Latest / Becker’s Healthcare Podcast / Rural Hospitals’ Growth Strategies and the Fight to Preserve Local Access to Care with Jeremiah Hodshire

Transcript

Rural Hospitals’ Growth Strategies and the Fight to Preserve Local Access to Care with Jeremiah Hodshire · Becker’s Healthcare Podcast

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  - This is Laura Dierdahl with the Becker's Healthcare
• 1:01
  - podcast. I'm thrilled today to be joined by
• 1:03
  - JJ Hodeshier, president and CEO of Hillsdale Hospital.
• 1:07
  - JJ, it's a pleasure to have you on
• 1:08
  - the podcast today. Well, it's great to be
• 1:10
  - back. I always enjoy my time with Becker's
• 1:12
  - friends, and so thank you for this great
• 1:14
  - opportunity.
• 1:15
  - Absolutely. My pleasure. And, you know, it's always
• 1:17
  - great to speak with you. You've got so
• 1:19
  - much going on in such an important and
• 1:21
  - critical time right now in health care for
• 1:23
  - especially rural health care. So, I I know
• 1:25
  - we'll be digging into a good amount of,
• 1:28
  - topics around what you've been doing in order
• 1:30
  - to kind of meet and combat the challenges
• 1:32
  - of the day as well as how you're
• 1:33
  - thinking about the future. But if we could
• 1:35
  - start off, could you give us a quick
• 1:37
  - state of the union? What has gone well
• 1:38
  - this year, and what what do you focus
• 1:40
  - on for the rest of 2026?
• 1:42
  - You know, let's let's start positive. Right? Because
• 1:45
  - that's most important because there's a lot of
• 1:46
  - negativity swirling right now in our industry, and
• 1:49
  - we'll certainly talk about that in a minute.
• 1:51
  - But what's really working well is community engagement,
• 1:55
  - opportunities to connect with our respective communities through
• 1:59
  - rural health clinics.
• 2:00
  - We launched a mobile health unit, which really
• 2:03
  - is addressing
• 2:04
  - communities who do not have,
• 2:07
  - primary care locations.
• 2:08
  - And
• 2:09
  - we really wanna take our,
• 2:12
  - hospital vision to each backyard of the communities
• 2:16
  - that do not have those services.
• 2:17
  - And in part because we lack transportation
• 2:20
  - in our community,
• 2:22
  - we do not have public transit throughout the
• 2:24
  - county. And so, you know, transportation is a
• 2:27
  - challenge. So what we did is we identified,
• 2:29
  - you know, through our community needs assessment,
• 2:32
  - looking at our strategic plan, what are the
• 2:34
  - things that we wanna achieve? And and I
• 2:35
  - I can say this year, it's been a
• 2:37
  - very successful year in achieving those things and,
• 2:41
  - building new service lines and looking at ways
• 2:43
  - that we can keep our patients right here
• 2:45
  - at Hillsdale
• 2:46
  - because of the travel restrictions, because of the
• 2:49
  - challenges, because of the cost of gas. You
• 2:52
  - know, the opportunity for individuals in our community
• 2:54
  - to drive
• 2:55
  - 40 to 50 miles and spend that gas
• 2:59
  - and the time is just not available for
• 3:01
  - them. And so ensuring that we have a
• 3:02
  - full continuum of care. And one way that
• 3:04
  - we've done that,
• 3:05
  - January 1, we launched a neurosurgery
• 3:08
  - program. Hard to believe that a rural hospital
• 3:11
  - in Southern Michigan,
• 3:12
  - you know, a 100 bed hospital would have
• 3:14
  - a neurosurgeon
• 3:16
  - full time engaged doing surgical intervention,
• 3:20
  - having clinic hours, supervising a very robust pain
• 3:22
  - clinic,
• 3:23
  - and it's worked out remarkably well. And there
• 3:26
  - was a proof
• 3:27
  - that our community
• 3:28
  - lacked that type of service in the availability
• 3:31
  - to gain access to that service
• 3:33
  - by way of the numbers that we're seeing
• 3:36
  - right now. This individual's booked out till October,
• 3:39
  - and doctor Loganathan has done an amazing job
• 3:41
  - for us as a skilled surgeon to be
• 3:43
  - able to serve a need in our community.
• 3:45
  - That's one example
• 3:46
  - of our growth strategy that has
• 3:49
  - created a lot of excitement in our community
• 3:51
  - beyond looking at going into the communities, the
• 3:54
  - smaller communities
• 3:55
  - of our county with the mobile unit and
• 3:58
  - with,
• 3:59
  - community care, connections.
• 4:01
  - It's really looking at what service lines can
• 4:03
  - we build up here at Hillsdale to ensure
• 4:06
  - patients
• 4:07
  - do not have to travel further in,
• 4:09
  - whether it's a neurosurgery program, whether it's our
• 4:11
  - relationship with vascular surgery. We have a vascular
• 4:14
  - surgeon that comes in. We did our first,
• 4:16
  - you know, EVARs, endovascular aneurysm repair,
• 4:20
  - several years ago, and I was told that
• 4:22
  - we would never do,
• 4:24
  - an EVAR at a rural hospital. And here
• 4:26
  - we have done,
• 4:27
  - dozens and dozens of those. And then we
• 4:29
  - just did a thoracic EVAR, which, again, was
• 4:32
  - told that would never happen,
• 4:34
  - in our community. So we are doing some
• 4:36
  - innovative things, some great things, but all with
• 4:39
  - an eye towards ensuring that patients have access
• 4:43
  - to care. And that's been very important for
• 4:45
  - us to do, and it's it's it's proven
• 4:47
  - to be very effective at meeting the needs
• 4:49
  - of our community as well as
• 4:51
  - also having a revenue aspect for the hospital.
