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The Current Landscape of Rural Health Care: One Hospital’s Journey
Rural health care has been facing significant headwinds, and that was before the passage of the One Big Beautiful Bill Act (OBBBA), which has introduced additional uncertainty. Donn Herring, Partner, Spencer Fane LLP, speaks with Lori Wightman, CEO, Bothwell Regional Health Center, and Jon Doolittle, President, Missouri Hospital Association, about the unique challenges facing rural health facilities and how government policy has a disproportionate impact on them, focusing on the journey of Wightman’s rural Missouri hospital. Wightman shares some innovative things her hospital is doing to address these challenges while remaining independent, and Doolittle shares how the OBBBA’s Rural Health Transformation Fund is being implemented.
Watch this episode: https://www.youtube.com/watch?v=cD7hgRcd-8w
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SPEAKER_03:Hello everyone. My name is Don Herring. I'm a partner in the St. Louis office of the law firm of Spencer Fain. I've been practicing law for 35 plus years and spent most of my time in healthcare space the last 15 years, spending a big portion of my time working with rural hospitals. And today we're going to have a session of the Speaking of Health Law podcast. We're going to focus on rural healthcare and rural hospitals. And there are a couple of folks who are really going to lead this discussion. I want to take a minute to introduce each of them so you'll know who they are and know their background and in that have a sense of the place from which they're speaking as far as their experience. First off, our first guest is Lori Whiteman. Lori is the CEO of Bothwell Regional Health Center in Sedalia, Missouri. And Lurie's background is Lori is the daughter of a father who was a hospital administrator and the mother who was a nurse. And because of that background, she decided she wanted to pursue both careers. And she has spent her whole life in the Midwest living in North Dakota, Minnesota, Oklahoma, and now Missouri. Just a little background on Bothwell. Bothwell is a rural hospital. It has, in addition to the hospital, 21 clinics and over a thousand employees and generates in the neighborhood of$175 million in net revenue per year. In addition to being a hospital administrator, Lori is also a nurse and has had a nursing license for over 45 years, in addition to 25 years of hospital administration experience. And above, and above all of those things, and I've known Lori for a fairly long period of time now, I can tell you with great certainty that Lori is, if nothing, passionate about rural communities and how rural healthcare serves those communities. And so she is in a great place to be able to share her thoughts about what currently is taking place with rural health care. Our second guest is John Doolittle. John is currently the CEO of the Missouri Hospital Association. But before that, John was literally a small town boy who left his small town to see the world and then came back to be the CEO of his local boyhood hospital. John was raised in Albany, Missouri. And following graduation from Albany High School, left Albany to pursue an undergraduate degree in government from Harvard University. And at least according to one bio I read, John might have may have been the first person from Albany to actually attend Harvard. But we will let that stand. I can't prove it, but that could be the case. Following graduation from Harvard, John returned to Missouri and after a period of time working for the Federal Reserve in Kansas City, took a position with Cerner, which is now part of Oracle. Eventually he left that position to become the CEO of his hospital in Albany, Missouri, where he led that hospital with an affiliation with a larger facility in St. Joseph, Missouri, and in doing so secured a stable future for his hospital. In 2021, John became the CEO of the Missouri Hospital Association. And in that role, he and his staff serve the 136 Missouri-based hospitals and the citizens of Missouri that they serve. And so, with that as background, I want to just do a quick kind of where are we going moment within the podcast. So here, I think we all know that healthcare has been a significant focus of political and societal action over the last several years and really is kind of a top-of-the-news item. That's especially true since the beginning of this year, with the passage of the One Big Beautiful Bill Act and the various changes it's going to cause to Medicaid and ACA coverage. And with all of those things happening, indicators are that some of the organizations most heavily affected by those changes are going to be rural healthcare providers and rural hospitals in particular. And it isn't as if the OBBBA was the beginning point of these issues. According to national statistics, over 190 hospitals have either rural hospitals have either closed or ceased providing inpatient services since 2005. And as of the beginning of this year, over 700 rural hospitals were at risk of closure due to financial conditions. And this is before any changes that are being uh caused by the passage of OBBBA. And so as we sit here today, rural hospitals and rural health care are facing significant headwinds. And really, our purpose of the conversation today is to let Lori and John discuss those issues a little bit and talk about the path they see forward. I think the three of us, and I know we're not alone, believe rural health care is vital to the survival of rural communities. And so we are all committed to doing everything we can to make sure these hospitals survive. But I think we need to unpack those issues and hear from the people in the trenches as to what's going on so we can help better understand the issues and what that path forward looks like. So we're going to do this in a question-answer format. Um, and just to start out, first question, and I'll open it up to both John and Lori. For a variety of reasons, healthcare has been a prominent political and economic issue in the United States for the last five years and quite frankly, for years before that. From your experience, who are the major stakeholders that are driving this discussion? What are their interests? What are they trying to accomplish? And how do hospitals, as kind of one of the marquee healthcare providers out there, how do they feature in those discussions?
