Planning for the Future: Evaluating Rural Facility Needs Through a Strategic and Financial Lens

Facility investment decisions are among the most consequential — and capital-intensive — choices rural hospital leaders will face. Whether considering renovation, expansion, replacement, or right-sizing, these decisions must be grounded in market realities and long-term financial sustainability.

This session will provide a structured framework for evaluating facility needs through both a strategic and financial lens. Attendees will explore how to assess market demand, population trends, service line utilization, and competitive dynamics before committing to major capital investments.

The discussion will also examine the financial implications of facility planning, including modeling projected volume changes, operational shifts, and capital investment through the Medicare Cost Report to ensure sustainability under rural reimbursement structures.

Eric Connell of North Big Horn Hospital will share practical insights from his organization’s experience navigating facility planning decisions, offering a real-world perspective on aligning community need, operational capacity, and financial feasibility.

Participants will leave with a practical methodology for evaluating whether, when, and how to invest in future facility needs — ensuring decisions strengthen long-term stability rather than increase financial vulnerability.

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

  • Assess market demand and community needs to determine the appropriate scope of facility investment.
  • Model the financial impact of capital investments using volume projections, operational assumptions, and Medicare Cost Report implications.
  • Develop a structured approach to facility planning that aligns strategic goals with long-term financial 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.