• 4:55
  - That's fascinating to hear about, and you're truly
• 4:57
  - impressive to see those services that you've been
• 5:00
  - able to bring into the hospital and bring
• 5:01
  - in the community. I know how important it
• 5:03
  - is to keep here local and then to
• 5:05
  - have that as an engine,
• 5:06
  - for better clinical care as well as, the
• 5:09
  - financial support, I can imagine, makes a really
• 5:12
  - big difference. So,
• 5:13
  - when you're bringing in a program like that,
• 5:15
  - when you're thinking about neurosurgery or other types
• 5:17
  - of procedures,
• 5:18
  - what does it take in order to make
• 5:20
  - that right investment and then build out a
• 5:23
  - program like that?
• 5:24
  - You know, obviously, bringing in the surgeon is
• 5:26
  - one thing, but then being able to put
• 5:28
  - everything
• 5:29
  - around that program too is is an additional,
• 5:32
  - investment. So I just love to hear from
• 5:34
  - your perspective how you know, what your
• 5:37
  - planning process was around that and then what
• 5:39
  - it really took to get kicked off. Yeah.
• 5:41
  - You know, it's it's always a heavy lift
• 5:42
  - whenever you implement a new program, specifically,
• 5:46
  - you know, a specialty program. And, you know,
• 5:48
  - we have a lot of specialty programs.
• 5:50
  - We have a pediatric ophthalmologist
• 5:53
  - that is in our community and she utilizes
• 5:55
  - our hospital,
• 5:56
  - for surgery. And that is a very rare
• 6:00
  - service line. And, you know, when we look
• 6:02
  - at the uniqueness
• 6:04
  - of, those type of specialty services, you know,
• 6:07
  - we're very blessed as a rural community. But
• 6:09
  - we go beyond that and say, okay. From
• 6:11
  - the community needs assessment, from some of the
• 6:14
  - quality reporting that we do with market studies,
• 6:17
  - what is the need in our community? We're
• 6:19
  - always analyzing. I just reviewed my report this
• 6:21
  - morning. You know, what is it that what
• 6:23
  - what's leaving the community?
• 6:25
  - What is the community telling us on these
• 6:27
  - surveys that they wanna have? And once we
• 6:29
  - identify that area, it's a very lengthy process.
• 6:31
  - It's not just that I go out and
• 6:33
  - say, hey. Community wants a neurosurgeon. Let's go
• 6:35
  - hire one. First of all, you know, to
• 6:36
  - find a neurosurgeon is very difficult.
• 6:38
  - Second of all, to implement it, fully is
• 6:41
  - even more difficult because it requires a tremendous
• 6:44
  - amount of coordination.
• 6:45
  - And before you even get to the implementation
• 6:47
  - rollout, you know, you really have the discovery
• 6:49
  - period. And it's it's looking at your ROI.
• 6:52
  - What's the return on investment gonna be? When
• 6:54
  - you when you do that, you know, we
• 6:56
  - are sitting down with our finance team, having
• 6:58
  - discussions with growth and strategy experts at the
• 7:00
  - hospital, our clinics director. But the CFO is
• 7:03
  - intimately involved in this because he's looking at
• 7:06
  - it from the lens of, okay, how many
• 7:08
  - years does it take to break even, and
• 7:10
  - how many years does it take to be
• 7:12
  - profitable? Because we know in this industry,
• 7:14
  - as any business, you know, where there's no
• 7:17
  - margin, there's no mission. And if we are
• 7:19
  - not making money, then we cannot carry out
• 7:21
  - the mission of the hospital. We can't reinvest
• 7:22
  - in our people, can't reinvest in technology.
• 7:25
  - And so we always have to look at
• 7:26
  - it from from that lens. I'm more of
• 7:29
  - a let's just go do it, you know,
• 7:31
  - charge hell with a score gun type guy.
• 7:33
  - The CFO tempers that often and says, no.
• 7:36
  - Not today.
• 7:38
  - And and we do have, you know, this
• 7:40
  - opportunity to vet it out, which I appreciate.
• 7:42
  - But we spend time looking at the market
• 7:44
  - demographics, and we look at the payer mix.
• 7:46
  - If we were to bring this particular service
• 7:48
  - line in, what are the payers paying for
• 7:50
  - that?
• 7:51
  - Historically, when you prior to the average partial
• 7:53
  - rate in Michigan, most of the Medicaid procedures
• 7:56
  - that we did,
• 7:58
  - that were Medicaid based, you know, were a
• 8:00
  - a loss to the hospital.
