Community and Rural: Recruiting, Retention, and RACs Top Concerns

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Workforce issues, especially the acute shortage of physicians in low-population areas, are the top concern for chief executive officers in hospitals serving rural and community hospitals, according to the HealthLeaders Media Industry Survey 2010.

Among CEOs in non-rural settings, physician recruitment and retention was ranked as among the top three priorities by only 27% of those responding, their fifth-highest overall priority. But among CEOs who direct rural hospitals, attracting and keeping doctors was among the top three priorities for 44% of those responding, making it their top overall priority.

Alan Morgan, CEO of the National Rural Health Association, says, "That's not terribly surprising."

"Workforce issues are always going to be the No. 1 concern for rural hospital CEOs, and that's what makes rural hospitals unique," he says. Many hospitals in low-population areas consist of fewer than 200 beds, and many are considered critical access facilities, with no more than 25.

Another key area of difference between rural hospital CEOs and those in urban areas is the weight they give cost-reduction strategies. Nearly half, or 45.7%, of CEOs who identified themselves as working at non-rural hospitals said that reducing costs is among their top priorities; indeed, it's their overall No. 1 priority. But when rural hospital CEOs were asked to specify their most important issues, only 25.1% cited cost reduction, putting it sixth-highest on their priority list.

So why is reducing cost not as much of an issue in rural settings as it is for non-rural ones? Morgan says that most rural hospitals are smaller, and "they're dealing with low-volume patient care. For the most part, they all seem to have a strong handle on the costs."

What they're more concerned about, Morgan says, is finding ways to improve health access, "how to recruit and retain quality professionals and how do they afford and implement health information technology. Those are certainly the issues I hear about most from our hospital CEOs as we move forward."

Indeed, nearly 63% of rural CEOs said they believe the government's stimulus IT/HITECH Act will have a positive impact on their organizations, while just 51% of non-rural CEOs saw it that way.

Of the 368 CEOs who responded to the survey, 175 identified themselves as working in a rural setting.

For the most part, personnel concerns are consistent between rural and non-rural CEOs. However, eliminating low performers is a top priority among nearly 59% of rural CEOs, versus just 47% of their non-rural counterparts. Retention of seasoned employees is actually a greater concern among non-rural CEOs, who ranked it fifth (26.23%), while rural CEOs put it ninth overall (17.71%).

Another area of marked difference is in the expected adverse impact of Recovery Audit Contractors. While a majority of non-rural CEOs said RACs will have a slightly or strongly negative impact on their organization (56.43%), that number is much higher among rural CEOs (77.57%).

And while 53.89% of non-rural CEOs projected growth in their geriatrics service line, 77.91% of rural CEOs were expecting growth.

Cheryl Clark

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