SPEAKER_02:Yeah. Since most of this conversation should really feature Lori and what's going on at Bothwell, I'll take a crack at this one, Don. Thanks, John. Healthcare is uh, I think, more of a tier one political issue in this country right now than it has been in the you know 30 or so years that I've been a grown-up. And uh that started a little bit, I think, with the COVID pandemic. I think obviously health and healthcare came to top of mind for everybody. There was a massive societal response. Um, and it really started asking some interesting questions about who's an essential worker? What are the things that absolutely have to happen? What are our obligations and rights uh to each other and all the rest? And it really started a framing uh from the perspective of someone who was a hospital president in a small town when in in 2020 and 2021. Um it prompted uh thinking about why we do what we do from a healthcare system perspective in a way that I most people had never done. And so I think what's followed from that has been a lot of conversation uh about okay, what does it mean access to healthcare, um, affordability, availability, uh kind of who's entitled to what, and and how how do we help each other, how do we infringe upon each other with the decisions that get made from a healthcare standpoint? When you talk about stakeholders, um, healthcare is kind of an interesting thing because the purchasers of care aren't always the people who receive care, right? When we think of purchasers of care, we might think of the person who's providing the insurance. That could be for people who are on Medicare, Medicaid, a few other programs. Those are governmental entities. Um, largely the private insurance in this country comes through employers. Um, with that system in place several years ago, we were a country that had 300 million people and 40 million of them were uninsured. And so we went through a process through what is now often referred to as Obamacare, right? The Affordable Care Act, of figuring out how are we going to provide access to those 40 million people who are uninsured. And it was a mix mostly of either government programs or government subsidies. And as we're recording this today, Don, it's early November and the government has closed down in part because we're having conversations about whether or not subsidies should be available to people who don't qualify at that sort of safety net Medicaid level, aren't eligible for Medicare, aren't covered by employer-sponsored insurance, and how much do we as a society want to intervene in how affordable health insurance and how adequate health insurance coverage is for those people. So that's at the macro level. People are concerned about affordability. If you're a purchaser, you're absolutely concerned about affordability and you're concerned about quality. If you're on the provider side, obviously I'll let Lori speak for herself, but I spent a little time there and I represent all the hospitals in Missouri. You want to be able to take care of people. These are mission-driven organizations that exist to take care of people. That means being there when they need you with the expertise and technology to do the job. We have extraordinary capability in this country and we have extraordinary access, much more than a lot of countries that sort of ration or meter healthcare. Here, you can get it. The weights are shorter, the technology is available, and then there are economic realities around that. And that that's the mix that we operate in today is how are we, as healthcare providers, hospitals and health systems among them, going to provide what this country wants and needs in a way that's sustainable? And for us, that often turns to can we get paid for our work? Because our work is expensive to produce, unfortunately.
SPEAKER_03:So, John, listening to your answer, it sounds like from your perspective, the pandemic, in a way, was almost a filter that caused people to really think more critically about why healthcare is important and the value of having access to it. And it kind of caused a consideration of issues that maybe always lived in the background, but people just didn't think about. And so this kind of put it in the front, and now people started to think about it. Is that accurate in how you saw the kind of the sudden or the renewed focus on healthcare of the last five years?
