Author Archive: Lynn Barr

National Rural ACO’s Response to the Proposed Rule for the Medicare Shared Savings Program

What is at stake? CMS has introduced a proposed rule to improve the integrity and attractiveness of the Medicare Shared Savings Program. Many of the changes are welcome improvements for all providers, but they fall short of meeting the unique needs of rural providers. For a brief summary of the proposed rule please see our comments, which follow.

Who is the National Rural ACO? The National Rural Accountable Care Organization was the first of its kind t bring together unaffiliated providers in multiple states to enable rural participation in the Medicare Shared Savings Program by pooling lives, expertise and financial resources. Now in its second program year, the leaders of National Rural ACO have blazed a trail for others to follow as a non-profit peer learning and education organization that can disseminate knowledge learned from our data. Today, thirty health systems in six ACOs covering nine states participate in the National Rural ACO under a single data warehouse.

Why do we care so much about the MSSP? Safety net providers are the only primary care systems left in the country that are not eligible for incentives for providing better care at a lower cost. This lack of incentives may create health disparities for rural beneficiaries, who are in desperate need of Medical Homes and Care Coordination. Without the appropriate data and incentives, cash-strapped rural providers cannot redesign their delivery systems to meet the three-part aim. The MSSP is the only program broadly available today to create the framework for change that safety-net patients need.

What are the rural issues? The key economic issues that affect rural providers are that they are low volume with high fixed costs and little or no operating margin, and are almost wholly dependent on Federal payments. They constantly struggle to survive and have very limited cash reserves, which provide no margin for error or “rainy days.” The effect of small cuts to their payments in the past few years has resulted in a record number of closures. According to the Flex Monitoring Team, the average days of cash on hand for CAHs is a paltry 69 days.

“We count our cash on hand in minutes. Every day we open the checks to see who we can pay.”

Lee Barron, CEO, Southern Inyo Hospital

The following chart illustrates key economic considerations of CAH-based health systems.Table1_SelectedMedian

Could volume be the answer to saving the rural safety net? Rural cost accountants postulate that CAHs have very high fixed costs; therefore incremental volume is essentially free. To illustrate that point, if CAH discharges are 75% Medicare, the CAH’s allowable costs are $5,000,000, and there are 1000 patient days, Medicare pays the CAH 75% x $5,000,000 x 101% = $3,787,500 or $3,786 per patient day. If the CAH doubled its average daily census from 3 to 6, and the incremental cost was only 15%, Medicare would pay the CAH $4,365,625, or $2,178 per patient day. The same is true for outpatient services, which account for almost 75% of CAH revenue. It is no coincidence that the CAH in our ACO that has the highest market share (62%) also has a very low cost per beneficiary. Different facilities have different fixed costs and different abilities to increase share, but increasing volume is a clear way to reduce the cost of rural healthcare. The following chart illustrates the potential savings by driving increased volume to cost-based reimbursed providers.

[1] “CAH Financial Indicators Report: Summary of Indicator Medians by State.” Flex Monitoring Team Data Summary Report No. 16. October 2014. [Data from 2012.]


Figure 1: Volume Effects on Cost-Based Reimbursement

Can rural health systems increase market share? From the claims data we see, they certainly can. Our ACOs only get claims data on the patients who use their primary care more than anyone else, so these are presumably our most loyal customers, yet the claims data shows that they on average only capture 35% of the claims for their attributed lives. Reviewing that claims data shows they would be capable of providing an additional 35% of the services if the patient chose to get their health care locally.


Figure 2: National Rural ACO Share of All Claims Data

Why aren’t people using the local health system, even when their PCP works for the CAH? We can only speculate here, but our Community Needs Assessments show some interesting data. Unlike the national average of 70%, only 50% of our patients can name their PCP. Similarly, only 30% of ED visits nationally are for primary care, yet our data shows that 50% of our rural ED visits are for primary care. Our patients use the ED, the internet, or get in their car and drive when they can’t get an appointment. There is no urgent care center in town to take care of their needs and it is very expensive to keep the clinic open after hours, in addition to creating yet another barrier to recruiting rural physicians.

Meet Linda. She is 74 rural resident and was in fair health. In the last two years she has broken her hand, broken her arm, sprained her ankle and suffered a head injury from a series of falls. She has been seen in 10 different Part A facilities and 43 Part B facilities with total claims exceeding $250,000 in the past two years. Without a regular PCP, Linda used the internet to find a doctor who would help her with her back pain. The botched spinal surgery resulted in her $163,000 admission to a renowned tertiary hospital to remove the implant and help her recover. Linda deserves a medical home and a care coordinator to “watch her back.”