• 8:02
  - And then we had average partial rate come
• 8:03
  - in several years ago, which is now being
• 8:05
  - reversed by HR one, which I won't get
• 8:07
  - into, but that's devastating for a community like
• 8:10
  - Hillsdale,
• 8:11
  - is that it has a different reimbursement model
• 8:14
  - to it because now we're getting the average
• 8:16
  - commercial rate. When our population right now of
• 8:18
  - payers
• 8:19
  - is 70% of the government,
• 8:21
  - it's, you know, Medicaid and Medicare.
• 8:23
  - You really have to look at it from
• 8:25
  - the lens of what happens if there's a
• 8:26
  - shift in those programs,
• 8:28
  - either left or right. And so when that
• 8:30
  - happens,
• 8:31
  - is this program able to be sustained throughout,
• 8:35
  - you know, a period of time, whether it's
• 8:36
  - an election cycle,
• 8:38
  - regardless, whatever the whatever it takes to get
• 8:40
  - through that that cycle.
• 8:42
  - And so the pro form a is critically
• 8:44
  - important in ensuring that we're following. And the
• 8:46
  - pro form a we build, it's looking at
• 8:48
  - staffing levels. It's looking at volumes. It's looking
• 8:50
  - at referral patterns. It's looking at ancillary services,
• 8:54
  - downstream revenue. All of those things come into
• 8:56
  - play. But then, you know, after that, it's
• 8:59
  - like, alright. We identified we wanna do it.
• 9:01
  - Now we have to go out and recruit.
• 9:02
  - Now we have to build up the workforce.
• 9:04
  - And today, a biggest challenge that we have
• 9:06
  - is retention and recruitment in health care. It's
• 9:09
  - finding those entry level positions as MAs, MORs,
• 9:12
  - medical office receptionists,
• 9:13
  - medical assistants, finding those individuals that wanna work
• 9:16
  - that come into that play of, alright, can
• 9:18
  - we get this office started? In many cases,
• 9:21
  - I have found the surgeon but have not
• 9:23
  - been able to bring the clinic online because
• 9:26
  - I don't have the entry level staff and
• 9:28
  - the frontline staff to be able to get
• 9:30
  - that done in a timely manner. And so
• 9:32
  - we're facing some of those challenges with talent
• 9:34
  - pipeline struggles. And that's another issue that is
• 9:38
  - heavy on on the minds of CEOs right
• 9:40
  - now is how do you build that talent
• 9:41
  - pipeline. But let's assume that we've identified the
• 9:43
  - surgeon, the performance shows a positive,
• 9:46
  - impact to the organization and community.
• 9:48
  - You see an ROI within a time frame
• 9:50
  - that's acceptable. You find the staff. Now you
• 9:52
  - gotta open the office. And we were able
• 9:54
  - to do that in a relatively short time.
• 9:57
  - And in neurosurgery, it's proven to be very
• 9:59
  - effective. And we've done this throughout many of
• 10:01
  - the service lines that we've launched here. A
• 10:03
  - very robust OB GYN program with certified nurse
• 10:06
  - midwives,
• 10:07
  - ortho program that is really second to none,
• 10:11
  - outstanding surgeons who do a great job. But
• 10:13
  - as we look at the market and it
• 10:15
  - shifts and it changes,
• 10:16
  - very, very quickly,
• 10:18
  - and we're always I'm looking at this in
• 10:20
  - real time. I look at it every quarter.
• 10:22
  - Where is the shift? And we try to
• 10:24
  - meet the needs
• 10:25
  - of the market in that shift. And when
• 10:28
  - we're able to roll that out effectively,
• 10:30
  - everyone,
• 10:31
  - wins. The community wins.
• 10:33
  - Physicians we hire win. The patient wins because
• 10:36
  - they're not traveling as far. And, ultimately,
• 10:38
  - the hospital wins through revenue
• 10:41
  - growth. And when you look at revenue growth,
• 10:43
  - it's important because our community hospitals today are
• 10:46
  - the leading organization. They're the number one or
• 10:48
  - number two employer in their community,
• 10:51
  - and they are the economic engines of that
• 10:53
  - community. So it's always done with an eye
• 10:56
  - towards how do we continue to build the
• 10:58
  - economic infrastructure of your respective community. And one
• 11:02
  - way to do that is through growth initiatives
• 11:03
  - like this.
• 11:05
  - I love that. I mean, I I think
• 11:06
  - it's such an amazing way, as you mentioned,
• 11:09
  - to be able to build out those services,
• 11:11
  - to think through what's happening now, what potentially
• 11:13
  - could happen in the future, how do we
• 11:15
  - Yeah. Make sure that this is viable and
• 11:17
  - sustainable
• 11:18
  - no matter where you are with, you know,
• 11:20
  - political, economics, everything else, and really boiling it
• 11:23
  - down to what's gonna be beneficial for the
• 11:25
  - patient. So Absolutely. I love that.
• 11:28
  - And in that vein, as you're looking into
• 11:30
  - the next couple of years, what are the
• 11:32
  - biggest headwinds that you're keeping your eye on
• 11:34
  - and preparing for? Yeah. I mean, do we
• 11:36
  - have two hours? Because that's what it's gonna
• 11:38
  - take. Right? You know, I'll I'll try to
• 11:39
  - do it as as quickly and, you know,
• 11:43
  - succinctly as I can.
