As the healthcare industry continues to learn from and adapt to the effects of the COVID-19 pandemic, the Arkansas Hospital Association (AHA) has maintained its advocacy and support for the state’s hospitals and the communities they serve. High costs of supplies, labor, and pharmaceuticals combined with near-stagnant reimbursement rates have challenged hospitals, especially in rural Arkansas. Nonetheless, AHA has implemented programs and initiatives to ensure Arkansas hospitals continue to provide high-quality care to their patients. Bo Ryall, AHA president and CEO, recently visited with us on AFMC TV to discuss these programs.
Supporting a Wide Range of Healthcare Facilities
Every hospital in Arkansas is an AHA member. “We have 105 member hospitals in total,” Ryall said. “These include acute care, long-term care, rehabilitation hospitals, psychiatric hospitals, and one hospice member.” AHA provides continuing education to both clinical and non-clinical staff within the hospital setting.
“We communicate with our members about a myriad of laws and regulations that govern healthcare and hospitals so that our members know exactly what laws are changing. Changes occur almost daily,” Ryall said. AHA also works with state and federal legislators and government agencies to shape laws that benefit and support hospitals and patient care.
Data Collection to Enhance Research and Policy
“Throughout my career, I have interacted with researchers and policymakers who think that hospitals are these huge data repositories where they can just ask for data, and we can easily provide it to them. That’s not really the case,” Ryall said.
He saw an opportunity to use hospital data from patient records to inform policy and research efforts. “We now have a data collection program we use to provide hospital and patient-level data so that researchers can analyze the data and we can learn how to improve our practices statewide.”
The data AHA collects also provides information about the financial viability of healthcare services. This allows hospitals to learn what efforts are beneficial for patients and which ones could be reworked.
Quality Programs Drive Best Practice
AHA’s quality team consists of three nurses. Since 2012, member hospitals have been engaged in inpatient safety initiatives developed by the quality team and funded by government contracts. AHA partners with AFMC and the Texas Medical Foundation to implement quality improvement initiatives under these contracts. “There’s been a big movement by the federal government to reduce hospital readmissions and hospital-acquired conditions, so we’re focusing our efforts in those areas,” Ryall said.
“It’s good for us not only to have boots on the ground visiting hospitals and interacting with their quality teams but also to have a forum where they can get together and share best practices and learn what works and what doesn’t,” Ryall added.
Patients and Their Families also Play a Role in Quality Initiatives.
One unique program AHA has implemented is called the Patient and Family Engagement Council, which brings patients and family members into a hospital setting to share their experiences about the care the hospital provides them. “It’s important that we include the patient and families in understanding what works and what doesn’t work in our hospitals. This all impacts AHA’s advocacy efforts,” Ryall said.
Policymakers, government regulators, and state agencies are all passing laws and regulations that can seem duplicative. This can result in hospital staff spending more time filling out paperwork than at the patient's bedside. “Leveraging patient experience helps us communicate with government agencies about what works and what doesn’t so that when we spend time at the patient’s bedside, we implement practices that work.”
Hospitals Rely on Medicaid and Medicare Funds to Stay Open
Pre-pandemic, Arkansas was one of the first southern states to take advantage of the additional health insurance coverage available through Medicaid. “At one time, we had 250,000 to 300,000 patients benefitting from this expanded coverage,” Ryall said. “This provided better healthcare to hundreds of thousands of people who were once uninsured. Our hospitals and doctors were getting reimbursed more for seeing more patients.”
However, since the end of the pandemic, inflation has caused healthcare costs to spike. The cost of medical supplies and pharmaceuticals has increased by 20%, and labor costs are up 30%. Despite these increases, reimbursement rates have not been able to keep pace.
“We’re not like other industries where we can raise prices to cover inflation costs. We’re paid by Medicare and Medicaid,” Ryall explained. “Medicaid has been flat in their payments, and Medicare reimbursement has only increased by a few percentage points. This is not nearly enough to keep up with inflation.” The challenge of inflation has placed undue pressure on hospitals to remain financially viable post-pandemic.
Rural Hospitals Are Hit the Hardest by Inflation.
Rural hospitals are more dependent on Medicare and Medicaid reimbursement than other hospitals. Due to higher costs, rural hospitals struggle to stay open.
“The risk of closure in rural areas of our state certainly raises a concern about access to care,” Ryall said. If a hospital closes in a small town or rural county, you’re looking at a 30–45-minute drive to access the emergency department or a provider. That’s a big concern.”
Hospital closures also strain rural communities' economic stability. “In most rural communities, the hospital is the largest or second largest employer. Having a hospital in the community means the community is more likely to be more financially viable and successful. The jobs and income available benefit the community. When that hospital closes, the community immediately sees a large portion of its economy disappear,” Ryall added.
“From an economic development standpoint, if an industry is looking to move into a city or county, they’re looking to see if there is a hospital nearby that can offer healthcare services to their employees,” he said.
Ryall also said that when conversing with CEOs of small hospitals, he has learned how slim their margin for error is. When a larger hospital commits a medical error or other mistake, while severe, they can learn from the mistake, replace the staff, and recover from the error financially. The same mistake could result in the complete closure of a smaller hospital in a rural area.
Recruiting Challenges
The salary and wages for Arkansas healthcare workers make it difficult to compete with other states. “When we try to go out to Dallas and recruit upcoming nurses and physicians, it’s hard,” Ryall said. “We have other great perks, but from a salary standpoint, it’s hard to compete. So, we must find new ways to get students interested in healthcare careers and get them in the pipeline.”
“We’ve got to get into middle schools, junior highs, and high schools to discuss healthcare careers. It’s a great way to make a living, and it can be a very satisfying career,” Ryall said.
Final Thoughts
The challenges Arkansas hospitals face can be daunting. With Medicaid and Medicare reimbursements struggling to keep pace with rising inflation costs, it can be difficult for hospitals and their staff to continue to provide quality medical services. AHA’s ongoing support of hospitals through statewide initiatives and collaboration shows their dedication to enhancing patient care, increasing access to essential healthcare services, and ensuring hospital staff and other healthcare professionals receive the reimbursement they deserve for the important work they do.
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