Baton Rouge, La.-based FMOL Health was sending patients to outside hospitals, even when the system could provide the same care. The 10-hospital system’s transfer acceptance rate sat at 67.5%.
President and CEO E.J. Kuiper decided the system needed a dedicated rural strategy and made it a mandate. Roughly 14 months ago, FMOL Health created the role of vice president of rural strategy and appointed Dave Estorge to fill it.
In the year since, FMOL Health raised its transfer acceptance rate to 79%, an 11-percentage point gain, and accepted more than 1,800 additional patients, putting the system on pace for a 10% to 11% increase in total accepted volume. Transfer contribution margin grew more than 10% year over year. Swing bed placements at rural partner hospitals increased 41%.
“The progress we’ve made is a direct reflection of E.J. Kuiper’s strategic vision,” Mr. Estorge told Becker’s. “He challenged us to think differently about our relationship with rural hospitals — not as competitors, but as partners in caring for our communities. That philosophy has fundamentally changed how we work together.”
The operational foundation was a shift from siloed transfer management to something more coordinated. FMOL built dedicated transfer centers, consolidating intake across its Louisiana and Mississippi markets. The health system also worked to reduce length of stay and improve discharges systemwide, staffing beds that had previously gone unused. Transfer acceptance had to improve before any other piece of the strategy could hold together, Mr. Estorge said on a recent episode of the Becker’s Healthcare Podcast.
“It was mainly out of necessity, because we had one of our hospitals transferring to another hospital where we could provide those same services within our health system,” he said, “and once we started to behave like a health system, we were able to keep a lot more business in the family.”
On post-acute placement, Mr. Estorge’s team built a database cataloging swing bed availability and insurance acceptance at every rural hospital feeding patients into the network. Case managers from those facilities were invited to join huddles with FMOL case managers. The system also deployed Epic Care Connect, a secure portal giving rural hospital staff real-time visibility into their patients’ clinical information after transfer and replacing the fax-based handoffs that had slowed coordination, he said.
The 41% increase in swing bed placements meant roughly 140 additional patients each year recovering at rural partner hospitals close to home. For patients who had traveled two or more hours to reach FMOL facilities, completing recovery near family was a meaningful difference. For the system, it freed tertiary capacity upstream, Mr. Estorge said.
The relationship behind the results
The structural changes required trust to work. Before any database or transfer center could function as intended, Mr. Estorge had to build credibility with the rural hospitals he was asking to send patients FMOL’s way.
Over 14 months, he logged 40,000 miles visiting care teams across the system’s four markets. Before each visit, he researched the community: its history, its demographics, the specific services its hospital could and could not offer. He made a point of eating at the restaurant nearest each facility, where he said the real stories of a community’s relationship with its healthcare were told.
The message he brought into those meetings was deliberate.
“There’s a big health system that’s going to start reaching out to these rural hospitals. Some of them are not going to know who I am. They’re not going to care who I am. But this is what we’re going to do,” he said. “We’re going to say ‘thank you,’ and then we’re going to offer to check on these patients for them, and then we’re going to offer to connect them with our care management team to see if we can help coordinate care better in post-acute placement.”
What reinforced the mission — visit after visit — was the commitment he found among rural hospital staff.
“I will tell you why rural healthcare will work and will continue to work in our country,” he said. “It’s because of the employees’ tremendous pride that each of these employees and leadership teams have in their respective hospitals. It’s inspiring to me, and they are tickled when someone actually shows up and wants to listen to them and actually help.”
For health system leaders considering a similar approach, Mr. Estorge said the technology and infrastructure matter, but posture comes first.
“You just have to be genuine,” he said. “You can’t be slick. You cannot fake your passion for rural healthcare.”
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