How can we increase volume for Medicare Beneficiaries? Essentially by creating a rural Medicare PPO. We could increase local volume considerably if we had the ability to incentivize our patients to get care in our community by having Medicare cover residual patient cost-sharing (after supplemental insurance.) As cost-based reimbursed facilities with high fixed costs, increased local volume naturally lowers costs for Medicare while also bringing the patient closer to their medical home.

The cost of having Medicare cover in-network cost-sharing after supplemental insurance can be estimated using 2012 data from MEDPAC reports, which showed average beneficiary cost-sharing is $1550 per year, and that 10% of seniors do not have supplemental insurance that covers these costs. Currently, our cost-based facilities only have a 35% of total claims. This should yield a cost per beneficiary of ($1,550 X 10% X 35% X 50%) = $54.25 per beneficiary per year, which would be charged against total Medicare spending for the ACO. Rural providers would bear 50% of this cost by virtue of being in a shared savings program. Medicare would gain significantly due to the effect of higher volumes on per capita cost-based reimbursement. The greatest winner would be the beneficiary and the rural community, which would see increased local spending, employment and better, more comprehensive care. See Figure 1 for a model of potential savings for Medicare based on increasing volume to cost based providers.

What does the data say about rural care coordination? Our patients are literally scattered to the wind. Our members range from 182-3200 patients attributed to them who are using from 75-300 different Part A facilities and thousands of different doctors.

A good example is Mammoth Lakes Hospital and Rural Health Clinics. Mammoth has 520 attributed lives that have been seen in 259 different Part A facilities and 3,294 unique Part B providers in the past two years. Review of their patients data is a “trail of tears” with patients bouncing from one provider to the next, one hospital to the next, without communication, coordination or forethought. Given the opportunity and the data, rural providers can do much better.

How can rural providers increase market share? Any business that is the sole proprietor of services in a service area that has the ability to increase its market share can do so by focusing on business fundamentals. Customers want value – high quality, great service and a low price. If a patient is ill and cannot get care in their community, the evidence suggests that he will either use the ED or get in his car and drive to the nearest available provider. They will not simply wait for the next appointment. Rural communities must create capacity for primary care to be successful in the future.

In addition, focusing on the 25% of Medicare patients that comprise 82% of total Medicare spending and giving them the help and support they need can increase market share the most with the least amount of effort. If implemented well, primary care frequently determines how and where patients get more advanced care. Rural health systems should actively recruit these patients providing them with care coordination services to help them navigate their disease and the byzantine healthcare system, identifying high value providers for them and ensuring their data and history follow them wherever they go. Losing these highly coveted patients to competing health systems can devastate a rural health system.

How can rural providers increase their margin? Increasing market share is good for our patients and good for Medicare, but cost-based reimbursement still leaves the rural provider without an operating margin, always teetering on the brink of insolvency. We think this can be solved by the Medicare Shared Savings Program, where rural providers can earn a margin by delivering high-quality care and lower cost through care coordination of the chronically ill and by building market share. In order for it to work, however, we need specific changes to the MSSP that recognizes our unique needs and payment system.


The Medicare Shared Savings Program provides the necessary framework for improving care, improving health and lowering costs for rural beneficiaries. Unlike urban providers, there are no other programs for the safety net that enable these new systems of care proven to improve cost and quality. Our proposed creation of a Safety Net Track 4 will make the program extremely attractive to safety net providers and encourage their participation. Cost-based reimbursement can be effective if coupled with the right incentives to provide the right care at the right time for the beneficiaries, while allowing rural providers to earn more for delivering better care. Please comment today at, CMS-1461-P.

Download the National Rural ACO’s comment letter here.

Download this blog post as a PDF here.

Announcing Our New ACOs: 30 Rural Health Systems Participating In Six ACOs In Nine States In 2015

This is a proud day for the National Rural ACO.  Today, we issued a news release about our new ACOs.  Read on and you’ll see why we are so excited.