SPEAKER_02:I think it was one of the causal factors, yes. And I think healthcare providers early in that time were viewed as heroic and selfless. Um, public opinion, it's easy to measure. It really turned against experts, against institutions, in some cases against the government, and against healthcare providers. And for those of us who were in there in the middle of the pandemic response, it's a very difficult thing to hear now, a little bit of revisionist history around people thinking that we were doing things to people for money. I was there, man. Um, we weren't doing things for money. We were part of a massive response trying to keep people safe and save lives. But from a political standpoint, um, a lot of viewpoints around COVID response and the institutions who were part of it is a huge causal factor today. And I think it paves the way for some of the governmental sort of policy decisions that we've taken around how broadly do we want to provide coverage, uh, who deserves it, how much should they pay, and whether or not people are seeking to benefit um in uh inappropriate ways from the money that does that flows through what is a very large part of the U.S. economy. I mean, you gotta say it. It's five trillion dollars is a lot of money. The U.S. health economy is the size of Germany's GDP. Um, so it's reasonable for people to ask those questions and have their uh perspectives represented from a provider perspective. We really try to navigate in that that in ways that we can afford to keep providing some of the best healthcare services in the world. Thanks.
SPEAKER_03:Okay. Um, Lori, you've lived your life as a or your career anyway, in rural healthcare. Um, and so you've been deep into this area for really your entire career. For the purposes of understanding, because certainly most of the population now lives in urban and suburban areas and experience health care coming from that environment. If we suddenly shift gears and take all those people and put them into a rural environment, how would does rural health care differ from what they might be familiar with in a suburban or urban setting?
SPEAKER_01:Well, in many ways, I would say we are uniquely the same. Um, we face similar challenges, rural and urban and suburban. Um, but in a community hospital, we have very personal reasons of why our care needs to be the safest, the best, the friendliest, because we are taking care of our family members, our um the teachers of our children, our co-workers. Um, it's very personal here. And for example, a third of the leaders that work here at the hospital were born here. I tell them they need to come up with a secret knock and handshake. I mean, it's very personal. And the connection to worthwhile work and making a difference happens every day. Um, and that's why I love healthcare and in particular community hospitals. Um, I always tell people if I didn't love it so, I'd be curled up in the fetal position in the in the corner. Um the so the challenges are the same for rural and urban, yet our ability as a rural hospital to excel is handicapped by our size and our location, whether that's economies of scale, um, having robust data capabilities, uh, strategic partnerships with payers, um, the ability to keep up with our aging infrastructure. I'm I'm sitting in a 96-year-old building, um, and all of the technological advances, um, the size of our talent pool and the ability to recruit to rural uh areas is it handicaps us as a rural hospital. Um, and as a rural independent hospital, we are literally at the bottom of the healthcare food chain. Um, there are people in the healthcare industry that are making money. It is not the rural independent hospital.
SPEAKER_03:Now, in in your situation, um, you mentioned some of the obstacles that you face as far as because of a remote location, because of access to talent pool, um, issues along those particular lines. Um obviously, one of the things that impacts you in a way that is different from a larger uh urban or suburban hospital has to be payer mix. And part of the reason these new changes that are taking place to Medicaid and potentially to the ACA coverage have a maybe a disproportionate impact on a rural hospital versus a suburban or urban hospital. Can you walk through that issue a little bit to help people understand how that difference exists and what that really means in the context of a hospital like Bothwell?
SPEAKER_01:Payer mix you brought up is very different in rural settings as compared to especially suburban. Um and payer mix has to do what percentage of your the people you care for are commercial insurance or governmental payers. And for Bothwell, um, we're we're like our rural counterparts in that 78% of the patients we care for are paid, the source of payment is a governmental, either Medicare or Medicaid or a small percentage TRICARE, the military. Um so 78% are not paying at a level that covers our costs. So, because governmental payers don't pay their fair share when it comes to covering the cost of providing care. Well, you don't make that up in volume by 78% not covering the cost of providing care. Um, so there's, you know, um, so we've tried to patch onto that system of getting an extra boost because we have so many of our patients are being covered by Medicare or Medicaid or our self-pay. Um and it it gets chipped away all the time. Um, and especially you talked about the One Big Beautiful Bill. Uh I was recently um uh interviewed for a different podcast of how are we going to prepare for the changes that are coming based on the One Big Beautiful Bill? I wish we had the luxury of being able to prepare because we're still trying to deal with digging out of a major COVID hole, um, always having um additional challenges for reimbursement, uh, Medicare Advantage plans taking forever to actually pay us when they have a at least have approved, authorized uh uh the care that's for a patient. So we're we're blocking and tackling with existing challenges and really not knowing how we are going to um handle what's out in uh in the future.
