"The challenge is around physician development and medical staff development to have the right depth in that area," he said.
Another big issue stand-alone hospitals encounter is that commercial payers sometimes do not feel it is necessary to include them in their product offerings, Dupper said.
"The challenge is being able to have enough size, clout, and influence in the way commercial payers structure their products to recognize a hospital that is on the fringe of the market, as we are. … We're 15 to 20 miles from other hospital providers, but the payers still see our patient population as being willing to travel to seek some services."
Myron Machula, CFO at Enloe Medical Center in Chico, CA, said one of his organization's biggest dilemmas centers around the shift to value-based purchasing.
"I wonder if we really understand how we can achieve greater quality with less cost. Last year was one of our most successful years ever with 7% or so margin. I think as we move toward trying to figure out how to produce value, we are just infants in being able to accomplish that at this point."
With all the financial pressures straining stand-alone hospitals, it's natural for a board of directors to consider the idea of consolidation, the panelists said.