• 11:45
  - Right now, we're faced with the most unprecedented
• 11:48
  - times for health care. And I know probably
• 11:51
  - every generation has said that, and I've been
• 11:53
  - in health care now for sixteen years. And
• 11:55
  - I'm telling you, this is the most,
• 11:57
  - unprecedented times that I've ever served. And,
• 12:01
  - the reason for that is, you know, with
• 12:03
  - a community hospital like ours with 70% of
• 12:05
  - the payer mix of government,
• 12:07
  - whatever decisions the government makes
• 12:10
  - has
• 12:11
  - an impact in the operations of our hospital
• 12:13
  - in real time.
• 12:14
  - For example,
• 12:16
  - you know, we had the average commercial rate
• 12:18
  - uplift for Medicaid in the state of Michigan.
• 12:20
  - Michigan was an expansion state for Medicaid. It
• 12:23
  - was a very good thing that happened.
• 12:25
  - Average commercial rate comes in. We're now getting
• 12:27
  - paid actually
• 12:29
  - cost or even a little bit better than
• 12:31
  - cost to deliver that service. Prior to that,
• 12:33
  - Medicaid patients, by and large, you would lose
• 12:35
  - on every patient that walked into your door,
• 12:37
  - and you try to make up the margin
• 12:39
  - on commercial. But when your community starts to
• 12:41
  - suffer economic losses and businesses run out of
• 12:43
  - town and close and divest, you see less
• 12:47
  - commercial and more government payers, and that becomes
• 12:49
  - a problem. So what we are faced with
• 12:52
  - right now is the devastation
• 12:55
  - that HR
• 12:56
  - one, also known as the one big beautiful
• 12:58
  - bill, is going to bring to our rural
• 13:00
  - communities. Now, you have talked to Scott Becker
• 13:03
  - many times on my podcast. I've had many
• 13:05
  - of the leading experts from the Center of
• 13:06
  - Payment Reform and all of these folks on
• 13:08
  - the program talking about
• 13:10
  - the impact of this in our community. And
• 13:12
  - I wanna tell you the numbers and the
• 13:14
  - statistics and the research that's been done is
• 13:16
  - real. 734
• 13:18
  - hospitals are at risk of closing this country
• 13:20
  - right now. Half of those are at immediate
• 13:22
  - risk of closure,
• 13:23
  - and this is only going to be accelerated
• 13:26
  - by what we see happening with HR one.
• 13:28
  - Now trace that back to 2010.
• 13:30
  - Since 2010 to 2016, a 150 hospitals have
• 13:34
  - closed this country. Every closure has been devastating
• 13:36
  - for the respective community.
• 13:38
  - Every closure for that community means less economic
• 13:41
  - engine, less economic growth,
• 13:44
  - more impoverished individuals,
• 13:46
  - lack of jobs, lack of access to care,
• 13:48
  - all of those things. And so what we
• 13:50
  - find is, yeah, that was a 150 hospitals
• 13:53
  - over a sixteen year span. Now imagine we're
• 13:56
  - losing 734
• 13:57
  - hospitals
• 13:58
  - over a much shorter time span of just
• 14:00
  - a few years, and half of those are
• 14:02
  - at immediate risk of closure. Several of those
• 14:05
  - have been identified in the state of Michigan.
• 14:07
  - So what concerns me and keeps me up
• 14:08
  - at night is looking at the policies that
• 14:11
  - have been enacted in Washington
• 14:13
  - and or in the respective states, Michigan itself.
• 14:16
  - You know, our governor has been pro health,
• 14:18
  - and I'm very grateful for that. But it's
• 14:20
  - in a very heated legislative
• 14:22
  - battle right now over such things as three
• 14:24
  - forty b,
• 14:25
  - over hospital price transparency, and all the new
• 14:29
  - buzzwords that are being used to basically
• 14:31
  - try to support the national agenda and talking
• 14:35
  - points
• 14:36
  - that hospitals are full of waste, fraud, and
• 14:38
  - abuse, which is garbage. That's not happening. But
• 14:40
  - HR one comes into play, and most Michigan
• 14:44
  - had a little reprieve because we were able
• 14:45
  - to get to CMS early and have the
• 14:48
  - continuation of the average commercial rate at least
• 14:50
  - throughout until next year, 2027. Most states did
• 14:52
  - not do that, which means they're starting to
• 14:54
  - feel the impact of HR one right now.
• 14:56
  - We're gonna feel the impact of it in
• 14:58
  - 2027, and the impact to my hospital is
• 15:01
  - $6,000,000
• 15:02
  - annually that we will lose as a result
• 15:03
  - of this. And that's the difference between profitability
• 15:06
  - and non profitability. It's the difference between providing
• 15:08
  - benefits to the community and community engagement
• 15:11
  - and community support,
• 15:13
  - and having your hospital doors open. There's a
• 15:16
  - lot of tough decisions that that are gonna
• 15:17
  - happen in boardrooms across this country for hospitals
• 15:20
  - and executives to have to make some very
• 15:22
  - tough decisions regarding programs that they run now
• 15:24
  - that are traditional community benefit programs such as
• 15:27
  - OB GYN,
• 15:28
  - psychiatric
• 15:29
  - care, home care, and the list goes on.
