Unrooting Provider Disparities in the Context of Rural Healthcare

How has Covid-19 impacted your daily clinical practice?

COVID-19 has impacted my daily practice by increasing the frequency of communication with hospital management, medical staff, the COVID task force, along with other key players such as the Department of Public Safety, County EMS Providers, Behavioral Health Organization, FQHC’s, LTAC’s, and hospitals in our region. The majority of our meetings have been pushed to virtual calls. Business transactions have moved to electronic e-sign with platforms such as Zoom and Microsoft Teams being used for communication and content delivery. COVID has risen to the top of my priority list and has consumed the majority of my time this past year. Items such as COVID testing, PPE inventory, ventilator availability, telemedicine implementation, WebEx deployment, bed availability, COVID antiviral treatments, vaccination roll out, staffing, and workforce health have all taken center stage. Although my daily routine and priorities have shifted, the organization continues to pursue its short and long term goals.

What effects has Covid-19 had on patient engagement and compliance?

COVID-19 has led to fewer patients seeking care and postponement of various health issues. From March 25th to April 21st, 2019, compared to March 23rd to April 19th, 2020, there was a 29.9% decrease in stroke, 63.2% decrease in transient ischemic attacks, and 46.3% decrease in stroke alerts. (Source: BMJ Stroke and Vascular Neurology.) Patients are delaying or just not getting their screenings. One analysis of Medicare claims data found that during the Spring 2020 pandemic peak, breast cancer screenings dropped by 85% while colonoscopies dropped by 75%. Studies also show that prostate and lung cancer screenings are also down year over year.

With the advent of the new vaccine, how would you describe the response in your patient population?

The response has been mixed amongst our patient population with most of those over the age of 50, more eager and willing to get the vaccine. Amongst a survey sent out to our employees, over half of our employees raised questions and concerns regarding receiving the vaccine. We are sending out regular all-staff emails with facts and data about the vaccination and approval process and efficacy behind receiving the vaccine. We are working with the Missouri Hospital Association and DHSS to provide more education to patients throughout the entire state.

And, what, if anything, can be done to stimulate support for encouraging patients to receive the vaccine?

To stimulate more support, we have been providing our staff with objective and factual data supported by the scientists and medical experts involved with all 3 stages of the vaccine trials. We are letting them know that the risks and benefits of getting the vaccine far outweigh the risks and benefits from not getting the vaccine. It is important for our staff and our patients to understand that the only way we will return to normal is if we get over 70% of the population vaccinated. I think leading by example will also help; as front line staff see our medical staff and hospital management take the vaccine, we hope that our employees follow suit. Once the specific vaccine is received, more vaccine specific data will be provided to help educate and inform our employees about the safety and efficacy behind getting the vaccine. Our medical providers and population health management staff will be contacting and educating their patients as the vaccine rollout progresses.

Regarding rural healthcare populations, with limited access to resources, how would we best advocate for positive healthcare outcomes?

The best way to advocate for positive healthcare outcomes is to place increased emphasis on primary care. Over the past 5 years, we have grown our population health department to include nurses, health coaches, behavioral health counselors, and care coordinators. This team works closely with patients in our Medicare Accountable Care Organization and Medicaid Medical Home to promote wellness and manage chronic conditions. The focus of this department is to improve compliance with annual wellness visits, transitions of care from inpatient to outpatient, decrease in hospital readmissions, keeping these patients out of the emergency department, along with medication and chronic disease management compliance.

Characteristics of a typical day.

Although there are certain tasks and duties that I perform routinely, there really is no typical day in the life of a healthcare system CEO. My days start with checking the hospital census, bed availability, emergency department visits, admissions and discharges, clinic visits, and staffing needs. I have daily operational and financial dashboards that provide me with snapshots of all the key performance metrics that I track and trend. I am engaged with administration, managers and directors, and medical staff on a daily basis through meetings and calls dealing with hospital and clinic operations. I am working daily to ensure that every aspect of the hospital is working efficiently. I rely heavily on my middle managers to handle day to day operations and my focus is on leading strategic development initiatives, establishing a positive and productive work culture, improving the quality and safety of patient care, closely managing revenues and expenses, and providing direction of the overall organization.

One piece of advice you could give to aspiring clinicians.

Follow your passion, and know that a career in healthcare is a high calling that requires a strong work ethic, empathy, focus, career-long knowledge and growth, and an unwavering commitment to your patients and care team.