Michelle Rathman: Hello, and welcome back to The Rural Impact, a podcast that works hard to connect the dots between policy and rural everything, or as I say, everything that we can think of. My name is Michelle Rathman, and it is always my sincere thanks to you for joining us, tuning in and subscribing. We are so glad that you are here for this conversation.
Today, we are going to shift gears just a little bit and we're going to take a pause in our series that we've been doing focused on opportunities to expand post-secondary education, job training, and apprenticeships for adult learners living in America's rural places. But I want you to stay tuned for that because in our next episode, our final episode in this series, we are going to tackle the hot topic of our nation's rural education shortage in this country.
We have a teacher shortage in rural America, if you have not heard that. And so you're going to hear an incredible story about how one school district through the support of a university initiative is making it possible to literally transform recruiting efforts and the lives of community members and students in the process.
So, as I said, be sure to subscribe to us wherever you listen so that you do not miss this conversation. As always, you know, I do invite you to follow us on social media as well. We appreciate that when you do and like, and in some platforms, since the likes are hidden as of today, be sure to repost and share your thoughts on the conversations that you're hearing.
Okay, now, as I said, switching gears, we are going to put the focus back on rural health because not only are we going to talk about some news that broke last week real quick sneak preview related to policy and partnerships born out of the need to address this country's growing extremely costly and even life-threatening situation of cyber-attacks on health care systems.
But I'm also excited to share with you a conversation I had with two outstanding rural health leaders. And I got to tell you, each of them sharing their insights about what is required to be a thriving rural hospital.
And you know, you've heard, we talk a lot about the challenges facing rural health organizations and for an optimistic person, Like myself and believe it or not, I am quite an optimistic person. There has been some difficulty finding some silver linings, but believe me, there are silver linings and you're going to hear from two individuals who've overcome tremendous hurdles to help ensure that their rural communities, it might be one of your rural communities, have access to high quality care, high paying jobs.
So many people really don't understand that rural hospitals and the clinics that they support and all the services they support are often the largest employer, a major economic driver for their communities. And you're also going to hear about programs that they. They really pursue out a passion that involves partnerships that create healthier communities and really works towards eliminating those conditions that drive poor health outcomes.
But, first up this is kind of breaking news for a podcast of our nature. It's not exactly happened yesterday, but we're a week after this happened and we really want to make sure that we brought this to you. You are going to hear a conversation I just had with an old friend of the show, Alan Morgan.
He's the CEO of the National Rural Health Association, and he joined me just one day after the White House announced news about a dynamic partnership designed to provide support to combat cyber-attacks. And I will just say with you, literally the day that I'm recording this, I just got off a webinar that was sponsored by the White House for the Rural Partners Network, and we heard from officials from Microsoft and Google about this.
So you're going to want to make sure you stay tuned for that. And then also check our website theruralimpact.com because we're going to put some connections in there. It's really incumbent upon us to spread the word that there is help, real financial support for rural hospitals who are working to combat these.
And the second part of this episode, you're going to hear from someone I have known for a very long time. I'm proud to say he's my friend, but he's an outstanding rural health leader. He is the CEO of Kirby Medical Center located in Monticello, Illinois, a bedroom community in the central Illinois rural region just sandwiched between Champaign and Decatur.
And we're also going to hear from Kathy Kuepers, and she is one courageous rural hospital leader. She is the CEO of Memorial Hospital of Lafayette County, soon to have a name change. And it is the last remaining public hospital in the state, county owned, and it is located in Darlington, Wisconsin. And you know, although it is true they both lead critical access hospitals, I've got to tell you this conversation is going to help demonstrate why no two rural hospitals are alike, regardless of what you might think.
With that said, I want to extend my thanks to Wipfli for their partnership with the Rural Impact. And I would also like to invite you to activate your podcast listening mode and get ready for my conversation with Alan Morgan, Steve Tenhouse, and Kathy Kuepers. Are you ready? Let's go.