• 15:32
  - These programs
• 15:33
  - are usually
• 15:35
  - losses to hospitals, but they're community benefit in
• 15:37
  - nature. We need to provide them because they're
• 15:39
  - important. They're safety nets. But when you strip
• 15:42
  - out of hospitals like Hillsdale $6,000,000
• 15:44
  - from very bad legislation that was enacted,
• 15:47
  - We are now on the receiving end of
• 15:49
  - that with very little representation, very little recourse,
• 15:53
  - and we have to make it work. And
• 15:55
  - that is what is most concerning right now
• 15:57
  - is as we look at the federal landscape,
• 16:00
  - that's a challenge. Now the federal government's gonna
• 16:01
  - say what's up to the state then to
• 16:02
  - make you whole,
• 16:04
  - in each respective state to come up with
• 16:06
  - the difference in the average commercial rate. And
• 16:09
  - you have states across this union who aren't
• 16:11
  - doing very well right now economically.
• 16:14
  - They see losses from their communities, of their
• 16:16
  - state. Individuals are not coming back after graduation,
• 16:19
  - staying in those states, housing crisis. The list
• 16:22
  - goes on and on. The states are not
• 16:24
  - in a position to cover that difference, and
• 16:26
  - yet the safety net hospitals in our communities
• 16:29
  - will dry up, which means access to care
• 16:31
  - is is
• 16:33
  - strangulated
• 16:34
  - and
• 16:35
  - quality of care is diminished.
• 16:39
  - And
• 16:40
  - as you trace it back, individual health care
• 16:43
  - outcomes become worse
• 16:45
  - because there's no access to local care in
• 16:47
  - communities that do not have transportation.
• 16:50
  - So that's what's keeping me up at night.
• 16:51
  - You know? Could there be a change in
• 16:52
  - this? Who knows? I mean, if there's a
• 16:55
  - change legislatively,
• 16:56
  - what we know is it's gonna take years,
• 16:59
  - for this to get reversed. And right now,
• 17:02
  - hospitals are bracing for how do we make
• 17:04
  - it in the new world, or do we
• 17:06
  - make it in the new world? And just
• 17:07
  - four weeks ago, a hospital forty minutes away
• 17:10
  - from me just shuttered their doors completely. Sturgis
• 17:13
  - Hospital. Close their doors. Shut the lights off
• 17:15
  - on a Friday afternoon. Done. That community is
• 17:18
  - gonna be devastated.
• 17:19
  - And and it's very, very sad sad day
• 17:22
  - in state of health care that that's happening.
• 17:24
  - We're already starting to see the effects of
• 17:26
  - of the rollback of the tax credits,
• 17:29
  - that happened in January. There's an under the
• 17:30
  - Affordable Care Act. There was tax credits given
• 17:33
  - for individuals that went to the marketplace. Now
• 17:35
  - those premiums have doubled, tripled,
• 17:38
  - quadrupled. People are just simply saying,
• 17:40
  - I can't afford this anymore. So they become
• 17:42
  - uninsured
• 17:43
  - and underinsured.
• 17:45
  - And they show up in our ERs because
• 17:46
  - they know under Intala, and we must serve
• 17:49
  - them that this is a place they can
• 17:50
  - go without insurance. And so you see bad
• 17:52
  - debt rising right now across this country.
• 17:55
  - You see charity care increasing. At the same
• 17:57
  - time, reimbursement is disappearing
• 18:00
  - and being cut off at the at the
• 18:02
  - federal and state levels. And now we create
• 18:04
  - the perfect storm. It's gonna be up to
• 18:06
  - the new generation of health care leaders to
• 18:08
  - step up. There's a lot of retirements going
• 18:09
  - on right now across the country with c
• 18:11
  - suites. But there's a new generation that's gonna
• 18:13
  - have to rise up and try to figure
• 18:15
  - this out because we lose our community hospital,
• 18:17
  - so goes the community.
• 18:19
  - Right. I couldn't have said it better. I
• 18:21
  - think it's such a powerful rallying cry for
• 18:23
  - so many leaders in health care right now,
• 18:25
  - especially those who are looking ahead and seeing,
• 18:27
  - you know, how challenging the environment's gonna be
• 18:30
  - with some of these legislative changes and,
• 18:33
  - the the things that really are are so
• 18:35
  - important to keep communities,
• 18:36
  - served and and access to care available to
• 18:39
  - them. Now I'm curious. When you're looking at
• 18:42
  - the next couple of years or so, what
• 18:44
  - opportunities
• 18:45
  - do you see as well? I I know,
• 18:47
  - obviously, we've talked a little bit about what
• 18:48
  - you've done, over the last, you know, year
• 18:51
  - or two in order to build, programs, specialty
• 18:54
  - programs at the hospital. But, you know, in
• 18:56
  - looking ahead at all these huge, huge challenges,
• 18:59
  - what are you doing to fortify that? And
• 19:01
  - are there places where you do see,
• 19:03
  - some opportunity or some glimmers that can you
• 19:06
  - can really hold on to? Yeah. I I
• 19:08
  - would you know, I'm I'm an eternal optimist,
• 19:10
  - and it doesn't sound like it on this
• 19:11
  - podcast today, but I promise you I am.
• 19:14
  - But, unfortunately, we find ourselves in a in
• 19:16
  - a very challenging time today in which we
• 19:18
  - have to be realist as well, and we
• 19:19
  - have to call out bad legislation and bad
• 19:22
  - actors, and we've done that.
