Abundance-Based Leadership in Rural Health: Strategies to Address Uncertainty in the Wake of OB3

With rising financial pressure and Medicaid uncertainties on the horizon, rural hospitals across the country are asking the same question: How do we survive what’s next — and still build toward a stronger future? What are the opportunities that we can implement now to care for our rural communities?

In this 90-minute session, the National Rural Health Association (NRHA) and a panel of rural health leaders discuss what The One Big Beautiful Bill Act means for rural providers, how to navigate potential Medicaid cuts, and how to position your organization to thrive in a time of change. Brock Slabach, COO of NRHA, opens with key insights from his July conversations in Washington, D.C., followed by perspectives from rural hospital CEOs: Mary Ellen Pratt of St. James Parish Hospital, Benjamin Anderson of Hutchinson Regional Health System and Kevin DeRonde of Mahaska Health.

Topics include:

  • What the Rural Transformation Program could unlock and how to prepare
  • Navigating Medicaid uncertainty without losing momentum
  • Leveraging rural identity for recruitment, philanthropy, and strategic growth
  • Aligning culture, physicians, and operations during volatile times
  • Turning an abundance mindset into a long-term competitive advantage and financial growth

Takeaways include:

  • Aligning medical staff who are creative, engaged, and caring
  • Implementing specific recruitment and retention strategies
  • Growing and adding new rural services versus reducing services
  • Unlocking the massive benefits of performing a Strategic, Financial & Operational Assessment (SFOA)
  • Implementing a culture that produces positive margins
  • Caring for the caregiver
  • Identifying the difference between signal versus noise
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Q&A

How do people stay on top of all the payer newsletters to sort through everything to pull out applicable information for the facility/provider? Who typically is going through the newsletter to gather the information to share with other staff?

Our billing specialists are organized by payer, allowing them to develop deep expertise in their respective areas. Each specialist subscribes to their payer’s newsletters to stay informed about updates and changes. Additionally, our team leads, Supervisor, and Director of Patient Accounts—along with the Prior Authorization Team—collaborate to share key insights and ensure the entire team stays up to date. This collective approach enhances our ability to navigate payer policies efficiently and provide the best possible service. 

What leadership structure do you have in place for your revenue cycle and who or what do you use for training when billers or coders need it? Especially for new service lines or common denials?

Our billing specialists are supported by a structured leadership team, including two team leads, one Supervisor, and one Director. Training for billing specialists is conducted by our Supervisor and team leads to ensure consistency and expertise. Additionally, billing specialists meet weekly with leadership to review denials and identify payer-specific trends. For new coders, who are required to be certified, training is led by our Coding Lead to maintain high standards of accuracy and compliance.

Are the billers assigned based on an alphabetical split or by insurance type, such as Medicare and Medicaid specialists?

Billers are first assigned by insurance type and then further divided by alphabetical split. Since each insurance type has multiple billers, the alpha split helps distribute the workload efficiently.

Since we have union employees, how could we implement a similar incentive to Kindal’s while ensuring compliance with union regulations?

This would depend on the specifics of your union contract. Stroudwater can work with you to review the contract and develop a compliant incentive model.

Does your Coding/HIM department manage CPT coding, modifiers, and ICD-10, or do they focus solely on ICD-10?

Our Coding team handles all aspects of coding, including CPT, modifiers, and ICD-10. They thoroughly review all provider documentation to ensure accuracy and compliance.