Medicaid funding shifts, access constraints and workforce shortages continue to test hospital leaders — challenges that weigh heavily on rural and community hospitals in particular.
For David Mantz, CEO of Dallas County Medical Center in Fordyce, Ark., Medicaid funding is a key concern, as the hospital is in a rural area and many patients rely on it.
“If they lose coverage, the impact will be strong,” Mr. Mantz said. “I would rank the protection of the 340B program at the top of my list. We depend on this program as it was designed and intended, to keep our hospital and clinics here to serve the patients that depend on us to be here for them.”
At Johnson City, Tenn.-based Ballad Health Niswonger Children’s Network, the most potentially impactful uncertainty is ensuring families have timely access to pediatric specialists, CEO Chris Jett told Becker’s.
“Across the country, and especially in rural areas, there’s a growing gap between the demand for specialty care and the number of providers available,” he said. “Referrals from primary care doctors are rising, children’s health needs are becoming more complex, and more families are seeking expert opinions — yet the pipeline of pediatric specialists is not keeping pace.”
Several factors are at work in this regard, including uncertainties about Medicaid’s future, reimbursement challenges and limits on visas that allow highly trained physicians to practice in the U.S., Mr. Jett said.
“This imbalance between need and supply is one of the defining challenges of children’s health in the decade ahead, and it’s where we are most focused on finding solutions for the families we serve,” he said.
As president and CEO of St. Bernard Hospital in Chicago, a safety-net hospital, Charles Holland sees Medicaid funding and long-term sustainability of services as the greatest uncertainty.
“The threat of reduced funding imperils our ability to provide much-needed services on a regular basis, and I must constantly manage through that threat,” Mr. Holland told Becker’s.
Scott Boyes, CEO of Wooster (Ohio) Community Hospital Health System, pointed to the aging U.S. population as a major source of uncertainty.
“Volatility in the healthcare marketplace creates anxiety in the entire healthcare continuum,” Mr. Boyes said. “With that, it may drive decisions that feel secure in the short term but will have long-term negative consequences, especially in rural marketplaces. The one thing we are certain of is our society is aging. My greatest uncertainty is adequacy of future funding sources to allow us to care for the anticipated higher volumes that typically come from this demographic segment.”
Brian Ulery, CEO of Saint Clare’s Health in Denville, N.J., told Becker’s the projected shortage of 24,000 nurses by 2036 in New Jersey creates “enormous uncertainty.”
“At Saint Clare’s Health, our position as a mid-sized health system means we must be thoughtful and innovative in how we recruit and retain nurses,” Mr. Ulery said. “While we are deeply committed to supporting our workforce, directly competing with the compensation packages offered by larger systems could undermine our long-term stability. Our focus is on building a supportive environment that attracts and retains talent while ensuring the sustainability of our mission.”
Strategy amid uncertainty
Uncertainty cannot be an excuse not to plan, Mr. Boyes said. His organization is focused on what it can control and improving where possible.
When the data does not provide a definitive path forward, Mr. Jett said he and his leadership team turn to patients, families and care teams.
“Their voices help guide us,” he said. “We have patient and family advisory councils that provide direct, real-time feedback, and we combine that with structured patient data and team member insights. This helps us understand needs, identify opportunities and improve care across our region.”
Mr. Holland also said decisions at St. Bernard Hospital are made with a focus on community needs.
“That’s our North Star as we assess the data we have and determine the adjustments we can make to sustain services in the short term while continually working to lengthen the runway through advocacy, operational efficiency and patient engagement,” he said.
Mr. Mantz said he leans on his board of directors so they can tackle hard decisions together.
“Our leadership team approaches decisions with the 110 families in mind that depend on us to be their employer,” he said. “That does not mean to say yes to every request, but rather to keep the organization strong and sustain operations for the greater good.”
Anchoring decisions in values and mission — delivery compassionate, quality care — is Mr. Ulery’s strategy when data is unclear.
“While data is vital, healthcare is ultimately about people,” he said. “By keeping patient care at the forefront, our values provide the clarity we need to guide our path forward.”
‘Heart, compassion and a servant mentality’
CEOs said they rely on integrity and communication when leading their organizations through uncertainty.
“This role is not for the faint of heart,” Mr. Mantz said. “But it does take a lot of heart, compassion and a servant mentality. Communication is key and always helping our team understand the ‘why’ behind the decisions we make is crucial to keep the support of the staff moving forward through change. No one seems to like change, but to survive in these times, change is not optional.”
Mr. Jett said he relies most on trust and collaboration.
“Trust is built over years — in moments of challenge and in moments of progress — and it allows us to lean on one another when the future feels unclear,” he said. “At our children’s hospital, this means drawing on the strength of the Niswonger Children’s Network, which connects pediatric providers across our region with shared resources, training and education. It means having a pediatric transport team ready to bring fragile newborns to our NICU, which is now expanding to serve even more families. And it means being part of a trauma network that ensures expert care is never out of reach.
“When we approach uncertainty with trust in each other and a spirit of collaboration, we not only find our way through, we come out stronger, for the children and families who depend on us.”
Staying focused on the mission is key for Mr. Holland.
“Perseverance and commitment to the mission within a business-minded framework drive leadership at our hospital, especially in times of uncertainty,” he said. “Insistence on these traits has been foundational to our institution for more than 120 years.”
Mr. Ulery relies most on gratitude.
“I come to work each day feeling blessed to serve alongside the dedicated teams in our three hospitals and clinics,” he said. “I am continually inspired by their ability to deliver high-quality, compassionate care in a rapidly changing healthcare environment. Recognizing and appreciating their commitment keeps us grounded and resilient, even amid constant change.”
Integrity is a top priority for Mr. Boyes when working with employees and medical staff.
“With that being said, you need to be adaptable while trying to synthesize all ideas and suggestions into a clearer path forward,” he said. “Having a supportive board instills confidence as we sail through these choppy waters.”
