Their biggest operating concerns in the current environment
Running a hospital today is a continued challenge — and no one knows that better than the CEO. CEOs are the face for their communities in providing outstanding healthcare services for patients while facing serious workforce shortages, rising rates of healthcare worker burnout, soaring operational costs, threats to cybersecurity, incorporating and integrating new technologies, and ever-changing regulatory requirements. It can seem like a nearly impossible task.
Rural hospitals, especially, are no strangers to dealing with ongoing operational challenges and delivering financial stability. Geographic isolation and socioeconomic factors make rural hospitals vital anchors in their communities, as both caregiver and employer. When the hospital struggles, so does its community, and when a hospital closes, it has a substantial impact on the people who rely on it. It can be said that a community without a hospital is like a farmer without a field.
Biggest Concerns for Rural Hospital CEOs
Considering the dynamics in healthcare, rural hospital CEOs have the greatest impact on healthcare in rural communities, and as leaders, they are faced with solving many challenges for their hospitals and communities.
Workforce/staff shortages
According to the National Institute for Health Care Management (NIHCM) Foundation, 80% of rural America is medically underserved, due in part to staffing shortages. The Foundation says there are only 39.8 physicians per 100,000 people in rural areas, compared with 53.3 physicians per 100,000 in urban areas. Living and working in a smaller, more remote town may not be appealing to many healthcare workers, and the hospital may not be able to match the salary and benefits of an urban hospital. This can lead to a smaller pool of applicants from which to hire.
Financial uncertainty
All hospitals are facing increased costs for staff and supplies. They are also wrestling with the probability of significantly reduced government funding, and considering that more than 20% of rural residents are Medicaid recipients, with cutbacks, these patients are less likely to have access to needed care. And while public coverage is the “safety net,” commercial insurance is the “financial engine” for most rural hospitals, as private plans typically pay significantly higher reimbursement rates than Medicare or Medicaid. If a hospital can’t adequately support its community members, these patients will seek care elsewhere, typically in an urban area.
Service line closures
With a limited number of physicians moving to rural communities due to factors including pay, family opportunities, and housing availability, rural hospitals make the difficult decision to not offer or to end certain service lines. With the struggles to recruit and retain specialists in a rural market, and often limited funding, it may not be feasible to provide niche services. This means that any patients in the community who need this specialized care must find providers outside their communities.
“This is not a silo solution. The capability to provide in-hospital care for patients with kidney disease impacts all service lines, since they often are being admitted for conditions other than kidney disease.”
Be Innovative to Thrive
So, what are rural hospitals to do? Rural hospital CEOs must prioritize effectively to serve and care for patients in their communities. Rural hospitals that are thriving despite the challenges have learned to innovate while not significantly increasing costs. This means their CEOs are most likely forward-thinking and can see the broader picture.
Multiple CEOs of critical access hospitals have implemented telenephrology programs that support all service lines because patients with chronic kidney disease or acute kidney injury, or who need dialysis, can be treated for non-dialysis issues. The telenephrology programs allow nephrology patients to stay in their community when they need care. The programs have led to additional new service lines for the hospitals, such as cardiovascular care. By identifying and implementing a solution that impacts all service lines, the hospitals have seen increased patient volume and revenue. The impact for a few of these hospitals has been:
- Over $10M in net revenue in six years
- Elimination of over 15,000 miles of patient travel
- Reduction in helicopter transport by over 30%
Some Potential Solutions
While solving these rural hospital issues is a complex process, as a telenephrology provider who is there in the trenches with you, we’d like to offer a few ideas to start.
In terms of the lack of workforce and staff shortages in rural health facilities, it’s beneficial to look into partnering with specialists and telemedicine offerings. Collaborating with experts virtually can provide staff to bridge gaps in service or provide coverage when local colleagues are on vacation. Joining forces means these experts become an integrated extension of your team. They provide the support and specialties you need to deliver exceptional care locally and improve patient outcomes in your community.
While financial uncertainty is an ongoing challenge in rural healthcare, the Rural Health Transformation Program (RHTP) is offering some new hope. CMS launched this $50 billion federal initiative in late 2025. Its purpose is to fundamentally redesign healthcare delivery in rural America over the next five years. According to the U.S. Department of Health and Human Services, “This unprecedented investment is designed to empower states to transform the existing rural health care infrastructure and build sustainable health care systems that expand access, enhance quality of care, and improve outcomes for patients.”
Not being able to offer certain service lines hurts not only your bottom line, but also the health of your community. Telenephrology allows hospitals the ability to provide vital services that impacts all other service lines. It keeps rural patients within their home community for care rather than needing to transfer their care to an urban facility. Telenephrology solutions extend the clinical team’s capabilities, allowing the hospital to provide a complete care solution. With innovative telenephrology solutions, CEOs can make cost-effective improvements that ripple throughout their entire organization and keep care local.
For more information on how telenephrology can help your hospital stay viable, contact us at 720.899.4990 or through our Contact form.