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Michelle Rathman: Alan Morgan, CEO of the National Rural Health Association. Thank you so much for joining us because we are in an episode that we're talking about what keeps rural hospital CEOs up at night. And one of those top of mind is cyber security and cyber-attacks. You've got some news to share. Tell us about that.
Alan Morgan: Absolutely. Michelle, thank you again for allowing me the opportunity to join with you on this program. I wish it was a better topic than the terrible topic of cyber security. But I am pleased to announce the National Rural Health Association is entered into a partnership with Microsoft to make sure that we can provide free technical analysis, and also reasonably priced products to safeguard our rural hospitals against the growing cyber security threat. And as you alluded to, this is part of a larger national effort that was announced yesterday involving the White House, Google, Microsoft, the American Hospital Association, and the National Rural Health Association, recognizing this growing threat to our rural communities.
Michelle Rathman: You know, I have said before that a cyber-attack on a rural hospital is just really at the kiss of death. And I think, you know, seeing that there's going to be massive discount and there's some attention being put to this from the White House. What do you think kind of put us where it was pushed over the edge, if you will, because talk about those threats.
What happens to a rural hospital when their EHRs are hijacked? And, you know, what does that do for operations? So, people really understand when we say threat, we are not talking about teetering on the edge, we are talking about some serious disruptions of services and patient care, right?
Alan Morgan: Oh, absolutely. I would go so far as we're talking about mortality. We're talking about putting the lives of rural communities at risk. And it's, it's, cybersecurity is impacting all health systems of all sizes. But in a rural context, when you may be miles from the nearest provider this, we are talking a life-or-death situation.
So much of this focus has been on large urban institutions and large health systems. But these rural hospitals where they're stretched thin, limited resources, workforce shortages, the impact is even more pronounced. And unfortunately, these are facilities that just do not have the resources that the large facilities do to protect themselves.
Michelle Rathman: And as we, you know, really work to increase interoperability and all of this stuff, I mean, it makes hospitals more vulnerable, even though we're working towards more innovation and more, you know, access to tools and whatnot. It makes us more vulnerable. I've got one more question for you before we go.
There has been some discussion about, you know, there's one thing to look at the investments and the attention that needs to be paid on the preventative side. But when the attacks happen, one of the things that we're talking about is what can we do at a policy level, because we're all about connecting the dots to policy.
And I would say something coming down from the White House is policy related. But what are you seeing or what do you think we need to be paying attention to with respect to easing the fight, the massive financial burden when a system does everything right? Everything they're told to do, and they are still compromised and then there's that nut, you know, they have to spend millions upon millions of dollars to right the wrong.
Where do you see policy playing a role in helping to ease the pain on the backside of an attack?
Alan Morgan: Such a good point, Michelle. In particular, you are right. This is really about prevention and how do we help avoid it. But once it happens that's one of the reasons why the National Rural Health Association is pushing now to increase the funding in the Small Hospital Improvement Program, which is a grant program under the Federal Office of Rural Health Policy.
It's available to all rural hospitals, and we want to make sure that we have funding in place to be able to help these facilities once they have been attacked. How do they recover? What's the next steps as a result of it? Again, I want to stress this before we lose our time here together. Of what's really at risk are these small independent rural hospitals that may not be part of a larger health system. And their services to these small communities are so viable important and viable to that community.
We've got to be able to protect that
Michelle Rathman: Thank you. So, I'm going to assume that folks can go to the National Rural Health Association website. We're going to put the links on our website to learn about this, how you might be able to participate in this program. And I would say we might be a day too late, but it's never too late to pay attention to this issue.
We're so happy that you had the opportunity to join us this morning. I know you're running in between meetings. So, Alan, you're welcome back anytime you've got breaking news like this. We'd love to hear from you.
Alan Morgan: Thanks, Michelle appreciate everything you do for rural
Michelle Rathman: Thank you so much.
Michelle Rathman: Kathy Kuepers, CEO of Memorial Hospital of Lafayette County, soon to be, Little Birdie tells me, Lafayette Hospital and Clinics in Darlington, Wisconsin, and Steve Tenhouse, CEO of Kirby Medical Center in Monticello, Illinois. Both of you from the bottom of my heart, welcome to The Rural Impact.