SPEAKER_03:So uh as I said at the beginning, the one big beautiful bill act is just one more brick in a otherwise very difficult wall to overcome, um, which has been there for a while. Now, John mentioned that that one of the things that that you have been doing at Bothwell is is continually working in trying to innovate how care is provided and those types of relationships, obviously with a goal of enhancing Bothwell's ability to be financially stable. Can you talk about some of the innovations that you've been putting into place or things you've done or things that are kind of on the drawing board to the extent you're able to share that information?
SPEAKER_01:Yeah, well, I'll first start with workforce because we've had some grow your own program in place for like long before I got here. Uh, we've been involved with medical explorers through the Boy Scouts for at least 15, 18 years. And in fact, one, and that's that's a program through the Boy Scouts that um, which is now the Scouts, I guess, um, that any high schooler that's interested thinks they're interested in healthcare, has an opportunity to shadow, to get some hands-on experience. And we even have uh uh uh ENT physician coming back home in two years, and he started out as a medical explorer. So that, I mean, that's uh you have to have a lot of patience, but it it's um we've had many come back that started out as medical explorers are now nurses or lab techs or um physicians. Um we've turned up the volume on that thought in terms of getting high schoolers um interested in healthcare careers by being the healthcare host of the healthcare strand for the uh CAPS program that is being done by our local school district. And don't ask me what CAPS stand for because I can't remember right now, but um this is um juniors and seniors in high school that have applied to be part of and they are on site three, it's um it's a regular um class they take for the entire year, and they are here every day of the week, um, either in the morning and then a different segment is here in the afternoon. We have a total of 35 um CAP students that are here. And we're in our second year. Um that is very immersive. Uh, the first semester, they are doing a lot of shadowing, trying to hone down what of what are the areas of interest, and then the second half of the semester is um the second half of the year is actually doing projects um within um in the hospital, within specific departments or in the clinic. Um I think it, you know, we've we're now have have a total of 70 high schoolers that have crawled all over our hospital and clinic, have discovered positions they never knew even existed. We had um one girl that was very interested in um uh being a nurse, but then she got exposed to social work and decided that is really what you know would get her up in the morning. So I think uh those kind of programs you have to, you know, it's a long tale or a long uh entry uh uh to that, but I think uh we're trying to um build the healthcare workforce of the future. You have a greater likelihood of someone uh that wants to stay um in their hometown uh where all their family is to grow your own. Uh we grow our own also through um, we have the first rural family medicine residency program. Um we just graduated our our first two um residents this last summer. Uh so we have two in every class. It's a three-year program, it's a fully accredited um GMAC uh residency program because people that and the first um the last two years of that three years is spent full time in Sedalia. Um, so you have a greater likelihood that um medical students or physicians that have spent three years in Sedalia have a greater likelihood of wanting to stay or even stay in a rural area uh when they're done with their residency program.
SPEAKER_03:So it sounds so it sounds like you've made some really big strides in addressing one of the issues that John referenced earlier, which is workforce because you the inability to access quality candidates for jobs makes keeping those jobs filled difficult. In a sense, you're doing the best you can to grow them at home so that when that time comes, they're they're already there and they already know your organization. Um, which again, certainly coming out of the pandemic, one of the things that was most frequently referenced as a cost driver was the continual need for agency nursing and other outside services to come in to keep the hospital functioning. This program over time would minimize or eliminate that need for a hospital like Bothwell. Is that a fair statement?
