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3 Ways Bassett is Addressing Critical Rural Health Struggles

Analysis  |  By Melanie Blackman  
   July 27, 2023

Bassett's president and CEO Tommy Ibrahim shares how the system is taking steps to mitigate struggles currently plaguing rural health systems across the country.

According to the Centers for Disease Control and Prevention (CDC), 15% of all Americans live in rural areas—that's 46 million people. And, in general, the CDC says, "residents of rural areas in the United States tend to be older and sicker than their urban counterparts."

A general lack of resources and a limited talent pool to chose from are only a few pain points plaguing rural health systems, who care for those communities. One rural health system is trying to fix that.

Bassett Healthcare Network is headquartered in Cooperstown, New York, a village in central New York state with a population of less than 1,900. The system serves communities in eight counties across 5,600 square miles in central New York, and sees more than 700,000 outpatient visits per year.

Bassett Healthcare Network president and CEO, Tommy Ibrahim, MD, MHA, recently spoke to HealthLeaders about the hardships that rural health systems are currently facing and what steps the health system is taking to mitigate those.

"We were fractured from a staffing perspective even prior to the pandemic," Ibrahim says.

"Through the pandemic, and certainly post-pandemic, there have been permanent shifts in workforce that we continue to grapple with. We've seen this gig economy that's been created where there are a number of nontraditional entrants into the healthcare delivery system vying for the same pool of resources that we're vying for. There's been price wars that have been created, and wage inflationary pressures that have been created across our region, where we're going after the same very scarce pool of resources, and essentially dealing with a significant supply and demand imbalance that we're constantly grappling with. That's led to the necessary capital infusion into our workforce to be able to remain competitive."

"Because of the supply balance, we've had to rely very heavily on travel agency nurses and other staff, which has just completely cratered our financial performance," he says.

"The inflationary pressures coupled with the volume and revenue declines that we've been experiencing has been incredibly difficult. When you're operating on a razor thin to negative margins already, it [becomes more difficult] for us to continue to sustain key services and programs for the community," he says. "At the very heart of it is, you have a weakened rural healthcare system already, that's been further decimated, quite frankly, by some of these economic and environmental shifts that we're seeing in the industry and crippling at the heart of our ability to continue to provide key access to our patients."

These pain points, if not addressed, can have lasting effects on health systems and the vulnerable communities that they serve.

"I fear long term that has pretty significant adverse outcomes for our community and our patients. Couple that with the various social determinant challenges that we have to deal with: transportation, access to broadband, food insecurity, poverty, digital illiteracy—you name it— it's a very challenging population to begin with, and now we've made it even more difficult for us to truly meet the needs that are required."

Bassett is taking necessary steps to ensure the sustainability of the organization for its workforce and the communities it serves, Ibrahim says. And although there may be a lot of struggles currently, there is also great opportunity.

"Through the pandemic, one thing that's become abundantly clear is that we had a weakened infrastructure that's now become weaker, and it's catalyzed a lot of very positive internal movement to begin to address some of the critical areas that were neglected in the past," he says.

One way Bassett is addressing critical areas is looking at the heart of the system's operations.

Bassett is looking at operations such as "surgical OR efficiency, and making sure that we're capitalizing on the effectiveness and the efficiencies of those systems throughout the organization," Ibrahim says. They are also "looking at how we could reduce unnecessary waste in the system, and identifying cost initiatives around supply chain, pharmaceuticals, and clinical variation, and other clinical workflows that could create enhanced value both through revenue enhancement or through expense reduction."

Additionally, the system has launched the Acceleration office, which has transformative mandates within it to hold accountability and address operational challenges.

This includes "looking at how we can enhance revenue cycle, how we can improve denials, how we can better partner with our payers to improve reimbursement methodologies, and a whole host of other revenue, as well as cost containment initiatives that begin to create stability in the organization," he says. "We've seen a significant margin deterioration over the course of the past 12 to 18 months, but through our efforts and these operational improvements, we've seen a very encouraging and optimistic turn that is hopefully going to be self-sustaining here as we embed new systems and processes and technologies and innovations in place to really continue the performance."

The system has also invested over $50 million into its workplace, Ibrahim says.

"At Bassett, we invested over $50 million over the past couple of years and in wage programs, bonus programs, leadership development programs, workplace violence programs, [and] critical initiatives into our people, so that we can be a very competitive and attractive employer for folks to come and see us," he says. "

Related: Bassett CEO on Not Giving Up on Value-Based Care

Melanie Blackman is a contributing editor for strategy, marketing, and human resources at HealthLeaders, an HCPro brand.

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