It's wonderful to have you both sitting in almost in the same room.
Steve Tenhouse: Yeah,
Kathy Kuepers: So, thank you, Michelle.
Steve Tenhouse: great to be here.
Michelle Rathman: It's great to be here. I've explained to everybody up front that I know both of you. So, it's going to be a great conversation because we go way back. Steve, I stop counting. I actually, I was trying to think about it today. Whenever your facility was you know, just but a mere dream. So how many years ago?
Steve Tenhouse: It's been 16 or 17 years.
Michelle Rathman: 16 or 17 years. We haven't aged a bit. And Kathy, we met during a very interesting point in time. And, you know, in the world's life, which was during a pandemic and, one of you is to the south of me and the other one is to the north of me, but I'm really glad that we're having this conversation because as, we all know in this room and people who listen to this podcast understand rural health is my livelihood and has been for many, many years.
And, unfortunately, I find myself going down the rabbit hole of all the things that are so wrong and there is plenty of it, especially when we're talking about policy. At the same time, a lot goes right, and the two of you who have been doing this for quite some time and your rural hospitals are thriving. And I'm going to label it as thriving.
That's, you know, you may say it in your literature or on your website, but I just know in the context of rural health, how well both of you are doing. But for, for those who have a picture of a critical access hospital, you know, there's that saying, if you've seen one critical access hospital, you've seen one, that's kind of true in many ways, but for those who have a picture in their mind of what we paint as with a broad stroke older, sicker, poorer, depressed, shuddering, vulnerable, and so forth.
Kathy let's start with you and just give us a snapshot of your hospital, kind of a few stats if you will, and then Steve, I'm going to ask you the same question.
Kathy Kuepers: Yeah, so we are a critical access hospital in rural Wisconsin. We are the only county owned hospital in Wisconsin, which makes us a little bit unique. Um, in our situation in being a critical access hospital has helped us, thrive financially as a result of it, our organization started really growing and, we were able to recruit.
And so our current facility, the structure is 70 plus years old. The, the core of it, it still remains 70 years old. We've done small remodel jobs over the course of time. But it came to a point where we needed to make a decision and the decision is, how are we going to be true to ourselves and continue to provide the level of care that we do in our community?
Being the only hospital in, in the county too, is a huge responsibility in providing that care. So, five years ago, we started down the journey of, what can we do because we cannot continue to provide, the care that needs to be in our community with the current footprint that we're in. It was set up to be an inpatient hospital and it served its purpose over the course of time.
But things have changed. You have gone from inpatient to more outpatient care. And so that is what, we struggled with, and so it was only, we needed to really communicate with the people in our county to help them understand it. Whether they used our services or didn't use our services, it really impacts our county.
We're the biggest employer in Lafayette County. Both in direct revenues and indirect revenues and what we, what purpose we provide. So, we went along the journey of deciding if we do nothing and if we do nothing that was a decision of really how do we work with the community to send our health care somewhere else because we no longer able to provide the level of service that we need to continue, build a remodel in place and then build on a green site.
I'm going to pause you right there because Steve, you, you, I'm just imagining you're sitting there going, Oh my gosh,
Steve Tenhouse: Right.
Michelle Rathman: cause for
Steve Tenhouse: Deja vu.
Michelle Rathman: Who don't know this, Steve and I met when he was going through the exact same process 17 years ago. And, you know, very much like you, Kathy, I mean, just real quick, Kathy, you're located in the southwest, southwest corner of Wisconsin.
Steve, you're kind of in central-ish, Illinois. Just, give us real quick, Kathy, how many employees do you have right now?
Kathy Kuepers: We have, about 180 direct employees and, but it moves up to about 210 with the contracted employees that we, that are providing services here.
Michelle Rathman: So, similar project, Steve, you know, you also built your landlocked built on a green site. We'll get more into kind of like your governance structures in a moment, but just give us a snapshot of of your place. And, you know, you could fast forward a little bit because Kathy doesn't know what the future holds, but you certainly do have an idea about that.
