Enloe Medical Center CEO talks rural hospital challenges


Rural hospitals, which play a crucial role in the communities they serve, face a myriad of challenges, such as physician recruitment, larger shares of indigent patients and low reimbursement.

Mike Wiltermood, CEO of Enloe Medical Center, a 298-bed nonprofit hospital in Chico, Calif., recently answered questions from Becker's Hospital Review about what it's like to lead a rural hospital in today's healthcare environment, and how his organization overcomes its challenges.

Note: Responses have been lightly edited for clarity. 

Question: What is it like leading a rural facility today?

Mike Wiltermood: Our facility is a Level 2 trauma center and it's rather geographically isolated. We take care of a large indigent population, and … about 78 [percent] to 80 percent [of patients here are covered by] government insurance … so there's a real financial pressure. That financial pressure is kind of the foundation of a lot of challenges like recruitment and retention of clinicians, particularly physicians. The dependency that a lot of rural areas have on government payers can be really nerve-wracking when we see policies that are debated in Congress kind of on an ad hoc basis rather than holistically and comprehensively, so this is where you get the cuts to [programs like] the 340B [drug pricing] program. These programs have evolved over decades to try and bring equity to these areas that are disproportionately Medicare and Medicaid or that treat a highly indigent population. So, it is frustrating and challenging. It's hard to develop a strategy when you don't know what's going to happen next, but I think we just do the best we can and try to focus on our mission and deal with changes that come and the reimbursement as best we can.

Q: What is the primary challenge Enloe Medical Center faces?

MW: We're able to manage operationally. When I think from a business standpoint, access to capital becomes kind of problematic. Being able to stay modern and up to date technologically is tough. Some of our bigger challenges recently have been as an independent hospital — and many rural facilities are — trying to keep up with the requirements for IT platforms is very difficult. It's extremely expensive, and we don't have the benefit of larger corporations that can spread those costs and the talent pool out over a larger organization. So that's a real challenge.

We're moving to our Epic platform, [and] we're using [software vendor] Infor for the financial piece. That's very expensive, but we feel that it's critical to our goal of recruiting and retaining physicians. We've been buying a lot of physician practices and contracting back with our physicians, so there are some major issues there. I don't know that those are unique to a rural area in particular. It can be a little difficult recruiting to rural areas, and … if we're going to be effective we have to keep up with the times, and that often requires a lot of capital infusion.

Q: How does the hospital address its challenges?

MW: Our approach has been to focus on the quality, safety and service we provide the patient. Sometimes that's expensive, but oftentimes focusing on quality and service also helps us focus on efficiency and effectiveness. We have had a number of epiphanies over the years that have helped us not only provide better patient care and keep patients safe, but also help manage the budget better. We can't focus on anything else but that major mission. We have to deal with those budgetary issues and having money makes things a lot easier for us, but I think what motivates us each day is knowing we're trying to do the best thing for our patients all the time and somehow, someway we're able to manage [financially].

Q: What is one goal you have for 2018?

MW: What we found is if we get too myopic and focus on one thing, we really lose the character of our organization. If we focus purely on financial results, we may be successful, but it would be to the detriment of employee morale and perhaps patient safety and quality. So, we have to keep those objectives in balance all the time …We have four major goals: the patient experience, employee engagement, alignment with our physician leaders and our medical staff and then the stewardship of our finances. We just can't separate one out and say, 'That's going to take precedence.' Our goal first and foremost is the care we provide our patients and the team that provides that care to those patients. We consider everyone in our organization a caregiver regardless of their license or their skills. We want to be not only patient-centric but we want to be I guess what they're calling now person-centric. We need to look at the morale and the working conditions of the folks that provide the care as well as making sure our patients are taken care of.

Q: What advice do you have for other rural hospitals?

MW: The imperative to balance the budget it so critical. In our area, we've had two hospitals go out of business recently and get bought up by a corporation that is probably going to convert them from acute medical care to some other [type of care]. But when you go out of business it's easy to say, 'You should have focused on the money.' But I think what inspires people to stay in rural areas is that sense of mission, and you can't lose that. 


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