20. Rural Solutions with Kelly Arduino
Michelle Rathman: Hello, and welcome to a very special episode of The Rural Impact. I'm Michelle Rathman, and as I do every single time we're together, I mean it when I say I'm so thankful that you've joined us. And with that, I'm very appreciative for the follows, the likes, the shares. I'm loving the notes that you're sending me on LinkedIn.
And so thank you for that. It means so much to me that these subjects that we're talking about are important to you as well. So, today's episode is a very special one because we are talking about one of my favorite subjects. And this is my 35th year in the industry, which is health care.
And even if you don't think you want to listen to this conversation you might want to reconsider that when I tell you that according to a recent poll conducted by the Associated Press, and you can rely on that data, I think and that with, which is also with the NORC Center for Public Affairs Research, almost 80 percent of Americans are concerned about accessing quality health care when they need it, 80 percent.
So, if you're the 20 percent who's not thinking about it, you might want to stick around because at some point in time in your life, it will be you. And of that, of those who were surveyed, Americans satisfaction with the US healthcare system is at an all-time low. More than half of the respondents of this poll said that the country does not handle healthcare well, either in general or for older adults.
And, when we're talking about rural, we all know that whole older, sicker, poorer factor. And, I wish we were all getting younger, but we aren't, we are aging. And so, in addition to that, I'll give you one more statistic. 70 percent of those respondents said the United States is not handling the cost of prescription drugs or mental health care well.
We know that. Okay? So now that was not enough to keep you tuned in. I want to share with you that there has never been a more challenging time for our rural health systems. And by systems, I mean, I think about it as a big, huge bundle of a mangled Christmas lights, if you will, because there is not really one cohesive system.
There is a patchwork and they've been handed. This is not something that just happened overnight. This has been going on for years and years and years, and leaders of these organizations, the last thing I want to say about it is, I think it's important to understand that leaders, different than big health systems, they really understand. And I'm not saying big health systems don't, but they understand the pain points of their communities. They know their communities. They stop them in the grocery store and talk about these pain points. Everything from access to insurance to primary care and so forth. So it's a big subject. You know, I say there are no light subjects, but we hope to enlighten you with that.
And it's really my pleasure to introduce you to someone I've known for over 20 years, I think is the right number.
Kelly Arduino: We stopped counting now.
Michelle Rathman: We stopped.. This is Kelly Arduino and Kelly is a health care industry leader and a partner with Wipfli, which is a top 20 accounting and consulting firm. And Kelly has over 25 years of diverse health care experience, which gives her a really unique perspective.
And on top of that, as a bonus, and this is something I just adore about her background is that she was also a psychotherapist and an academic researcher in health outcomes and spent a number of years as a health strategy consultant. So, I read you those statistics up top from that survey, because it is understanding both sides of the coin.
And I know very few people who know those sides of the coin, including the financial piece more than you. So Kelly, welcome to the Rural Impact. It's really a pleasure to have you here with us today.
Kelly Arduino: Thank you for having me. I'm excited to be here too. You know, in addition to my bio, I did grow up in a rural town. So, we had a critical access hospital where one time my sister and my mom and I were playing ball in the backyard and my sister threw a baseball right into my face on my nose.
And where did we go? We went to that critical access hospital. So rural, is always near and dear to my heart, and I have lived it. And it's been an important part of my career, Michelle, so thank you.
Michelle Rathman: Yeah, we've had the pleasure of working on several projects together. And, I mean, we understand, I mean, we both have different perspectives. But we both understand that whole picture. And I think that's really what I want to talk about, because I had a conversation this morning with three CEOs of critical access hospitals.
And we were talking about the fact that while each of them have their governance structure, one's a 501c3, one's a public hospital district, another one's a county owned facility, but they share the same challenges and they have to arrive at the solutions. And we talked about the fact that we spend an inordinate amount of time talking about challenges.