The National Rural ACO announced today it has successfully formed five additional ACOs in 2015 for rural providers following in the steps of the first ACO started in 2014. Using the organization’s unique collaborative model, fifty-two entities, including 28 rural and critical access hospitals, 42 rural health clinics, 12 federally qualified health centers and 9 private physician practices in thirty rural health systems were able to afford and qualify for the Medicare Shared Savings Program. More than 65,000 attributed Medicare beneficiaries from the states of Texas, California, Washington, Iowa, Indiana, Missouri, Oregon, Illinois and Michigan are now benefitting from the program under the care of 1,300 clinicians.

Our newest ACOs are:

  • National Rural ACO
  • Reid ACO, Suburban Health ACO
  • American Rural ACO
  • Northwest Rural ACO
  • National Rural ACO II

In almost all cases, the rural hospital sponsored the program and invited local providers to join at no charge. Although annual revenue for the hospitals ranged from $5 million to $758 million per year, and they all included employed or contracted physicians, only one applicant had enough beneficiaries to form its own ACO. All of the others joined forces to achieve the minimum number of beneficiaries and to reduce the cost of participation in proportion to what rural providers can expect to earn from the program.

The National Rural ACO provides comprehensive services including claims data access and analysis, evidence-based medicine leadership, care coordination coaching and the governance, legal and compliance services needed to succeed.

“The National Rural ACO’s unique model of collaboration is the first of its kind to enable rural providers to receive higher reimbursement for improving the care they deliver,” said Tim Putnam, CEO of Margaret Mary Hospital and chair of the board for the first National Rural ACO. “We can access the same type of powerful data, waivers and programs that urban ACOs can for about the same cost as it would be to hire one person to figure out how to get into the program.”

Please contact us if you would like more information about our new ACOs.


A Nice Note from our Chief Medical Officer about Data and Care Coordination:

We had a very productive telephone meeting regarding one of our member’s patient care opportunities this morning. The combination of Lightbeam’s data and the ability to collate with the EMR data really illuminated some opportunities for care coordination. Everyone was motivated to work together. Drilling down on individual patients locally, especially the high utilizers, is invaluable.

The two specific patient cases were interesting in that they were both very sick patients, but had very different healthcare barriers:

Patient 1. An end-of-life patient who had multiple admissions, but only 3 visits to her primary care provider.

This patient would have likely benefited from some care coordination between the discharge Planner at the hospital and the outpatient Care Coordinator to facilitate better follow-up with their PCP. This may have led to more in-depth discussions about end of life, Hospice, etc. Even if the patient or family was not interested in palliative care, it would have at least allowed for closer follow-up between hospitalizations for preventative care, medication compliance or dosing adjustments, etc. All of which could have improved the stability of this patient’s health and comfort in the months leading up to her death.

The other patient was very different, but also very sick.

Patient 2.  A chronic disease patient (COPD) who had seen multiple physicians, but was, nonetheless, admitted 8 times for COPD in the first 9 months of 2014.

The opportunities for care coordination here are certainly different, but equally important and achievable. The outpatient chart review was interesting: showing yet another admission since data collection in the spreadsheet. In this subsequent admission, the patient refused follow-up in the 3 days of respiratory worsening leading up to admission. The opportunity for a Care Coordinator to be collating all the discharge information, specialist care/recommendations, communicating with the patient and PCP with the goal of breaking down barriers to outpatient care access or novel methods for and outpatient action plan (ie corticosteroids) or redirecting care away from the ER when appropriate are obvious.

There seem to be many windows of opportunity that were identified and taking the Lightbeam data back to the Care Coordinators, hospital discharge planners and associated PCPs at the local level seems to be an actionable way to improve the patients’ care and also decrease costs.
Paul Krause, MD
Chief Medical Officer

What Makes a Care Coordination Program Great?

In August of 2014 the Commonwealth Fund published a study of 18 care coordination programs in Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program?  

Showing double digit improvements in all categories for the programs studied, the authors concluded that the keys to a successful care coordination program were as follows: customizing the program to the local health system; using qualitative and quantitative methods to identify patients; treating care coordination as an essential service; building trust with patients and providers; effective, specialized training; and the use of technology.

Our care coordination program was built on the same evidence evaluated for this study. It isn’t rocket science, it’s common sense. Our patients and our communities deserve this type of care and so do we.

It’s All About the Data

The best part of being in an ACO is getting the claims data from CMS. For the first time, we can measure the impact of the programs we implement to improve care and lower cost. If the data shows that we are successful, we can move on to other initiatives. If not, then we know we have to adjust our strategy. It allows us to use our resources wisely and efficiently, an absolute requirement for resource-constrained rural providers.