SPEAKER_01:Yeah, yes. And we are fortunate that we have um a community college in our town as well. And we partner very well with them around nursing, uh, x-ray lab. Uh, we developed a nurse residency program um to um support nurses as they're um going to school and then as they are a new graduate to help them ease into going from student to being um a nurse. So it's it's all in um we know there's a nursing shortage, it's only gonna get worse. Um, and we're trying to keep the people that are interested or get them interested in healthcare and keep them in rural communities. Um I so that's growing your own. I would also say I identified, you know, we're at the bottom of the healthcare food chain because of size. Um, and so we are, I'm very excited that there are 20 of us independent hospitals in Missouri that have recently launched um an independent hospital network. We haven't even gotten an official name yet, um, but we are um wanting to gain scale, uh, create a clinically integrated network that puts us at the ability to um have a robust data warehouse so that we can also get really good at improving the health of the patients we serve and keep them out of expensive places like our emergency room or the hospital, and do that together. Um in a we're really trying to create what uh large health systems have while remaining independent. So I'm I'm very excited about that, and that will help us move up that healthcare food chain, develop stronger and better relationships with payers. Uh, the other thing we do is pilot everything. Um uh trying out things. We are one of six pilots in our state with our Medicaid program to pilot being able to provide to Medicaid recipients in our um county things that are not you typically covered by Medicaid. So housing modifications, nutrition counseling, different home-delivered meals, transportation. Um, and uh we are in the second year of this, and we're showing that we are able to, once you are able to um uh solve what is getting in the way of people being able to focus on health, like they don't have any heat in their home, or they um they have uh no way to access food, um, then they can start talking then you can get their attention on being able to lower their A1C or address their hypertension. And we've been successful in um showing that we can move the needle on um improving uh people's health. And in a population that's typically really hard to influence behavior. I mean, we talk about we're going towards um population health and getting paid in different ways. Well, it's really about we're moving from getting paid for doing to getting paid for the ability to influence behavior. Well, that's really hard to do, and especially in a population that is more concerned about um social determinants of health, um, the things that get in the way of you know, focusing on health.
SPEAKER_03:So now, John Laurie has given us a laundry list of things that are taking place at Bothwell and the things they're doing to innovate how care is provided. You have a position from which you can see what's going on across the state. Uh how are things going at the other rural hospitals? Are you seeing similar types of initiatives taking place? What does that look like from your perspective?
SPEAKER_02:Yeah, no, thanks, Don. I a couple of things, right? I it's always and or but, right? So, number one, uh Lori and and Bothwell um are at the forefront of a lot of really interesting developments. There, there's no question about that. But she said a couple things that brought to mind for me some things that I I want the listeners of this podcast to understand. Um my experience with uh hospitals in general, and perhaps rural hospitals in particular and rural people, is that um they're trying to solve a lot of their own problems, right? So when we talk about grow your own strategies, when you talk about connecting the community, when you talk about going upstream into these causal factors and all the rest, there's not a lot of blame flying around. And and there's an accountability that comes with hospitals and health systems. Um it sometimes when all else goes wrong in society, people end up in the emergency department. Uh, when there's a major disaster, the healthcare infrastructure is a huge part of the response. And and and the point I want to make here um strong rural matters to rural people. Strong rural matters to this country. Um, sparsely populated areas that produce incredible amounts of food. Um, that contribute to national security, that house a lot of uh very critical infrastructure for the country, they're important to people no matter where they live. And the construct that's most important here is um nobody wants to be anybody's charity case. And so, to answer your question, as I look at rural hospitals around the state, other hospitals also, but you ask a question about rural, they're trying to figure out how to solve a lot of really difficult challenges, and they're sharing ideas and they're coming together in different ways. They're collegial, they're helpful, as you would imagine. Sometimes, sometimes stereotypes are true. Rural people are hardworking, industrious, and innovative. And so there are a lot of folks who are doing the sorts of things that Lori mentioned here, and they're doing it for the betterment of the state, the country, in addition to themselves.