Steve Tenhouse: Yeah. So, we're in East Central Illinois. We're in a rural community of a town of about 5800 people, but we serve probably 18, 000 people in all of Piatt County and some of those surrounding areas. What's interesting is we're sandwiched right in between two large urban areas, about 25 miles either direction that, you know, each have a couple of hospitals and multi-specialty clinic.
You know, they're also two major universities, plus manufacturing in those areas. So we're, we're kind of sitting right here in between right on the interstate that connects those those communities.
Somewhat different about us is we're an independent 501c3. We were created in 1941, through the state gift by the Kirby family, hence, the name of our hospital.
And, you know, we're now up to about 400 employees, which,
Michelle Rathman: Oh my gosh. If you're not, if you're not watching us on YouTube, you didn't see the eyes pop out of my head.
Kathy Kuepers: Hee
Steve Tenhouse: Yeah, yeah, that that number has increased dramatically from when we were designing the hospital. And when we moved in.
Michelle Rathman: Wow. That's amazing. And you are now on a, I remember standing in the middle of a cornfield. Well, was it a cornfield? Standing,
Steve Tenhouse: Depending on what year it was.
Michelle Rathman: standing in the middle of a field mapped out, you know, with, with the banners and whatnot, mapped out of what the footprint was going to be compared to what you, you are.
So, both of you, Kathy, you're in the midst of a rebuild. Steve, you've been at this now for several years and it looks very different than what, as I said earlier, what so many hospitals are experiencing today. And unfortunately, in many areas that is declining, let's kind of talk about moving on.
It takes a lot of things to make the good things happening in your communities for you to be the economic, an economic engine in your community for you to have all the jobs that you have the secondary impact spending and so forth. And, you know, leadership is a very big part of this, because within leadership is the voice that are those who make policy here.
You know, when that you can share your stories with them. So, I just want to kind of ask a little bit about the leadership and the engagement of people because another major issue that we're hearing that our keep hospital CEOs, like yourselves up at night. And you'll correct me if I'm wrong. I don't want to be in your shoes.
I have walked alongside and, you know, seeing what happens when, when you lose staff, we've got a lot of workforce challenges right now. And you, you, there's a lot of conversation about who will carry the torch, you know, who will you pass the baton to? Would you each venture to talk a little bit about what's required today in terms of being a visionary leader?
And then with that, how you bring teams along with you, that lead you to being a thriving organization versus the other side of the coin. Steve, can you share a little bit about that with us?
Steve Tenhouse: Yeah, you know, we talk a lot of here that, you know, the development of our people in our culture is our strategic advantage, compared to those around us. And, you know, I, I think if we were to look back a few years, I think, to put it into perspective. We had no layoffs, and we had no turnover during COVID.
And there were, there were a lot of, you know, a lot of threats, so to speak, or a lot of opportunities that our staff were seeing and hearing from surrounding hospitals that were offering, you know significant increases in pay and significant bonuses. And, you know, we just had a lot of discussion, with our staff about, you know, there might be a reason that's happening.
You know, they might be in a position of where they have to do this in order to, order to survive and to attract people because maybe they've had turnover. And just warn them that, you know, that never lasts forever. And there's always, been a reaction to that. And, you know, I, I think, again, our, our culture and what we have really worked on over the last, seven or eight years is what got us to the time and what has also led us to the success that we've had. Some examples, you know, again, a lot of it is obviously around transparency that we're gets thrown a lot around a lot,
Michelle Rathman: It sure does.
Steve Tenhouse: But it is one that we focus on, you know, I give a, I have a monthly employee forum that people can attend virtually or attend in person, write us, talk about what's going on around the hospital.
There might be specific things I kind of dig into the detail, but we have a gain sharing program that if we, if we succeed patient satisfaction and our quality results, and then, you know, a small piece related to our financial results are all of our employees get to, get the benefit from that. And I update those results every month and talk about them.
