It was the mid-90s and Michelle Rathman felt like she’d made it. She had successfully launched her own business, Impact! Communications, growing it from a small outfit (think: a card table in the kitchen) to a firm that represented hundreds of clients on national platforms like The Oprah Winfrey Show. Then, in 1996, a cancer diagnosis turned her world upside down.
Rathman was diagnosed with Level 3 malignant melanoma. While she battled her way to recovery, she describes her past experiences in the health care system as “unpleasant.” This ignited a passion in Rathman to change health care for the better. She felt patients, who were often facing life’s toughest challenges in the hospital, deserved more.
After some soul searching, Rathman won a contract to manage communications for the University of Illinois Medical Center in Chicago. She worked on outreach campaigns to expand care in underserved communities throughout the city. But it wasn’t until Rathman found herself strategizing to gain community support for a new health care facility in Galena, Illinois, (population: 3,183) that things really clicked into place. Rathman not only helped the Galena hospital rebuild, but also brokered a partnership between the hospital and the University of Illinois Medical Center to bring more board-certified emergency physicians to the small town.
“So many of the things in my life aligned,” Rathman told Ben Rowley on the Rural Business Show. Combined with her work in Galena, Rathman grew up with family ties to rural Minnesota, and she was officially drawn into the world of rural health care, where she has now worked for more than two decades.
“I’ve worked in 30 states, in rural communities of every shape and size. I see a quality of life and I’ve met people who really inspire me to understand how important it is that we take a look at rural [life] from a different lens,” she said.
Rathman believes every rural community and rural hospital is unique, but many face similar challenges. Rural residents are often older, more likely to be uninsured, and face higher rates of poverty and disease compared to residents living in urban areas. An older, sicker, and poorer patient population, plus relatively low patient volumes, means rural hospitals are often strapped for cash. That’s a big part of the reason why 133 rural hospitals have closed over the past decade, according to the latest tally from the University of North Carolina’s Cecil G. Sheps Center for Health Services Research. Hospitals in states that did not expand Medicaid feel this pressure even more acutely.
“You can look at the map and you can see where we have clusters [of hospital closures], and those are specifically in states that did not expand Medicaid. That is not a political statement. That is just a statement of fact, and there is no way around it,” Rathman said. One of her goals is to help communities identify the policies and trends that are putting health care services at risk before the doors of the local hospital close. This is crucial because a hospital closure can have a huge ripple effect on a small town’s economy.
“A rural hospital is typically in the top three, if not the top, employer in their community, and those are really good paying jobs. When you close the doors and you’ve got 120-250 [people out of work] … those folks aren’t going to stay in that community because they have these incredibly valuable backgrounds,” Rathman said. “They have to go someplace where there is a health entity, and they can be gainfully employed and support their families.”
The coronavirus pandemic has layered on yet another challenge. Rural hospitals, like hospitals around the nation, had to put many revenue-generating, elective services on hold this spring to prevent the spread of the virus. The added pressure of COVID-related financial losses shuttered 11 rural hospitals since March, according to Time magazine.
However, for rural hospitals, the worst may still be ahead. While COVID-19 was ravaging major metropolitan areas in March and April, it had barely touched rural communities. By June, 9% of rural counties hadn’t even encountered a single case of COVID-19 yet, according to the rural news outlet The Daily Yonder. Now after losing revenue during the first wave of the pandemic, rural hospitals are bracing for what The Daily Yonder calls “the rural wave.” Rates of new infections are now 65% higher than urban counties and just one county in the lower 48 remains untouched.
Despite these challenges, Rathman is optimistic about rural health care because she has seen the success stories first hand. “The rural hospitals I really see succeed, they expand beyond what they know within their walls,” Rathman said. “They are really super involved in their communities, and they are innovative.” She recalled the story of a critical access hospital in Oregon that partnered with an academic medical center to bring world-class cancer treatment to their community. “It’s those kinds of leadership teams that understand the need to invest in their people, invest in their community, and never let up,” she said.
Community engagement, both with local stakeholders and with peer organizations throughout the state, is one of the major differentiators of successful rural hospitals, according to Rathman. She believes community engagement is essential for rural businesses of all stripes.
“Surround yourself with people who have been successful and ask a lot of questions about how they did it. A small business isn’t going to have a board of directors, but you can have a community of advisors,” she said.
“Smaller communities have a real advantage because people do know each other and they are rooting for each other in so many ways,” Rathman said. “I see so often people are so willing to provide that level of feedback without expecting anything else in return.”