Like, we know that we are challenged with our aging facilities. We know that we have major workforce challenges. We know that COVID decimated the rural health workforce, health workforce in general. And so one of the things I want to talk to you about today, Kelly, is that the work that you are doing and this is not just plugging Wipfli, this is saying you guys are really focused on solutions, versus the challenges.
And to understand the solutions, I think it's important to know that the challenges, but you're focused on solutions. And so, I want to talk to you about just kind of go down our tick sheet of challenges and then talk a little bit about what can people expect in terms of if they're going to find a solution in 2024 and beyond, what are the things that they need to think about?
So, let's first, talk about workforce challenges because you cannot escape any conversation in this world without talking about the shortages of doctors, nurses, phlebotomists, so forth and so on.
Kelly Arduino: Well, and Michelle, I mean, the workforce challenges extend even beyond clinical care, right? They extend to the housekeepers and the folks in the cafeteria and all parts of the organization. In the last, I'd say year or so, we've seen organizations start to outsource some of their, what I call, back office functions.
So that they could really focus on their front of the house type solutions around clinical care, doctors, nurses, et cetera. So as a solution to making sure that your systems and your security is in place, and you have the right expertise that's something that people are starting to outsource.
If you are struggling to find the right mix of people who can do the financial statements and, or the billing. You know, how many times have we seen where a hospital's AR in a rural area will just spike up because Sally was on vacation in August? Right? And so the challenge, which was always there, is now kind of multiplied because it's just the stakes are so much higher because every dollar really counts.
And so, we're starting to see organizations outsource that back office function. Because then they know they have the consistency, the right kind of expertise, and, and let's be frank, it is a lot of time and energy to recruit somebody, make sure that's the right person, you know, verifying their credentials, get them on board to the particular nuances of your situation, and then kind of monitor their performance.
So, this
Michelle Rathman: Yeah. I've never been more aware of how, I mean, it is the most complex. You don't just step out of a general accounting background and then pick up. Because it is the most highly regulated and it's, I mean, it is a bear. And then you've got, we talk about the challenges because on top of, those precious AR days, there's all of the let's talk about a few of the other challenges where, I mean, there are some things that you can have, that you can easily remedy with solutions, but there are things like prior authorization.
Kelly Arduino: right.
Michelle Rathman: There are things like, you know, the multitude of insurance plans that, it's kind of a hodgepodge. So these are some of the things that, that hospital leaders and healthcare leaders are struggling, are juggling with is that it is so complex. So, let's stay on workforce. One of the things that you mentioned earlier is.
Two, two things some believe that the solution to some of these challenges is AI.
Kelly Arduino: Mm hmm.
Mm
Michelle Rathman: Some are coming a little bit kicking and screaming. So how does AI and technology play a role in your mind to address some of the workforce challenges that we are experiencing today? And I don't think where there's any toothpaste to put back in the tube, I don't think we're going back to fully staffed organizations.
Kelly Arduino: No, we're absolutely not. So, I see the outsourcing is a bit of a transitional or bridge to technology. And, this is not a situation where we just flick on the light switch and all of a sudden, it's happened. But it's more of rethinking how business behind the scenes for health care gets done.
It's kind of interesting with AI because originally it started out and there's still a lot of it. AI was all around the kind of the clinical side of the house, right? How do you optimize the diagnosis or take ensure that the person is identified as at risk for falls and do interventions.
But what we've found, at least in the evolution of AI right now. Is that AI is almost better suited in the immediate term and it's going to be a longer-term evolution. Believe me, it's not, again, one and done. AI is well suited to automation of mundane tasks and that's that whole back of the house. Right?
Nonclinical stuff that is absolutely essential for the financial health of the organization and that also, again, has these workforce challenges. So, in terms of what we see with AI, it's never a silver bullet for anything, but organizations are starting to think about what does this look like over a longer term?
How would I roll out AI solutions because think of them as not a one and done, but just part of the whole ecosystem of your employers are almost like, hey, we're hiring a new employee. And how does AI come on board with us? And then rolling that out over time and where does where do you get the most bang for the buck first?