SPEAKER_03:You know, that actually, John, makes a great segue because I think one of the topics, at least for those of us that are in the healthcare industry, that's really been kind of top of mind for the last several months is part of the OBBBA, which is these rural health transformation program funds, which is some additional money that's being put into the system by the federal government in order to enhance innovation in rural health care in order to maybe help overcome some of these things. And certainly when you read through what the federal government is looking for, this idea of collaboration and working together and kind of overcoming some of the obstacles created by isolation is kind of forefront in this. From what you've seen, you know, where where is this process? I mean, what is what has the state of Missouri done? Is it, you know, is it in line? Obviously, this podcast isn't Missouri only, but what are you seeing as far as how the states are inputting into this process, what they're setting up as programming? Where do you anticipate that going over the next several months as this program kind of hits the ground? So thoughts on that?
SPEAKER_02:Yeah, no, let me share. Um Rural Health Transformation Program was uh an idea that was born as part of the discussions with with OBBA. Um OB3, we start calling it. Um HR1, you pick. Um the estimated impact over 10 years of the provisions in that bill, uh pick pick whoever's estimate you want, uh, could be close to a trillion dollars in impact on funding that flows through states today uh to take care of people in those states through social programs, including Medicaid. So there's no question that um the way it's written, um impacts don't happen for a while. They happen along a timeline. Um when it comes to eligibility checking and things like that, that that happens a lot sooner. When it comes to financing changes around what provider taxes, state directed payments, a few other things, those are a little bit further in the future. But they're on the books, and and we we're forced to deal with the reality that things are uh expected to change radically in the amount of federal support that will flow to states so that states can then administer that Medicaid program that's uh you know a joint offering of the federal and state government. So that's a really big number and a really big impact nationwide, maybe a trillion dollars over 10 years. The rural health transformation program, as part of the negotiations for that bill, was it was an idea that was born and eventually it passed as part of the law, and it was funded at$50 billion over five years. Um$50 billion is not a small amount of money. Um it pales in comparison to the size of the impacts that are expected from other parts of OB3. Um, but it should be available sooner. Here's how it was structured high-level. Um it's gonna be equally distributed over a five-year period and distributed through states. So individual provider organizations, hospital associations, whoever else, they they got to give input to this process, but the 50 states were able to put in an application. All the states that put in a qualifying application were going to get um their 150th per year. Um, and and those applications now have gone in. I don't think we've received final determination on. I think we did hear that all 50 states applied. I don't know if that means all the applications were accepted. But when you think of half of the money, 25 billion or 5 billion a year would be equally spread across 50 states, regardless of how large they are, how rural they are, uh, anything else. The other part are part of a competitive process that does have weighting of how rural are you, what is the need, what's your population, and then what are your ideas? And CMS came out with a notice of funding opportunity on September 15th and said, hey, here's how we want you to apply. And these are the, this is how we're gonna score it, and these are some ideas of what we want to do. Um, I'm not the only person who believes that there was a fairly major difference in verbiage between um things that came from individual members of the House and Senate in regard to this fund that talked a lot about stabilization, talked a lot about rural hospitals, talked a lot about preserving um rural infrastructure. And then the notice of funding opportunity came out from CMS and it had a different focus. And it's not exclusive. It's not that it's not for hospitals, um, but it was very much around transformation, which is a different idea than stabilization. I get that to stabilize and then make sustainable probably is to transform. And I'm and I'm not trying to make an argument here about anything uh good or bad related to RHTP. Um, you asked, you know, as we pivot here, what are people thinking? The 50 states each took an approach to how they would want to use this money to help get to a sustainable rural health delivery system. Helping the incumbents uh is going to be a part of that everywhere. Helping the incumbents transform, helping grow workforce, helping upskill people, helping get people practicing at the top of their licenses. There are a lot of use of telehealth, there are a lot of very popular concepts that were noted by CMS. Um the challenge now will be CMS will make its scoring determinations, funding determinations. We should know about those determinations by the end of this calendar year. And then states will start to administer programs over five years with the goal of helping rural citizens receive care. Rural citizens receive care in suburban and urban areas. But they but that a lot of the care they receive, a lot of the connections they have are local, they are very rural. Um, and and we in Missouri, like other states, will work to try to um use this money very well to help solidify, I would say stabilize. I think it's awfully important, uh, and then also seek to transform uh the delivery system for people who receive care in rural areas. I have such incredible respect uh for Lori and a whole lot of people like her who um are in that situation where the accountability that I talked about for hospitals and health systems, when all else fails, you go to the ER. That's true in urban, suburban, and rural settings. In rural settings, um, folks often are um the only game in town in a different way. And I don't mean that there aren't other independent clinics or dentists or pharmacists or what I mean is from a hospital or health system perspective, the buck stops with them. And I think we need to help them do that well.