You know, my senior team rounds on, you know, the departments in the hospital once a month. So, the other employees are able to hear from our senior team what's going on to answer questions. We develop culture champions that are, staff people that we feel really, walk our, our core values and they do the final interview with every single person that we're getting ready to offer a job to.
And their sole job is to talk to that person and understand how they're going to fit with the culture of the organization. And it doesn't matter who it is. If the culture champion does not feel that they're a good fit, then we don't hire them. So, we really, we really, protect, the culture that we developed here. You know, and for me, the, the key was surrounding myself with a strong leadership team that, exhibits those, those core values too. And, you know, when our staff see what right looks like, they do the same thing.
Michelle Rathman: Yeah. I love that. Kathy, you know, you're, it's interesting because you and I, in the past have had conversation about what a replacement facility, you know, what a, what a modern healthcare facility can do for recruiting. And the things that Steve talking about, you know, retention is kind of elusive for, for many people, it's kind of elusive.
There's a lot of fluctuating conditions right now that are driving people one way or the other. What has, you know, and under your, your leadership, you, I watched the recruiting happening before, like many years before you even had a replacement factor. So, talk a bit about where you see leadership on your team playing a role.
And maybe if you can, a little bit about the role of what the facility actually means to recruiting. healthcare professionals today and not just clinic, not just clinical professionals, right? Because your team is, is you're growing, your needs are growing as well.
Kathy Kuepers: Yeah. And I think actually having the replacement hospital on the horizon has really improved our recruiting. People actually, when we attempted to recruit years ago, saw a critical access hospital, old bone, stagnant, no future. The people that are coming out of the residency programs and are really those highly skilled individuals want to come out and they want to have the technology that they were trained in.
They want to have, they want to go to their forever home in a place where they're going to be able to use the skills. And we actually have been able to recruit, fabulous orthopedic surgeon as a result of it. He was born and raised here.
His father was primary care, but he wanted to come back and be able to keep all the skills he learned in his residency program, including robotic surgery.
We recruited a, a gynecologist who will be coming in this next year in 2025. Very excited about the future, developing a women's health program, wants to do robotic surgery. We're able to recruit more primary care as a result of it. Everybody wants to go someplace where there's a future.
A new facility really expresses that quite clearly. There is a future here. We are able to provide the footprint that you need, the technology that you need to continue to develop in your careers. And when we are bringing on board some of these highly skilled surgeons and primary care physicians, they are also people that our clinical staff want to work with, right?
And so, we're able to actually onboard those. And during COVID, we also retained our staff. We never had any layoffs. They stayed true to us. And I think we collaborate well. We have a very, very slim administrative team, but we do rounding with our department heads on some weekly, some every other week to discuss what's going on, what's going well, what's not going well, what we need to work on.
They have a voice at the table. And I think that is part of our culture that we developed over time is they bring value. They have a lot of insight on what the day-to-day operations are, and we can give them insight into what the bigger picture is. And so, if we're all aimed in the same direction, working together in tandem, just like a string of lights, you know, you're gonna, you're gonna work well together.
So, I think that's a culture that we've worked on for a number of years here and, and it's, it's working for us.
Michelle Rathman: Yeah, and it, and it exudes beyond, I mean, so we talk about the fact that transformation does begin from within and both of you, both of your organizations have gone through some growing pains. I mean, Steve, I know that you all faced and it's like, we don't even want to go back there. You know, you had a lot of hurdles as did you Kathy and, you know, at the end of the day, both of you are now Kathy, you're going through it. You've gone through Steve. You got that great shirt on, you know, you went through, it wasn't just a logo, it was kind of a brand transformation. And I feel very strongly as you both know about this, because you can, you could talk a good game.
Things can look really nice, you know, out there and so forth. But really what, it's, I wouldn't call it a thriving brand. And what you really worked at was building up a trusting brand, you know, building those friendships, the friend-raising, as they say, and see if I wonder if you wouldn't mind touching on that because, you know, right now it is, depending on what you consume, trust is eroding.
Kathy, your public hospital, your, your taxed, as we could say, levy dependent, you know. But even though you weren't Steve, people have this notion that do you, you know, I pay your salary. So, let's talk about building that trusting brand and then, and then how do you retain that?