Is this solution compatible with other solutions that we might want to add in the future? And at first, I think there was some worry that it was going to replace people, but there's a heck of a lot of manual work that gets done, especially at rural hospitals that we would want to take that person and let them spend more time doing thinking or you know, interacting with the patients or the processes of the billing instead of the actual billing.
So, I think that AI has a place. It's like you said it's inevitable. There just is not a bunch of people waiting to be hired. We're just going to have to think of it as another workforce partner.
Michelle Rathman: Absolutely. And with that communicate to communities who might be skeptical, maybe worried about other things. For example, we talked about some of the challenges. I mean, I wanted to talk about financial challenges and I think it's important for our listeners to understand that. Not only is it financial challenges from the fact that there are just money losing services that rural health organizations must provide to care for their community.
And so we're looking at OB units being shut down everywhere. Tragic because women, there's swaths of land, the size of counties, the size of a state, a small state that doesn't have a single OB provider, but that's a big financial challenge to operate a service that you don't have the volumes.
But let's talk about the financial challenges that are associated with just cyber security, Kelly. We have seen literally, we have seen hospitals have to shut their doors indefinitely, because of the financial hit they took about cyber security. Talk to us about some of the solutions for that.
Kelly Arduino: Sure, let's talk a little bit about the landscape because when I first started hearing about these cyber attacks on hospitals or other health care organizations, I thought, why, why aren't these criminals like targeting, a bank or, some other financial institution, right? And you think the hospital, so, so what? So, what Sally got a blood drawn 2 days ago?
But what they have realized, cyber criminals, unfortunately, is that if they can shut it down, the services that are being provided are so absolutely life and death. I mean, literally. That they're able to get the ransom money for it. Right? That's I know my brain doesn't go there, Michelle, but that is what we've been starting to understand about why healthcare organizations have been, you know, kind of disproportionately targeted because literally what they're doing is life and death.
And so, organizations have been paying the ransom to get that undone because you're right, they absolutely do shut down.
And for many years, we saw that cybersecurity again was kind of a low priority. It has really bubbled to the top and back to this notion of many organizations don't even know where to start. They don't even know what their vulnerabilities are. You know, some of the solutions are, hiring someone for a relatively low fee to hack you. Like a friendly person.
Michelle Rathman: Yes. I, I've been, I've been a party to understanding that that was going on. I couldn't say anything. Yeah, absolutely. Cause that's how you learn where your vulnerabilities are, unfortunately. And if it's not someone friendly, it's certainly, could take your organization to its knees. So I, that is a significant and people think it's not hitting small rural hospitals, but that is just simply not true.
Kelly Arduino: mm hmm, mm hmm. No one is exempt. It's unfortunate because it's kind of a pylon and we've got all these other stressors around finances and you think, oh man, I don't even want to have to, shell out more money to get our organization kind of cyber tight. But I think it's a reality in this next couple of years.
Michelle Rathman: And you know, Kelly, I have seen it have a kind of a ripple effect in that it because patients in general, I tell people, I don't have to know what's happening under the hood of my car to be able to stick the key in and drive it. And so, when people hear cyber security threats, and they, we talked about how important is to access your electronic health records and our communities are equating being online and electronic health records with, an infringement or encroachment on their privacy. And so, we've got a really big job to do to educate our community members about the importance of embracing technology. At the same time, the amount of investments that must be made
Kelly Arduino: Mm hmm.
Michelle Rathman: protecting
Kelly Arduino: hmm.
Michelle Rathman: that very important data, because it's the data that they're after.
Kelly Arduino: Right. Right. And HIPAA, you know, which is our protection act around patient privacy has to be more than just a checkbox and done. It really is kind of a cultural shift in the organization for everyone to really understand that, that privacy is really important and so is that security and we can't be really just cavalier and expect that, that the organization isn't going to be a target.
Michelle Rathman: That's right. All right. So, let's talk about some other threats here and potential solutions. You and I have had many a conversation about this, mostly banging our heads against the wall about private equity in healthcare. And I'm, of course, very focused on the rural aspect because you know, there's, there's if you follow the work of Sarah Jane Tribble, I hope that you all do.
