Challenges & Opportunities in Rural Healthcare: Q&A With CHI's Jeffrey Drop

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Englewood, Colo.-based Catholic Health Initiatives, which has 93 acute-care facilities, boasts 24 critical access hospitals in its system — the largest number in the nation.

And as senior vice president and division executive officer for the Fargo, N.D., division of Catholic Health Initiatives, Jeffrey Drop oversees 12 of the 24 critical access hospitals, seven in North Dakota and five in Minnesota.

Here, Mr. Drop addresses the challenges facing critical access hospitals and providing care in rural areas in general, including physician recruitment and telemedicine use.

Note: Interview has been edited for length and clarity.

Question: I understand you oversee 12 critical access hospitals — what do you find most enjoyable and challenging about overseeing critical access hospitals?

Jeffrey Drop: The thing I find most enjoyable is making things work for those small communities. We can bring expertise to these areas they never had, like in human resources or physician resources — we can bring it to these little communities and make those hospitals thrive.

What I find challenging is also working in small communities. You just don't have a lot of resources in these small towns. The communities have the right attitude to support the small hospitals, but they don't have the resources. So it's both enjoyable and challenging.

Q: How are your hospitals able to finance large, costly health IT projects, like electronic health record systems and data analytics?

JD: If it wasn't for us being a part of Catholic Health Initiatives, I don't know how we'd be able to finance these large purchases. It's the buying power CHI brings to our disposal. I'll be honest with you; I don't know how a small critical access hospital can stand alone any more in this day and age and get the financing to pull stuff like this off. They have to do everything a larger facility has to do, but they just have less money to do it with.

I find it troubling. A community can't support a small hospital on its own any more. You find very few critical access hospitals able to make it on their own, [and they] have to tie in with someone. It's just the nature of the beast right now, I don't see it getting any easier with the rules and regulations and cost of complying with Joint Commission standards and electronic health record standards.

There are solutions to every problem. If you have to network with a bunch of hospitals to get some resources and have to affiliate, you can still do this and keep your identity. It's possible. We're all tied together somehow and want what's best for our patients. Hang in there, there's ways to do this.

Q: How are your hospitals handling the challenge of recruiting physicians to practice in a nonurban setting?

JD: I'll tell you what, you'd be surprised at the number of physicians looking for a small-town setting. Small towns offer affordable housing, great schools, low crime rates and a rural atmosphere. This is what we have to offer. There are a number of physicians who like these types of scenarios. We hired a full-time recruiter for the Fargo Division and that's what she does 100 percent of the time: find physicians who meet our profile and like this type of atmosphere. You just have to market it appropriately.

Q: How is CHI using telemedicine? What's the future potential there?

JD: We have a company in CHI called Virtual Health Services. We're on the forefront of the telemedicine revolution. It started with a grant in the Fargo division to get a telepharmacy program put into place. It works so well that Catholic Health Initiatives is marketing and selling that service nationwide. The service enables small hospitals to have 24/7 pharmacist coverage, which is great because there are not enough pharmacists to go around.

We're also doing a telepsychiatry pilot here. Psychiatrists see patients through video screens and have virtual sessions with our patients, and that's working out very well.

CHI is committed to move forward in this endeavor. Telemedicine is important because of the lack of manpower in some of these small towns. It's hard to find pharmacists out there. But if we can get a bunch of pharmacists to work for us and provide coverage no matter where they are in the U.S., as long as they are appropriately licensed, it's easier than having a full-time pharmacist on-staff all the time.

Q: How have telemedicine regulation issues affected the programs?

JD: It's been an issue we've been able to deal with. The country has to start getting serious about this. We need to make it easier to do virtual health services as opposed to making it harder. We're going to keep pushing it and showing the safety of the endeavor and hope they eventually come up with a solution. I'm looking forward to it, we'll be on the forefront of a lot of this stuff.

Q: Since taking your current position, what has been the accomplishment you're most proud of?

JD: I'm most proud of making Catholic Health Initiative's critical access hospitals that I'm responsible for relevant in today's market. We're not just "afterthoughts," we're relevant, vibrant community resources. We're one of the largest providers of rural healthcare in America, and we're continually rewriting our playbook of how to manage critical access hospitals. We're on the forefront of having an actual playbook where you follow these rules and your hospital will have a great chance at survivability.

Q: Any main priorities for the rest of the year you can share?

JD: All we want to do is make sure these little town hospitals survive in one form or another. I'm not sure all little towns need a hospital, but they need access to some sort of care, the appropriate care. Be it a critical access hospital, a rural health clinic or an emergency room and a doctor's clinic. Whatever it takes, we want to provide the appropriate level of care. If we can accomplish that, we're doing service to all of our little towns.

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