The Road to Closure: Key Warning Signs and Early Interventions

Rural hospital closures have been rising since 2010, with financial distress, staffing shortages, and escalating costs pushing many facilities to the brink. This session presents findings from an in-depth study of rural hospital closures, identifying key risk factors and warning signs present years before closure occurs. Participants will learn how to recognize early indicators of financial and operational risk and explore proven intervention strategies to sustain long-term hospital viability.

By comparing hospitals that closed with those that remained open, this session provides a data-driven framework for rural health leaders to proactively assess and mitigate risk. Too often, leaders act too late—this study equips them with the tools to take timely, effective action.

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

  • Recognize the Early Warning Signs of Future Hospital Closure – Understand the five-year trajectory leading to closure and key financial and operational indicators that signal distress.
  • Analyze Strategic and Operational Risks – Learn how to evaluate a hospital’s risk profile and compare it with peer institutions that remained open.
  • Implement Proactive Strategies to Prevent Closure – Explore actionable steps for early intervention, financial stabilization, and long-term sustainability to avoid shutdown.
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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.