Steve Tenhouse: Yeah, you know, I do go back in time and I look at kind of how we got to where we were. You know, we were in a building that was 35 years old, completely landlocked. So, we had no room to grow and, you know, when you look at services, we were providing then to what we're providing now, the board realized that we had really one, one direction to go to. One, we could just continue to slide into oblivion, or we could, you know, basically take a chance to grow and retain our independence. And that's what we did. We designed the hospital, built and opened it in September of 2011 and to give ourselves the opportunity for, for the growth and those different departments that that we needed to.
And it was not easy because, as you said, Michelle, the building isn't it? It's the people within the building and the culture that's providing the care that makes a difference for people. And that's what we have been able to do is once we got through, the, the perception of us being as, you know, I think you put it, Kathy, kind of a small, stale organization.
Once we got beyond that perception and started to bring in, more specialists, more services, then the people slowly, you know, followed after that. The main difference that is a big change that was made for us. It was probably 7 or 8 years ago when we were going through some strategic planning. We're looking at our vision statement and we make one small change to our vision statement is at the end of it after all the things that, you know, we have been saying that we want to do for the community and how we want to do it.
We said, and we want to make Piatt County a healthier place to live.
Michelle Rathman: Right. I love that.
Steve Tenhouse: And that really changed our focus going forward. It basically said, okay, what do we need to do in order to, bring people to the campus and to keep them healthy? So that started with our wellness trail that we developed around the campus to give people a reason to come out here.
And it's since expanded to the development of our therapy and wellness center. Because we had also started a CrossFit gym, and, you know, I told the board, it's like, I want to give people a reason to come to this campus not because they're sick. I want them to give the reason to come to stay healthy.
And we opened a CrossFit gym and expanded and a year ago, we developed a new therapy and wellness center. That includes our therapy department that had grown tremendously as well as our CrossFit gym.
Michelle Rathman: Oh, excuse me, sir, but I have to just add here, you were doing it long before that. You just didn't do it on your campus because you have the Kirby Derby. You have your, I mean, I, you, so you guys have been focused on, I'm going to give you credit where it's due. You've been focused on community wellness for a long time, but I love the idea that you have the space.
You've nearly had a conference room for people to do diabetes education in , and so what you're, what you're really saying here is that, I mean, they come to you to know you is to trust you. To have one experience with you in the ER or waiting for a clinic time or what have you, but you really see that you are, are getting into, you know, where they you're improving the quality of their life, that's really what it boils down to.
Does it not?
Steve Tenhouse: It does and that and then, you know, that brand becomes top of mind when they do need healthcare, they do need something else. They have something happening. You know, they need primary care for their, for their children, for themselves. And again, you know, we kind of promote that. It's like, you know, it's never too early to be thinking about your own health care, if you're 20 or 30 years old.
So it has developed and created an entirely new population of people that know about us and, you know, have a reason to come. Whether it's to get health care, whether that's to stay healthy.
Michelle Rathman: Yeah. I love it. All right. So, all of that is wonderful and new facilities and all of the things that you're doing. And then there's the thing called health care finance. Steve, that is your favorite subject, is
Steve Tenhouse: Sure, it is. Yeah.
Michelle Rathman: Kathy, has a clinical background. Steve has a financial background and they all have to converge. So, operational excellence and financial confidence. I think with with the time that we have, I want to make sure that we touch on the fact that. Um, so much of your work is, you know, you're, even though you're not, in essence, just working to keep the lights on, you are still working to keep the lights shining. It's hard right now.
Can we talk a little bit about healthcare finance in the context of the challenges that you all are facing right now, that we need to have addressed people listening to this podcast know, it has to be addressed. It's a priority. Let's start there. What are the challenges that you are facing as leaders with healthcare finance that, people should know about that they don't?
Steve Tenhouse: Kathy, you want to go first? You want me to go
Kathy Kuepers: I'll let the finance guy go first.