The main initiative we have implemented for the National Rural Accountable Care Organization has been care coordination services for the chronically ill. Every community has hired a care coordinator, trained and coached by the National Rural ACO. We use the claims data to identify high-risk patients. Our first targets for care coordination were the ED frequent flyers. We saw an immediate result from that program and have reduced our ED admissions by 5%. Since implementing this program, we have seen our avoidable admissions steadily drop.

To date, we have reduced per capita hospitalizations by 14%, yet our hospitals are not concerned about declining admissions and budgets. Whether that is because of increased market share, or a greater propensity to keep patients for observation locally, prior to transfer, is not yet clear. Maybe it is because inpatient services are usually less than 30% of a typical rural health system’s business. Perhaps it is a combination of all three. Regardless, we are proud of this success and the National Rural ACO member hospitals do not report feeling threatened by reduced inpatient and ED utilization.

The program I am most proud of is our evidence-based medicine program on COPD. When we began, our members were at 138% of the national average for admissions for COPD and asthma. Our Medical Director, Dr. Mark Hamed, put together an education program on the latest evidence for treating COPD. Our Vice President of Clinical Development, Mary Bittner, worked with the care coordinators to support his program. We watched our admission rate drop to 103% of the national average in nine months.

I tell people it isn’t about the shared savings, it’s about the data. The potential value of the data to help our patients and our communities is so great that I joke that I would pay CMS to participate in this program. Hospitals invest millions in technology and people in order to help patients, yet few of those investments are as powerful to improve the health of the community as the data we get from CMS, simply because we are an ACO. Of course, we also need a way to analyze that data and make it useful, and we are lucky to have found tools that enable us. Claims data is hard to obtain, organize, manage, and interpret in its raw form. It’s not about data, really, but about turning that data into information and using that information to implement new programs. When we also use that information to evaluate our programs, we have converted that information into knowledge, the holy grail of transformation.

CMMI is providing funding for hundreds of rural communities to join the Medicare Shared Savings Program in 2016, removing the last barrier for rural health systems to get on board. This is a one-time opportunity, and it has a very short fuse. CEOs should be talking to their medical staff and boards now if they want to take advantage of these dollars, in order to form an ACO and get invaluable data to support their patients.

Have You Registered Yet? Agenda for Rural ACO Summit on Feb. 2

Fifty-nine Critical Access Hospitals participated in the Medicare Shared Savings Program in 2014. This number will more than double in 2015, representing more than 10% of all Critical Access Hospitals. Rural leaders should attend this conference to determine whether they can or should join an ACO, as a means of transforming their delivery systems to keep current with national healthcare trends and to better serve their communities.

This free educational conference, sponsored by the National Rural Health Association and the National Rural ACO, will bring together experienced 2012-2014 rural ACOs, new 2015 rural ACO participants and potential applicants for the 2016 Program. Participants will learn the basics of ACO participation — including positive and negative effects on budgets, staffing, billing, and utilization. They will learn about policy issues that must be addressed to fix unique rural issues and the potential risks and benefits of the ACO program, waivers and access to claims data to your health system and your community. The meeting will take place in Washington, DC on February 2, 2015, immediately before the NRHA Policy Institute.



8:00 AM – Introduction – Lynn Barr, MPH, Founder, National Rural ACO Coalition. Why would a rural provider want to join the MSSP?

8:20 – 9:00 – CMS – What is the Medicare Shared Savings Program? Where is it going? How do rural providers fit in? How does it integrate with Meaningful Use, PQRS, Value-Based Modifiers, etc. How does CMS support rural ACOs?

9:05 – 9:45 – CMMI – ACO Investment Model and the Transforming Clinical Practice Initiative – implications for rural providers.

9:45 – 10:00 – Break

10:00 – 10:40– Congress – The Welch-Black ACO Improvement Bill – learn about the Welch-Black bill and how you can support it to improve outcomes for rural ACOs.

10:45 – 12:00 – Panel Discussion: Experience from the field. Early rural adopters discuss their experiences in the program and answer questions from the audience.


1:00 – 2:30 – Breakout Sessions

Track 1 – ACO Quality and Evidence-Based Medicine – ACOs are required to report on quality measures and promote Evidence-Based Medicine. What are the ACO measures? How are they reported? How are current ACOs performing? What are the implications for PQRS, VBM and Meaningful Use? How is Evidence-Based Medicine promoted and supported in an ACO?

