Performance Improvement and Strategic Options: Success Factors that Expand Opportunities

In today’s rural healthcare environment, performance improvement is no longer a short-term financial exercise but a strategic imperative.

This session will explore how targeted performance improvement initiatives directly expand the strategic options available to rural hospitals. Whether pursuing continued independence or evaluating partnership pathways, organizations with stronger operational and financial performance have more leverage, more flexibility, and more influence.

Attendees will examine high-impact focus areas that consistently drive measurable improvement, including revenue cycle optimization, 340B program strategy, emergency department performance, cost report optimization, swing bed utilization, and clinic designation opportunities. The discussion will emphasize how these initiatives work together to strengthen contribution margin, stabilize cash flow, and improve long-term sustainability.

Participants will also explore how value levers within existing or potential partnerships can be amplified when aligned with performance improvement efforts positioning hospitals to negotiate and collaborate from a place of strength.

A real-world case study will illustrate how a focused performance improvement strategy translated into measurable financial gains and expanded strategic flexibility.

At the end of this session, participants will be able to:

  • Identify the highest-impact performance improvement levers in rural healthcare, including revenue cycle, 340B, emergency department performance, cost reporting, and service line optimization.
  • Understand how operational and financial performance directly influences strategic options, including independence and partnership pathways.
  • Develop a structured approach to sequencing performance initiatives to strengthen contribution margin, cash flow, and long-term sustainability. 
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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.