• 19:24
  - At the end of the day, you know,
• 19:25
  - I I firmly believe in our sustainability as
• 19:28
  - a rural hospital, independent hospital.
• 19:30
  - You know, we don't belong to a system.
• 19:31
  - We're one of a very few hospitals in
• 19:33
  - the state of Michigan and across the nation
• 19:35
  - that still is independent, that believes that the
• 19:37
  - local control of health care is local care
• 19:39
  - is very important.
• 19:41
  - And we know what the community needs, and
• 19:42
  - I can implement it overnight if I need
• 19:44
  - to. I don't need to go through 27
• 19:46
  - programs, 13,
• 19:47
  - you know, boards and committees that we can
• 19:49
  - implement change effectively immediately.
• 19:52
  - So as I look to the horizon of
• 19:54
  - the future, you know, I am encouraged. You
• 19:56
  - know, we we have a very aggressive strategic
• 19:59
  - plan that's gonna start in January.
• 20:01
  - Strategic plans, as you know, used to be
• 20:02
  - three to five years. They're now one to
• 20:04
  - two years,
• 20:05
  - because the changing landscape in health care and
• 20:07
  - and the tumultuous changes. And so we have
• 20:10
  - a two year plan,
• 20:11
  - and that that will change, even probably within
• 20:14
  - the first year. But the two year plan
• 20:15
  - is very aggressive. It focuses on all five
• 20:17
  - pillars, of our strategy at the hospital, and
• 20:20
  - that's people service, quality, growth, and finance.
• 20:23
  - And growth is really an important pillar for
• 20:25
  - us. And looking at our growth strategy, it's
• 20:28
  - looking at what are the needs of our
• 20:30
  - community.
• 20:31
  - You know, do they need cancer services? Do
• 20:33
  - they need,
• 20:34
  - specific rheumatology?
• 20:35
  - And trying to address those needs. Now we've
• 20:37
  - been addressing those needs for several, several years.
• 20:40
  - The problem is recruitment and retention
• 20:42
  - of specialty care is very difficult in rural
• 20:44
  - communities. We don't have a lot of providers
• 20:47
  - graduating
• 20:48
  - saying, I want to go practice in a
• 20:50
  - rural community,
• 20:52
  - where housing is very difficult to find,
• 20:55
  - and where it's very difficult,
• 20:58
  - to unfortunately
• 20:59
  - start a practice because of insurances and malpractice
• 21:02
  - and those things. So they oftentimes lean on
• 21:05
  - hospitals. Hospitals who have a very thin margin
• 21:08
  - oftentimes would love to do that, but they
• 21:10
  - can't afford to bring on services
• 21:12
  - like that. So they encourage them to come
• 21:13
  - to the community as independent, and there's all
• 21:15
  - these challenges. For me, you know, we have
• 21:17
  - sustained,
• 21:19
  - through some very tough times. And, you know,
• 21:22
  - we have decent cash on hand right now
• 21:24
  - that we're going to turn around. I've already
• 21:25
  - shared this with my board and my senior
• 21:27
  - leadership team. We're gonna spend some of that
• 21:29
  - money. We have to. And it's a gamble
• 21:32
  - because we're going to be going into areas
• 21:34
  - that rural health has traditionally not gone into.
• 21:37
  - We're gonna be looking at a relationship between,
• 21:40
  - oncology
• 21:41
  - and
• 21:42
  - urology
• 21:43
  - and having a partnership there. We're looking at
• 21:47
  - what's the potential of the cath lab even.
• 21:49
  - We're looking at some things that are nontraditional
• 21:52
  - for rural hospitals our size, and it's all
• 21:54
  - towards the eye of how do we serve
• 21:56
  - the patient better
• 21:57
  - and how do we keep them in our
• 22:00
  - system
• 22:00
  - so they're not traveling forty, fifty, and 60
• 22:03
  - miles away. So as I look at the
• 22:05
  - horizon,
• 22:06
  - our growth strategy is what will guide us,
• 22:09
  - with an eye towards the finances. It has
• 22:11
  - to make sense financially
• 22:13
  - and really looking at, okay, specialty care.
• 22:16
  - And the biggest
• 22:18
  - focus area for me, the most expensive place
• 22:20
  - in health care today is the walls of
• 22:21
  - my hospital. Right? Right inside the walls of
• 22:24
  - the hospital is truly the ER, the inpatient.
• 22:27
  - This is why payers are, you know, challenging
• 22:29
  - us and and readmission rates and all the
• 22:31
  - things that are happening.
• 22:33
  - It's because it's very costly. So looking at
• 22:35
  - moving
• 22:36
  - outside the walls of the hospital to community
• 22:38
  - based care,
• 22:40
  - looking at, you know, hospital and home programs,
• 22:43
  - looking at ways that we can keep people
• 22:45
  - out of the hospital. You don't have a
• 22:46
  - lot of CEOs today talking about how do
• 22:48
  - I keep people out of my hospital? Well,
• 22:50
  - obviously, it's the hospital is shepherding the process,
• 22:54
  - and we really want to reserve the hospital
• 22:57
  - for those sickest patients.