Track 2 – Beneficiary Notification, Data and Analytics – ACOs receive complete claim files on their Medicare Beneficiaries that don’t opt out of data-sharing. How are patients attributed to ACOs? How are they notified the provider is participating in the ACO? Can they opt out of the ACO or just data-sharing? How can claims data be used to improve patient care? How can claims data be used to evaluate service lines, referral networks and revenue opportunities? How can claims data be used to track ACO performance? How current is the data?

Track 3 – Care Coordination and Beneficiary Engagement – ACOs are required to coordinate care and are scored on patient satisfaction. What is a Care Coordinator? What are the elements of a successful care coordination program? How can you bill for these services? How do you get buy-in from the community physicians? How do you motivate patients to change?

Track 4 – ACO 101 – There are many legal requirements and benefits of being in the Medicare Shared Savings Program. How are beneficiaries assigned? How do rural providers aggregate to get to 5,000 beneficiaries? What type of entity can be an ACO? How is the ACO governed? How does shared savings work in a collaborative ACO model? What happens if a member has increases in costs? How are payments distributed based on cost and quality? What are the compliance requirements? What waivers do you get and how do they work? What do Physicians need to sign/agree to? Who can be in an ACO? What about exclusivity? What type of agreement do you need to sign with CMS? What is the commitment? How can you terminate participation?

2:30 – 3:00 Wrap up session (Main Hall)

What are your concerns?

What are your hopes for this program?

What do you think about participating in the MSSP?

Click here to register for the Rural ACO Summit. 

The Critical Role of the CFO and Financial Consultants in Healthcare Reform

Many have described the transition from fee-for-service to fee-for-value for hospitals as crossing a “shaky bridge.” We are being asked to increase our spending to manage population health, resulting in preventing avoidable admissions that reduces per capita hospital revenue. It is no wonder that CFO’s are often reluctant to join ACOs.

The beauty of rural health is that the mission of a rural hospital CEO isn’t maximizing the daily census; it is serving the community’s health needs. Over time, most rural hospitals have acquired the majority of health services in town, including physician practices, skilled nursing, home health and hospice. The average rural hospital’s income is only 30% for inpatient care, with 70% of income coming from outpatient care. They have evolved into integrated delivery networks that provide about 70% of the total services that their community needs, although we do not capture anywhere near 100% of the market share for those services.

Rural hospitals also have small cash reserves, so any disruption in payment can be threatening to its survival. Our bridges are a bit shakier than most, and that is why the CFO and Financial Consultants are critical to the success of the transformation of rural health.

As we continue to implement our rural ACOs and study their impact on rural health systems, we have instituted a new role for the CFO and Financial Consultants in the transformation of the rural health system. We begin our monthly community steering committee meetings with a report from the CFO about the effect of the transition on the finances of the community health system. The hospital can and must control the rate of change so that the health system survives to serve its community for many years to come. If the bridge feels shaky, we can focus on quality, prevention and wellness visits until the system has time to adapt. We can work on our referral patterns to maximize the value of care given outside of the community.

We have to work on building local market share at the same time we help people manage their disease and keep them healthy. We have to increase primary care services and access, while still supporting the largely fixed costs of the hospital. Using the claims data provided for ACOs, we have to understand what services we could provide our patients that we don’t today, and how to increase our market share for the ones we do offer.

Beginning with our 2016 ACOs, we will have Financial Consultants at the table to hold the bridge steady while we cross to the new value-based payment models. Working side by side with the CFOs, we can create a better future for our communities with better quality of life and a thriving rural health system. Rural health systems are blessed with several great Financial Consulting firms, and the National Rural Accountable Care Organization will be announcing partnerships with these firms in the weeks to come.


Call for Speakers: Rural ACO Summit

The National Rural ACO is hosting a free educational conference at the Capitol Hilton in Washington, DC on Monday, February 2, 2015; the day before the National Rural Health Association’s Policy Institute. We are looking for current rural ACO members to participate in the conference as we seek to provide real world perspectives of implementing an ACO from your unique experience as rural providers.

If you are selected to speak you will receive a $1,000 travel stipend to attend the Summit in addition to the opportunity to present your experiences as an ACO member in either one of our plenary panel sessions or in one of our breakout sessions. Speakers should be prepared to present for 15 minutes followed by Question & Answers.

Who should submit a proposal?