Steve Tenhouse: Great. So, I've been in health care for, you know, 35 years and I've been here now for almost 23, and everything is cyclical. So, you know, there's the ebb and the flow of, of legislation that can change reimbursement. Right now, I think the thing that we are probably feeling the most and that we see our patients feeling the most is kind of the change from Medicare to Medicare Advantage plans. And, you know, there are significant differences in, the care that you have available to you through your plan, whether you're a traditional Medicare or Medicare Advantage.
And, there's a big push of in Washington to continue to push more of the traditional Medicare population into Medicare Advantage plans. Because it's a way for the Medicare program to manage its cost. You know, if it's got a fixed cost that it's paying to an advantage plan, then really, it's up to that insurance company to manage the care of the patient. A lot of our patients are starting to realize the real difference, you know, in coverage and how that works.
And, it will be interesting to see what this looks like a few years from now, because I don't think it's working. Definitely not working, I think, is, as the population thought it would.
Michelle Rathman: We're hearing that a lot. We're actually going to be on the road in Nebraska talking about this very subject matter. Kathy, what are you, what kind of squeeze are you guys feeling up where you are? I mean, it's, it's rough to, to keep, and you're balancing a project at the same time. That's in your
Kathy Kuepers: Yeah, So we're experiencing a lot of what Steve is with people choosing the Medicare Advantage plans, and what they don't realize is what they are, what they are given with those plans, and they're not providing as many services. And it is impacting them. But another thing that has really affected us since the beginning of the year is the cyber-attack against Change Health Care and getting our dollars in. Because the bills are going out, the remittances aren't coming in, the payments aren't coming in.
And I think we have to be very aware of cyber security and what that means, even if our building is safe. Those exchange agencies that we're using to do our billing and getting our remittances are being attacked. And that is really affecting us at this particular time.
And I think those are things that people don't really realize between the, the plans, Medicare and Medicare Advantage plans. We're in a, location within our state that the commercial payers are, we, we live in southwest Wisconsin, we're on the border of Illinois, Iowa, and Wisconsin, and we have a state plan that is Medical Associates of Iowa.
And so they not only, own the plan, they own the, the specialists. And so they are basically have monopoly. And they're requiring all these, these, people that have signed up for their plan to go back to Iowa to receive their care, their specialty care. Which is, again, very concerning. So, we have the, the commercial payers that, are making the determination of where our patients can receive their care.
It's taking them out of their community. It's not necessarily giving them choices nor necessarily better care, but, it's a monopoly.
Michelle Rathman: And you're right, and it's not well understood because who can understand it? I mean, it is truly a very tangled, tangled web as we see, as we've seen with change healthcare and the fallout from that.
Steve, you experiencing, I mean, nodding your head, experiencing some of those same things. And so let me ask you, I mean, you're very involved with the American Hospital Association.
I know that you are in connection with your state representatives when, you know, on various issues. As a rural health organization CEO, what is in your advocates toolkit? Because, you know, you, we've said, you cannot do this alone. You shouldn't be expected to do alone. We need CMS to be hearing. And even if you have an Office of Rural Health within your office, what's in your toolkit?
What, what do you think is important for us, you know, all of us to do our part to go forward and advocate for what, what do you use?
Steve Tenhouse: Well, I, I think that the key as much as you can, is try not to do it alone. You know, we're fortunate in Illinois with the only critical access hospital network. So, there are 51 or 52 of us in the state. You have a much louder voice and you have 52 hospitals that are, you know, all, basically trying to address the same issue.
And that also obviously helps with the, you know, with the state hospital association to trying to get our points across. So, you know, I, there's that and, I think again, it, it, a lot of it does start local is us utilizing our governing board, our foundation board, and all auxiliary when it comes to trying to get that message into, especially into the state related to state issues, just tapping into the network that you've got, choosing your battles carefully, and, and just pushing.
Because it's, you know, you can quickly prove how many people it's affecting. And a lot of times the message that we've got as a, as a critical access hospital is something that's probably maybe a little more direct and, and I think a little more focused on the impact it can have on a significant group of people in a, in a, in a defined area.