• 22:58
  - It's not come into the ER with a
• 23:00
  - backache. Let's talk about primary care and what
• 23:03
  - you can do to to deal with that
• 23:04
  - pain. We started a pain clinic. We have
• 23:06
  - two CRNAs. Those CRNAs,
• 23:08
  - and a team, behind them, practice five days
• 23:11
  - a week and provide interventional pain strategies.
• 23:14
  - That's one way to keep people out of
• 23:15
  - the ER. When we identify
• 23:17
  - individuals that have, you know, habitual use of
• 23:19
  - the ER because they have chronic pain, we
• 23:22
  - refer them up. And so these are the
• 23:24
  - types of relationships
• 23:25
  - working with
• 23:26
  - specialty services, whether it's oncology,
• 23:29
  - whether it's urology, or blending them both together
• 23:31
  - for specialty, whether it's looking at cath lab,
• 23:33
  - whether it's looking at alright. When we look
• 23:35
  - at new markets, what areas can we go
• 23:37
  - into? Because as Sturgis closes down, which is
• 23:40
  - forty minutes away, who's gonna serve that community?
• 23:43
  - Is the big systems you're just gonna expect
• 23:44
  - them to just come on their doorstep? They
• 23:46
  - probably would. But big systems are overwhelmed as
• 23:49
  - well. They really don't wanna look forward to
• 23:51
  - when they're already dealing with days of individuals
• 23:54
  - boarding in the ER wanting hundreds and thousands
• 23:57
  - of more patients. So we have to find
• 23:58
  - ways
• 23:59
  - to connect with those communities to be able
• 24:01
  - to provide resources. And one of the things
• 24:03
  - I'm looking at is, alright, we provide resources
• 24:05
  - right to them, and then we bring some
• 24:07
  - of those ancillaries back to the hospital, some
• 24:09
  - of the surgeries back to perform surgeries here,
• 24:12
  - look at this as a surgery center perspective,
• 24:14
  - but ultimately look at how we can serve
• 24:16
  - those patients in those communities. I think through
• 24:18
  - growth
• 24:20
  - of programs
• 24:21
  - and growth of new markets,
• 24:24
  - we're gonna be able to sustain this into
• 24:26
  - the future. There is no hope in the
• 24:28
  - rural health transformation funds. There's none. That money
• 24:31
  - is gonna create nothing more than legacy costs
• 24:33
  - with programs that are not gonna be effective
• 24:35
  - for communities like Hillsdale. State of Michigan got,
• 24:38
  - you know, a $173,000,000
• 24:40
  - divided by all the hospitals that are, able
• 24:43
  - to receive it. It's pennies
• 24:45
  - that we would even receive. It can't be
• 24:46
  - used to offset,
• 24:48
  - any type of financial losses. It has to
• 24:50
  - be used to create programs and parameters that
• 24:52
  - have been established by bureau bureaucrats in each
• 24:55
  - respective state. Not it's not the answer. I
• 24:57
  - have politicians today rising up saying, yeah. Well,
• 25:00
  - we cut you a a trillion dollars, but
• 25:02
  - we gave you back 50,000,000,000. You didn't give
• 25:04
  - me back 50,000,000,000. Some are even saying we're
• 25:06
  - gonna save health care through these funds. Many
• 25:08
  - leading articles and research that's been done today
• 25:10
  - says, in fact, this is a bad thing
• 25:12
  - for rural hospitals, that it's gonna create legacy
• 25:15
  - costs and that even if hospitals qualify and
• 25:17
  - apply for it, the types of things that
• 25:18
  - we need right now, access to, you know,
• 25:21
  - EMRs.
• 25:22
  - We need technology to make sure we're state
• 25:24
  - of the art. We need to make sure
• 25:26
  - that we can serve, an underserved population
• 25:29
  - like Medicaid population. So these are all the
• 25:31
  - factors we face, not creating fluff programs,
• 25:34
  - you know, through programs that have been established
• 25:36
  - at the federal and state level. So I'm
• 25:38
  - optimistic about what the future holds for our
• 25:41
  - growth strategy and our strategic plan.
• 25:44
  - And that makes a ton of sense. You
• 25:45
  - know, it's really helpful to understand how you're
• 25:47
  - looking out and seeing all of these things.
• 25:49
  - Obviously, you know, when you think about the
• 25:51
  - local level, you you can tell what's gonna
• 25:53
  - be most impactful and and how you wanna,
• 25:56
  - truly, truly transform the way you're thinking about
• 25:59
  - health care and and looking at rural health
• 26:00
  - care today.
• 26:02
  - And so I think this makes a lot
• 26:03
  - of sense, and I certainly appreciate the efforts
• 26:05
  - you're going to because it it's not easy,
• 26:07
  - and a lot a lot of dynamics go
• 26:09
  - into it.
• 26:10
  - So I appreciate that.
• 26:12
  - Before we wrap up here, I'm curious, who
• 26:14
  - do you admire as a leader, really, from
• 26:16
  - any industry and why?
• 26:18
  - You know, I mean, I I've got some
• 26:19
  - heroes. I actually interviewed one a few weeks
• 26:21
  - ago on my podcast, and, you know, I
• 26:23
  - think maybe a surprise to to think that,
• 26:26
  - I'd consider him a hero given that we
• 26:28
  - didn't have really a personal relationship. But, you
• 26:30
  - know, I looked I looked to individuals like
• 26:33
  - Bob Reiny.