SPEAKER_03:Yeah, and and and and again, I do think what you pointed out there, John, about discussion of stabilization, but then pivoting to transformation as it moved from legislation into kind of regulatory action from CMS is important because again, the if the focus of this is these rural hospitals who have already been identified as you know, facing an uphill battle financially, it's inherently difficult to try to be innovative while still trying to just survive. And so, I mean, I think the way this has been rolled out, it it's like they've they've thrown kind of a life preserver out there, but now they've made it difficult to get to the life preserver in order in order to be stabilized. So I think it's I think how this plays out is gonna be uh I would use the word interesting, but interesting doesn't really convey the importance of it because how this rolls out for some will be the difference between survival and closing.
SPEAKER_02:Um as an association, Don, we have to help this go well. We want to help this go well. If um if the program pivots a lot to studies and technical assistance, uh and yet it also is being given the job by government officials of stabilizing rural health, then we've got a difference between perception and reality that could be very damaging. We we we have clear direction from the Missouri congressional delegation, put this money to work, use it to help people, um, and and and use it to help our providers in the state. And that's a part of the work that we'll be doing along with the state of Missouri. Great partnerships with the state, with the governor, with folks who are trying to figure out how to use this to transform, uh, but use it responsibly and and use it for real effect.
SPEAKER_03:Well, I would love to keep talking longer because I mean, quite honestly, these issues we could spend a day and probably still not scratch the surface of all of the things that are taking place and the headwinds that that hospitals are facing, rural hospitals in particular. Um, but we do have a short time, and I I want to wrap this up with one, I guess maybe slightly more personal question. Um I guess my question for each of you is how do you maintain what I perceive as a very positive attitude when facing these great difficulties that are on the horizon? And I think to survive requires it, but I even could say personally, there are days it is really hard to feel positive when you when you see the obstacles that are coming, but I know that you both do. How do you do that? How do how does John Doolittle? How does Lori Whiteman get up in the morning, you know, with a smile on your face, ready to go out there and and try again to slay the dragon that's kind of heading toward us, but knowing the difficulty of the task?
SPEAKER_01:Well, I could say I probably need a a healthier way to deal with stress than Jin. But uh, you know, I I'm I I'm fueled by that this is the right work, and I don't want to let this community or the thousand people that work for me down.
SPEAKER_02:She means it, man.
SPEAKER_03:Um people I I I I could that was as sincere as the day is long. I think that is 100%.
SPEAKER_02:That's why I tried to go first. I wanted to give Lori the last word. Instead, I'm just gonna amplify her. Um, she's cool, but she's not unique. Um there are people all around this state who understand the tasks they've been given. Um, they are they are there's a lot of pressure being placed on the healthcare system. There is a sense that it has too much money, it's not providing good enough outcomes. Somebody needs to do this better. I will tell you that there are a lot of people who come into this space looking to carve off a small piece of that$5 trillion and try and make a pretty good living. They're not the ones who are competing with us to be open at 3 a.m. taking care of whatever walks in the emergency department. People who see the miracles that are worked in their organizations and understand that they are the last line of defense and the best line of defense in so many areas. It's easy to be mission-driven. It's easy to get excited about taking care of people who take care of people. And that's what I think keeps us going.
SPEAKER_03:All right. Well, again, thank you, John and Lori, for your time, for your willingness to share your ideas. Again, I hope and I believe that this information will be helpful for others. Um, and and obviously, I wish you both the best as you continue down the path of trying to find the way to get through the next few years so that we're all still moving forward, serving the community uh in the future. So thanks so much, guys. I appreciate your time, and we're gonna sign off.
SPEAKER_00:Take care all.org and stay updated on breaking healthcare industry news from the major media outlets with AHLA's Health Law Daily Podcast, exclusively for AHLA comprehensive members. To subscribe and add this private podcast feed to your podcast app, go to americanhealthlaw.org slash daily podcast.