Michelle Rathman: Okay, and, you know, Kathy, because you're in a different situation, and you don't have a board like Steve has. Steve's board is made up of really nice community members from all sorts of walks of life, professional backgrounds, and not to say that yours is not, but yours is made up of a county.
And so you, I mean, you are, you know, policy is, it's in your oxygen out there, really, everything that you have to do, if you will. So, you know, you're in a situation where you, you, you are advocating for the hospital, but a completely different set of circumstances. What, what's in your toolkit? I mean, how did you convince?
Kathy Kuepers: Yeah, so yes, our committee is made up of county board supervisors, which they're elected officials every two years. So, we could have a revolving door every two years and not a lot of consistency in our board.
But what I have relied on a lot is we have a Rural Wisconsin Health Cooperative that we belong to that probably 70 plus rural hospitals, not just critical access hospitals belong to this network and they are very, we meet monthly, but they go to the state. They go to D.C. They lobby for us. They hear what the rural hospitals are saying.
I know, you know, Tim Size, Michelle, and he is just a huge advocate and he has been at the cooperative for many, many years.
And I don't know what we're going to ever do without Tim, but they actually, are very good about getting the messaging to the politicians that they need to hear what's going on in the rural areas and really save our rural hospitals. We rely on Wisconsin Hospital Association a lot. They're very, very good advocates for us as well as the American Hospital Association. I actually have gone out and met with some of our politicians and, you know, have actually, had conversations with them so they can hear from me personally what is affecting not only myself but other similar rural hospitals. And I think it's important to actually really advocate for yourself and really have those connections, but as I mentioned, we're very fortunate with having the rural health, cooperative.
Michelle Rathman: I would think that you would both agree with it's important to have your community leaders who are active in their own ways. I mean, they're active in their own league of women voters, or whatever the clubs rotary that having them come to you. I mean, there's nothing that can do it like seeing it.
You know, seeing is believing and then, just the importance of making sure that those who are influencers can also share your stories because it's, it's so important for those very reasons. I mean, you are thriving and you have vulnerabilities, hate to admit it, but we all do. I'm glad that you touched on cyber-attacks.
It's not, it's something that's not lost on me at all every single day. And we're hearing more and more the cost to you to prevent and the, I can't even I said, cyber-attack on a rural hospital is the kiss of death. And it, and it really would be. So that's another whole conversation. Oh my gosh, Kathy and Steve.
I am so, so, so grateful that we had this conversation. It is like an old, you know, we could be sitting around having, you know, a beverage. But
Steve Tenhouse: Next time.
Michelle Rathman: next time, Kathy invited us up for your next golf outing,
Kathy Kuepers: Okay.
Michelle Rathman: maybe you'll just dust off your clubs. But again, just really, thank you. Congratulations to you both on your great successes.
And I, I think one of the things I hope for our listeners take away from this conversation is really, and I say it so often, so please don't be upset with me when I say they are, your rural hospitals are important. And it's not just because of the hospitals and the lifesaving care and the clinics and whatnot, but it is because that they are drivers of the economy locally.
They provide jobs. I mean, who wants to live in a community with no access to any of the things that what these two share with us today? I know that's not me. And I hope that's not you either for your sake, quite frankly. With that, I just want to say it wraps up another episode of the Rural Impact.
A very special thank you to Wipfli for their support for this programming. And I want to thank them for the excellent contributions they make to rural health as well. You'd be hard pressed to go to any of the conferences that Steve and Kathy talked about without hearing from them. And all the things that they're doing to help rural hospitals thrive.
Also real quickly, thank you, Brea Corsaro, Sarah Staub, Jonah Mancino. And lastly, a quick reminder, you can now listen to The Rural Impact on iHeart, GoodPods, Spotify, anywhere you like to, and we encourage you to subscribe, make sure you subscribe to our e-blast cause they come out after every episode with all the goods, discounts on books and so forth.
And if you're so inclined, rate us and share a comment that helps people find us. So, until the next time, take good care of each other and yourselves, and we'll see you again on the Rural Impact.