She writes an amazing, a lot of pieces about rural health. And she has talked about private equity and rural health organizations. I do not see it as an opportunity. I see it as a threat because there's nothing that I have no evidence to show me otherwise. So, talk to us Kelly about how are rural health organizations kind of, fortifying themselves.
Not to be looking around for, forgive the term, a savior, which I think is often what happens, how a private equity firm is able to woo an organization and to coming over to the dark side.
I did say that out loud.
Kelly Arduino: Actually, Sarah just interviewed me last week,
Michelle Rathman: Oh great!
Kelly Arduino: So, I have this at the ready. One of the things that I've talked about and we haven't seen it for a while but I think it's time to bring it back. So, I've always felt like rural is scrappy, right? They're always getting thrown all these different curveballs and then they figure out something to do. Well, she asked me for examples and about what I'm gonna tell you and I said gosh I haven't seen any for a while because they're kind of old now. But, when organizations were really struggling with leadership in particular, right?
This is often when we see the board throw up their hands and be like, let's bring in a private equity firm because they just can't find the right leader or their management company just isn't working out. And it's kind of a, revolving door around leadership. I think that's one of the times when the organization is most vulnerable to making a decision like private equity.
Well, back in the day, what happened was they would dig deep in their community and they would say, even if someone does not have healthcare experience, is there a leader who can help marshal the troops, who can help, kind of think about what we need to do differently that isn't, you talked about it in the very beginning of this, truly invested in the community.
Michelle Rathman: hmm.
Kelly Arduino: I remember a hospital in the upper peninsula of Michigan. Heck, there's only 750,000 people in the whole upper peninsula. They recruited the retired CEO from the mill,
Michelle Rathman: Oh,
Kelly Arduino: the paper mill. Mm-Hmm. And he served for almost eight years and he actually got a new hospital built where his predecessors had tried three times and failed.
But he lived there, he knew the people, he was truly invested in the community and he brought over the CFO who was from the construction business. And she again, didn't know a lot. She relied on a lot of external consultants to help with the nuances that are associated with finances. But again, she had a vested interest in making that go.
We've started to see some of those folks retire but opening up the thought process on what could we do. You know, sometimes we get so fixated and, oh my gosh, they have to have this specialty knowledge around leadership. And really, to me, especially in the rural, the most, when I look at the most successful rural hospitals, they are the ones with the committed leaders that live in the community that are just involved in every facet.
I know you can think of a few as well.
Michelle Rathman: You know, absolutely. And part of it is as well, is really being able to, and this is where your background and psychotherapy comes into mind, is that being able to really identify when it's too risky or healthy risk. And I think we can agree that this is, you know, the year 2024, we are faced with some of the, I said in the very beginning, some of the most challenging times I can recall. And we've been through some challenging times in rural health to be sure, but never so many threats coming from so many different directions.
And I don't want to paint the picture that every single rural hospital is, struggling to survive because, to your point, you have seen rural hospitals and health organizations truly thrive, maintain their independence, grow their services for their community, and that doesn't happen overnight, but it does happen with a healthy dose of healthy risk taking. And to your point surrounding yourself with individuals who are eager, willing, well prepared to develop their leadership skills to you know, carry things forward.
I think that between the two of us and a few other people, we could solve a lot of problems in theory.
Kelly Arduino: Well, we can sure try, Michelle. I know that we're both committed to the success of this space, and so I really appreciate you having me on.
Michelle Rathman: Well, I'm so appreciative that you're here folks who know me know that it not on my watch if I can help it no more rural hospital closures. We got to turn the ship around and we need thriving rural hospitals. So, this is great. And, it's always again. I just thank you for tuning in to The Rural Impact.
And we're going to see you as our continuing series on arriving at thriving goes on. We're going to be having another series that's focused on rural housing and homelessness, rural transportation. So, we're going to cover all of these topics and more. Thanks again for joining us. Take good care until next time on The Rural Impact.
