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Tuesday September 13, 2022  |  Luke Marinac

Diagnosing Rural Health with Beth O’Connor, NRHA President (Part II)

Earlier this month, Ken Misch, president of MEDHOST, had the opportunity to interview Beth O’Connor, executive director of the Virginia Rural Health Association and president of the National Rural Health Association (NRHA).

In this two-part series, Ken and Beth discuss the developing nature of rural healthcare, some of its most pressing challenges, and how MEDHOST collaborates with rural health systems to continue serving their needs.

The first section of this article emphasized the challenges of connectivity, population health management, and the impact of COVID-19. In this section, Ken and Beth delve into the social determinants of health, interoperability, and the ongoing crisis of rural hospital closures.

Ken: There is a general belief that the social determinants of health present even more challenges for rural populations. Is the NRHA aware of any community organizations trying to address these challenges, and if so, what best practices can rural providers adopt?

Beth: The buzzword is changing.

If you take a look at the term “social determinants of health,” it makes it sound like the outcome is predetermined. Why would we spend time and resources on a population when we already know the outcome?

Instead, we’ve started talking about the “social drivers” of health. Indicators such as poverty, education, and race may drive health outcomes in a certain direction, but we can still do a course correction. Addressing these social drivers is absolutely essential for communities to make progress. Any hospital that wants to address social drivers of health needs to conduct a community health needs assessment that includes questions about those influences and how they should be addressed.

Most grant applications for the Federal Office of Rural Health Policy require that these social drivers be taken into consideration.

Ken: What is your advice for rural health hospital leaders to achieve success?

Beth: I would encourage hospital leaders to take advantage of the tools and resources the National Rural Health Association offers.

At the very least, sign up to receive announcements from NRHA, so you can stay on top of regulations and updates, and what's going on in Congress that could impact your local facilities. No one has time to do all that themselves. Let NRHA do it for you. Then, attend the NRHA rural hospital innovation summit in San Diego next May. This is an opportunity to hear about best practices and talk to your peers about what's working on the ground, and what's not. It's a great opportunity to connect with others that are dealing with the same issue you are and see what new ideas pop out.

When you’re ready to dig deeper, check out NRHA rural hospital CEO certification program. It arms rural CEOs with the competencies and skillsets to take on the unique challenges of rural hospitals and continue to be a top-performing CEO.

Ken: One of the buzzwords we tech geeks have lived with for a while, especially in the provider environment, is the word “interoperability,” which basically means that systems need to talk to each other. What challenges does rural health face in achieving true interoperability?

Beth: Software challenges apply to everyone. For rural areas, the issues are a lack of internet access and digital literacy.

I remember a few years ago, the Virginia Secretary of Technology had asked me to send out a survey to rural clinics about broadband access. I was annoyed because the request was to send it specifically to rural health clinic IT Directors.

There isn't a single rural health clinic in Virginia with its own IT director. If they are part of a larger healthcare system, the IT director is based out of the hub facility and only visits the clinic when necessary.

If we’re talking about an independent facility, the person who installed the server is likely the office manager's nephew, who visited over Thanksgiving. The smaller entities just don't have the capacity to keep up with many of the digital changes we are seeing.

Ken: Healthcare IT companies like MEDHOST partner very closely with rural providers and we’ve become an integral part of that infrastructure. Can you elaborate on how you see the role of healthcare IT companies changing in the future?

Beth: I see that role continuing to expand. Increasingly, rural entities are outsourcing tasks to control costs while maintaining quality. I think the line between healthcare providers and IT providers will become invisible.

Ken: We have been seeing that, certainly. Our clients ask us to do more and more for them because they lack the time or the resources, and we can often do it more effectively at a lower cost.

We’ve talked a little bit about the regulatory environment. What are some of the critical policies that have or will affect rural health in the future?

Beth: The regulatory changes implemented during the early days of COVID, such as those that facilitated telehealth, must stay in place. I encourage everyone to contact their members of Congress and demand that those changes become permanent.

Ken: According to some 2020 numbers, rural hospital closures are at a crisis level. Over 135 rural hospitals have closed since 2010, and more than 450 have been identified as vulnerable based on performance levels.

What are some ways we can see these numbers go down or reverse this trend?

Beth: Hospital closures are a crisis not just for healthcare, but for the overall well-being of the community in terms of the economic impact.

So, there are a few things we can do:

First, we absolutely must extend the Medicare-dependent hospital and low-volume hospital designations. Those are set to expire on September 30, 2022. Currently, there are 139 Medicare-dependent hospitals and 535 low-volume hospitals that are an integral part of this nation’s healthcare safety net. These designations allow hospitals to receive additional Medicare payments that help them stay open to continue to serve the community. It's time for Congress to make those designations permanent.

And when you call your members of Congress to tell them to make the telehealth regulations permanent, make sure to also ask for their support of the Rural Hospital Act to avoid a potential lapse of these lifeline programs

Second, it’s important to permanently eliminate Medicare sequestration for these hospitals. The Medicare cuts are relatively minor for urban facilities, but a 1-2% reduction in reimbursement can make the difference between staying open or closed for rural hospitals.

Ken: What is your vision for the future of rural healthcare IT?

Beth: I’m going to touch back on interoperability, here.

I would love to see a seamless interface between physicians and coders and insurance processes, all of them able to access the information they need without having to check multiple sets of software.

Ken: That is certainly the goal and the vision I think for all of us IT companies that serve rural healthcare customers. We believe interoperability is good for efficiency, clinical care, and the financial well-being of companies in the long term.

The interview concluded with Beth O’Connor reiterating the importance of rural providers getting involved in self-advocacy and staying informed about ongoing Congressional legislation that affects their operation.

To hear more of Beth’s insights on rural health advocacy, check out her contribution to Misinformation, and Making Do: Appalachian Health-Care Workers and the COVID-19 Pandemic, an upcoming collection from Ohio University Press.

As a partner of the NRHA, MEDHOST is pleased to contribute to the sustainability of healthcare in rural America. Please contact us at or call 1.800.383.6278 to learn more about the numerous ways MEDHOST helps address difficulties in both rural and community hospital settings.

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