brink of closure, which has a trickle effect on these local communities that may be the only rural hospital within an hour to two-hour drive. As we’ve seen with the pandemic, telehealth has played a critical role in rural areas and the ER.  

One in five Americans live in a rural community and it’s really hard to recruit physicians and maintain these facilities. This makes telehealth in rural hospitals a great avenue for people. Teleneuro is a big one we’ve seen popup in rural hospitals. Furthermore, psychiatric care is very hard to get in small communities so telepsych we see at almost all rural hospitals.  

We’ve seen that as a good way to get care to patients that need it. We’ve seen an interesting thing as telehospitalists, which is interesting because we’ll have as the emergency medicine physicians, we will see patients be admitted, stay for several days, and then be discharged. And the only ever the only physician that they ever actually see in person will be the ER provider, because sometimes they’re the only people in the whole hospital, especially at night. This works well in some circumstances because the telehealth physicians are available 24/7 eager and engaged. As long as you have somebody onsite who can handle emergencies, then that model works well. You have to have a strong emergency department to make that well because you won’t, in case somebody crashes or crumbs, you want to be able to have somebody there.

We’ve seen a big rise in telenephrology. It used to be when somebody needed dialysis, they had to drive many hours to a big center to get care. And now, as long as you have a dialysis nurse, that can put in that central line, then those patients can stay in their communities, which is important. Nobody wants to travel three hours for dialysis.

Another one that has directly been impacted by COVID is we’ve seen a lot of TeleCritical care in ICU. These smaller hospitals have put in beds with negative pressure rooms, so they feel more comfortable keeping higher acuity patients where in the past they would have shipped them to a larger center. Now they’re able to keep them and they’re able to care for them because they have these measures in place, um, which has been good financially and also just for the patients in the community.

How can the ED or rural hospitals partner with local senior communities?

Rural hospitals are thinking outside of the box to working closely with long-term care, senior living, and skilled nursing in their local communities that might only have a part-time physician on staff.  Telehealth in rural areas can provide instant access to care, reduce provider rounding and reduce the need to transport patients with low acuity needs.

 What should be on the roadmap in 2021 for rural hospitals and telehealth administrators?

  1. There is a trend towards telehealth. Looking at operational efficiencies and not just billable revenue. Looking at efficiencies with less staff might equal things like seeing three patients via telehealth versus one in person.
  2. You need a strong emergency department. Ashley thinks it’s critical to have somebody there who can handle the emergencies as you add in all these virtual physicians, it’s the backbone of the hospital.
  3. The supply chain is antiquated and large gaps in the supply chain came out once COVID hit. Many rural hospitals only had one vendor for supplies. And when that vendor ran out of things during COVID, everybody was put in a really difficult situation. So my recommendation would be to establish multiple relationships with multiple vendors. So you aren’t victim to that again.
  4. Build strong relationships with similar hospitals, whether it’s in your area that binds you together. It’s a great repository for idea-sharing. So you’re not reinventing the wheel when something comes up.
  5. Review your billing and coding practices to make sure you are not letting things slip through the cracks. There’s just so much data that flows through that department daily. What we’ve found is that you can make really big impacts by making a really small change. 

Listen to find out more tips Ashley gives on keeping the community and employees safe in rural hospitals and emergency departments.


To learn more about One Touch Telehealth or Innova Emergency Medical Associates.