–      Members of the National Rural ACO

–      Members of other Rural ACOs

–      Rural members of Urban ACOs

–      Rural members of Advanced Payment Model ACOs

Suggested Content of Proposals (not limited to the below):

–     Best practices for quality improvement

–     Lessons learned from the Advanced Payment Model

–      Policy recommendations to improve rural ACO participation and performance

–      Using data to improve care and lower costs

–      Care Coordination case studies

–       IT and data challenges and successes

–       If I could do it all over again, I would…..


To submit your proposal, please submit the following items to Denise Brewer by Wednesday, December 3, 2014.

  1. Complete Contact Information of proposed speakers and bios
  2. The ACO you will be representing and what cohort year
  3. Brief overview of your presentation/ACO experiences
  4. 3-5 learning objectives attendees will gain from your presentation

CMS is at the table. Are you? We look forward to seeing you in Washington, DC! Go to to register today. There is no cost to register.

What is the National Rural ACO?  It is an affiliation of rural providers who are moving toward new models of care delivery that implement coordinated, patient-centered care to improve the quality of life for their community and reduces avoidable healthcare spending. It provides educational resources and learning networks for existing ACOs and future ACO applicants. Membership is open to all interested parties, at no cost or obligation.


Does CMS Really Hate Rural Hospitals?

We often hear in our travels the opinion that CMS wants to close rural hospitals and have everyone use urban hospitals instead. Many think that CMS believes rural hospitals are too expensive and provide low quality care. They point to the plethora of innovation models focused on urban areas, with almost no rural health system participation, unless the rural member joins as part of an urban system. Sixty percent of rural health systems are supported by local tax dollars and would rather “live free or die.”

Is it that CMS doesn’t care, or is it that they don’t know? Historically, health insurance payment innovation has always come from the private sector first. Commercial insurers created ACOs long before Medicare did. Diagnosis Related Groups (DRGs) were a commercial insurance innovation. Capitation and HMOs were tested in the private sector first. The government needs data and experience before it can implement new payment models, and the private sector is not testing new models in rural America. Furthermore, urban payment models cannot scale down to rural health systems. Everyone remembers when DRGs were implemented in rural hospitals. Hundreds of rural hospitals closed as a result. CMS is wise to be cautious.

As rural healthcare providers, we are going to have to lead innovation if we want to survive. No one else can or will do it for us. We have formed the National Rural Accountable Care Organization so that we can pool our resources, our knowledge, our lives and our ideas to create and test new payment models. The future of our communities depends on us working together. Join us.

Celebrate National Rural Health Day on November 20

This was written by my colleague Bob Humphrey of CSPI and I want to share it with you.  Celebrate Rural Health Day!

National Rural Health Day

November 20th is National Rural Health day. As a former CEO of 3 rural hospitals in Alabama, let me share my thoughts on the important role of our rural healthcare providers, employees and volunteers and their contribution to the fabric of rural America.

In the small, rural hospital we know our patients; we know their first name and their relatives. We know the patient whose grandfather started the town’s feed store. We respect the intent of HIPAA, but we respect our patients even more.

We provide good quality care. We have excellent clinical systems and our quality and patient satisfaction scores rival any medical center. Our employees are knowledgeable and work hard; and many have worked at our facility for decades.

We have been under constant financial pressures lately, mainly due to scale, but we will persevere because the alternative is not acceptable to us or our community.

There have actually been some developments that should offer some encouragement to us and relieve some of this financial pressure….

-adoption and acceptance of telemedicine along with fair reimbursement

-our existing and longstanding rural primary care base will be a strength as we shift the payment model to ACOs and other Value Based Purchasing mechanisms

-our economic value to the local community is being fully realized

-our high quality measurement scores and patient satisfaction scores are being recognized by our community, peers and by payers and leaders on the national level.

All of this give us reason to celebrate Rural Health Day and here are some ways to celebrate…

-Go see the doctor who has been there for 30 years and shake his /her hand.

-Have a cup of coffee with the coworker who has been working at the hospital since they wer 18 years old.

-Take hold of a patient’s hand that you know has been in your hospital several times and assure them that we will always be there to take care of them.

-Thank a volunteer for their special role at the hospital.

-Tell Dietary how good that Peanut Butter pie is and Housekeeping how spotless the patient rooms are.

-Visit the employees out back in the trailer and thank them for their contribution to the mission of the hospital.

Then try to leave work early enough to catch the sunset over your community and reflect how vital your hospital is to you and all of those around you.

Go Rural!