AHA Rural Chair: Reimbursement Top Challenge

HLM: What other issues facing small and rural hospitals do you hope to address in your tenure as chairman?

AH: There are always opportunities to get the message heard on the small things. Even in this fix that Congress did right before the end of the year there were some low-volume adjustments that they plugged back in. There is the Medicare-dependent hospital stuff that they plugged back in.

But the overarching challenge is going to be to helping the legislators understand that massive cuts to reimbursement to try to lower the deficit can't all be on the backs of hospitals. We presented some options to the legislators about what they can cut besides healthcare and we are going to take that message to them again.

We know we have to be more efficient and effective in the care we give and we have to eliminate waste in our system. But that takes a little time so they need to work with us on how they adjust the reimbursements for hospitals to give us the time to work on those efficiencies.

We are going to look at quality, which you can tie back to reimbursements, value-based purchasing, and the penalties we are seeing coming down for not providing good care or having good scores. In small and rural hospitals a lot of times you just don't have the resources.

Big hospitals face the same challenges on a larger scale but they typically have some resources available on the quality side and the performance improvement side that small and rural hospitals don't have. We are going to have to learn how to do quality and develop a quality culture in our hospitals. It has to be different than business as usual. We have been asked to do more with less year after year.