• 26:34
  - Bob Reiny, you know, served nearly five decades
• 26:37
  - and serving nearly five decades
• 26:39
  - as the president
• 26:41
  - and CEO of Henry Ford Health.
• 26:44
  - You know, starting as a security officer guarding,
• 26:47
  - you know, some dorms,
• 26:49
  - at at Henry Ford when they were running
• 26:51
  - nursing schools,
• 26:53
  - and then moving up the ranks and,
• 26:56
  - now securing several years ago the top post
• 26:59
  - at Henry Ford. And and the reason I
• 27:01
  - would say he's he's a health care hero
• 27:03
  - is really looking at,
• 27:05
  - what he's been able to do to transform
• 27:07
  - health care, to look at it from a
• 27:08
  - global perspective, not just our what are we
• 27:10
  - doing today, but what can we do tomorrow,
• 27:13
  - to impact care to ensure that, you know,
• 27:16
  - our communities,
• 27:18
  - social determinants of health are met. And and
• 27:20
  - not only looking at from that lens, but
• 27:22
  - also,
• 27:23
  - on the side of innovation, you know, what
• 27:25
  - can be done to keep patients healthier and
• 27:27
  - safer, not only in their homes, but even
• 27:29
  - when they're at the hospital. And some of
• 27:31
  - the work that he's done to lead those
• 27:33
  - global initiatives has has just been incredible. It's
• 27:35
  - an inspiration,
• 27:36
  - you know, that it's it's worth the fight.
• 27:39
  - And, I look at him as kinda, you
• 27:41
  - know, Roosevelt's,
• 27:43
  - in the arena.
• 27:44
  - You know, he's been knocked down a lot.
• 27:46
  - He's been marred. He's got a lot of
• 27:48
  - dust on his face. But every time he
• 27:50
  - comes up and,
• 27:51
  - he has done remarkable things to stay in
• 27:53
  - the arena and to fight for health care,
• 27:55
  - and he's, you know, created a a national
• 27:57
  - brand that's high quality and,
• 28:00
  - very well known in our region. And then
• 28:02
  - I look at other leaders that, you know,
• 28:04
  - like like our association here at Michigan Hospital
• 28:06
  - Association. You know, Brian Peters,
• 28:09
  - a great mentor and friend of mine. And
• 28:12
  - these are leaders that have been around for
• 28:14
  - decades
• 28:15
  - and who have great wisdom about,
• 28:18
  - infrastructure,
• 28:19
  - about government,
• 28:21
  - interaction,
• 28:22
  - about payers. And it's really just great to
• 28:25
  - be able to, when you're having one of
• 28:26
  - those rough days, be able to reach out
• 28:28
  - to someone like that and say, how'd you
• 28:29
  - do it? How are you doing it? And
• 28:31
  - and those are some of my my heroes.
• 28:33
  - There's a lot of them, you know, that
• 28:35
  - are in the health care industry. Outside the
• 28:36
  - health care industry, you know, obviously, I'm shaped
• 28:38
  - by my faith. I think that's very important.
• 28:40
  - That's what keeps me centered.
• 28:42
  - A man of faith. I believe that there
• 28:44
  - has to be a some central point to
• 28:45
  - my life in which the things that I
• 28:47
  - do, have to have a mission base, and
• 28:49
  - I think that's what is so special about
• 28:51
  - Hillsborough Hospital because hundred and ten years ago,
• 28:53
  - as we celebrate a hundred and ten years,
• 28:55
  - you know, of existence,
• 28:56
  - the Midgley's came here with a mission,
• 28:58
  - a vision,
• 29:00
  - to create a place where individuals could seek
• 29:03
  - care, low cost, high quality in their backyard.
• 29:06
  - We've continued that tradition, but, you know, we've
• 29:09
  - obviously
• 29:10
  - escalated it to, the quality that it is
• 29:13
  - today. So a lot of heroes, a lot
• 29:14
  - of friends, and I would encourage those listening
• 29:17
  - today. These are very difficult times. Times in
• 29:20
  - which, were challenged by
• 29:22
  - payers,
• 29:24
  - communities,
• 29:25
  - politicians.
• 29:27
  - The list goes on. Right? Is is to
• 29:28
  - stay focused. Stay in the arena.
• 29:31
  - You're gonna get marred. You're gonna get knocked
• 29:32
  - down, but let let examples like Bob Riney
• 29:35
  - and others,
• 29:36
  - you know, go before us to say we
• 29:38
  - can do it too.
• 29:39
  - I love that. Thank you so much, JJ,
• 29:41
  - for being here on the podcast today. This
• 29:43
  - has been such an amazing discussion. You know,
• 29:44
  - I think we covered a lot of ground
• 29:46
  - and certainly will be a lot of fun
• 29:48
  - to see you as well of our CEO
• 29:49
  - CFO roundtable. I know you'll be speaking on
• 29:51
  - a panel, and we'll dig deeper into a
• 29:53
  - lot of the things we talked about today,
• 29:55
  - especially looking at rural health care and what
• 29:56
  - needs to happen in order to survive and
• 29:58
  - thrive in the future.
• 30:00
  - I look forward to it.