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The Exec: Small But Mighty, How This Rural Provider Is Overcoming Financial Challenges

Analysis  |  By Amanda Schiavo  
   May 01, 2023

CFO Matt Minor says Columbia County Health System is taking a unique approach to managing the healthcare labor crisis.

Rural healthcare providers face a unique set of financial challenges that make serving the small communities in which they operate more difficult than their larger counterparts.

Rural hospitals and health systems got a financial boost during the pandemic thanks to federal relief funds, but now that aid has dried up and these organizations are facing a fight to keep their doors open. Seven rural hospitals closed in 2022, according to data from the Kaiser Family Foundation, more than the previous year. Over 600 rural hospitals are in danger of closing this year, according to the Center for Healthcare and Quality Payment Reform.

Losses on patient services, low financial reserves, inadequate revenue to cover expenses, rising labor costs, and increasing inflation are all contributing factors to the financial challenges facing rural healthcare providers. But despite these obstacles, one rural hospital isn’t ready to throw in the towel and is implementing a unique set of strategies to help keep its doors open and serve the patients in its community.

Matt Minor, CFO for Columbia County Health System, a 25-bed hospital in Dayton Washington, recently connected with HealthLeaders to discuss how this small but mighty organization is staying true to its mission of superior patient care.

HealthLeaders: Tell me about Columbia County Health System.

Matt Minor: The health system is a hospital district in Columbia County, Washington. It's the, I believe, second least populated county in the state of Washington. We have a 25-bed critical access hospital. Through that, we have a significant rehab outpatient services department. We have a wound care department. We have a lab; we have an X-ray on site. We have an MRI trailer right there on campus that stays there all the time. So, there are a lot of great services for the community at the hospital. In addition to that, we have two rural health clinics. In the middle of February, we finally saw the fruition of about seven years of work getting an assisted living facility open. We've transitioned from skilled nursing in the skilled nursing facility to assisted living and the goal behind that was to provide a larger spectrum of care for the community. It’s a very, very small percentage of the population that ever needs skilled care and it's a larger population that needs assisted living. So, we wanted to make sure that we were positioned right for the community there. In addition, at one of our agencies, we have a dental clinic. So, we’re doing a lot of great work for an underserved population.

HL: What is the biggest financial challenge facing Columbia County Health System?

Minor: Labor. Even before the pandemic, it was the number one issue. That has always been the highest cost. Before the pandemic, it was a problem that was somewhat unique to rural providers because there is just a smaller percentage of the population that wants to live there. Our closest major city is 45 minutes away by car. The next one from that is an hour away. So, it takes a lot to get people to want to come and live in Dayton. Then after the pandemic, when you have a much smaller pool to work with, it becomes even more difficult. So that has absolutely been our single greatest financial hurdle over the last few years.

HL: How is Columbia County Health System combating the labor issue?

Minor: We know we can’t compete with the big systems monetarily. So, the strategy has to be what makes it better to work for us than for them. There are reasons to come work for us. We try to keep staffing ratios reasonable for the nurses so that they feel safe and able to care for their patients. We try to make it more of a community and more of a team so that they have their voices heard. We're not a faceless system that operates somewhere else and just has this hospital in Dayton, we are the community.

Another strategy we’re currently utilizing is to start an education department. We decided to do this because we spoke with our nurse supervisors last year, and one of the biggest things they said is that to feel safe, we need even the less experienced nurses to have the specialized skills needed to care for these patients, especially on the night shift or during weekends, when you don't have as many people on hand. And so, to that end, we've been looking for a nurse education coordinator.

Additionally, we’ve purchased a sim manikin, these things are amazing. They are able to fully simulate a patient, a patient who is crashing, a patient who has sepsis; a patient who has a whole lot of different life-threatening needs to deal with. It can simulate scenarios that our nurses see naturally maybe once or twice a year. We're very excited to get that off the ground because it's going to give them the muscle memory to feel confident when they go into these very stressful situations.   

HL: What are some unique strengths that rural hospitals have that maybe their larger counterparts don’t?

Minor: Commitment to and support from the community is a huge one. We’re the largest employer in Columbia County, by a long shot. Additionally, we are a public hospital district. So, we have public board meetings every month. We’re actively engaged with reaching out to our community and I think they understand that this isn't about money, right? We're not a faceless corporation that's here to milk them for every healthcare dollar they're worth. They don't always see that but that's the general strength that we have. We can be very focused on what our patients and our community need and not necessarily on what looks best on paper. We do have to keep the doors open. And that’s cliche but it's something that we have to remind our clinical people of quite frequently. We want to do what's best for the patient, but what's best for the patient is keeping a hospital here.

HL: How is Columbia County Health System keeping the doors open?

Minor: It’s an evolving strategy. But one of the things that we embraced very early on was value-based care. We’ve been on an ACO for years, and we recently switched to a new ACO this year. Finding ways to reduce costs while increasing quality and positive outcomes for the patient is a passion of ours. Along with that comes recognizing that fee-for-service is not the future, and neither is cost-based reimbursement.

Value-based care is the future and disparate revenue streams are the future. So, looking to where we can find revenue streams that match specific community needs is important. Sometimes that means providing a service when there isn’t a clear revenue stream. For example, we have our transportation department, which has never made us a dime. We've never seen direct revenue from that transportation department, but what they do is they pick patients up and make sure that they make their appointments. And so, we get compliance. We get patients that see their doctors when they're supposed to, that are managing their chronic illnesses, and who don’t end up in the ER. So, it's about looking for those disparate revenue streams, but also thinking about the things that can contribute to those shared savings.

Amanda Schiavo is the Finance Editor for HealthLeaders.


Investing in tech that can help staff sharpen their medical skills can make a rural hospital an in-demand place to work.

Embracing value-based care can help rural hospitals keep their doors open.

An in-house education department can help small nursing staff manage difficult medical situations.

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