Hillsdale Hospital News

Episode 88: Taking Lessons from the Past to Thrive Now and in the Future

Today, we get into the history of rural health as well as taking a look to the future. This week, we welcome someone who has been leading the National Rural Health Association for more than 20 years, and was advocating for hospitals even before that. Our guest today is Alan Morgan, CEO of The National Rural Health Association.


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Audio Engineering & Original Music by Kenji Ulmer




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Rachel: Rural hospitals have a long history of caring for their community. Patients are their neighbors, family and friends. But as the world and the healthcare industry has changed, so has rural health, for better or worse. So how do rural hospitals take lessons from the past to thrive now and in the future?

JJ: With an understanding of their history, engagement in their present, and a focus on their tomorrow.

Rachel: I’m Rachel Lott.

JJ: And I’m JJ. Hodshire.

Rachel: And this is Rural Health rising.

JJ: Welcome to episode 87 of Rural Health Rising. I’m JJ. Hodshire, president and chief executive officer of Hillsdale Hospital.

Rachel: And I’m Rachel Lott, director of Marketing and Development.

JJ: So, Rachel, we have talked to our friends at the National Health Association before, and we have explored every topic I think imaginable relative to rural health. But today we’re going to get into a little bit of the history of rural health and also look toward the future.

Rachel: That’s right. We are talking with someone who has been leading the National Rural Health Association for more than 20 years and was advocating for rural hospitals even before that.

JJ: Wow. And we can see him on our screen. He looks like he’s 32. So, I’m thinking he started this when he was twelve, probably. At least. All right. Well, it’s exciting because today our guest is Alan Morgan, chief executive officer of the National Rural Health Association. And we welcome you to Rural Health Rising. Alan?

Alan Morgan: Well, JJ. And Rachel, I really appreciate the opportunity to join you today and talk about my favorite topic, which is rural America, and in specific, rule health care.

Rachel: So, to start then, Alan, that’s a perfect segue. Why don’t you tell us a little bit about yourself, your background and your work at NRHA?

Alan Morgan: Sure. Well, perhaps not surprising as a CEO of the National Rural Health Association. I’m originally from a small town myself, northeast Kansas, a small farming town known as Fulton, Kansas. You don’t have to be from a rural area to work at the National Rural Health Association, but I got to tell you, it helps quite a bit. It really does. So, you did mention I’ve had 30 years in health policy development, which seems like quite a while, 20 years with the National Rural Health Association, and I’m based in Washington, DC. But when people ask me where I’m from, I always say, I’m from Holton, Kansas. If you’re from a rural community, you.

Rachel: Understand that, or if you’re from Texas, you understand that. Because I have the same DJ always laughs. Anyone who doesn’t know I’m from Texas, he’s like, oh, you haven’t known her for at least 30 seconds, because it’s.

JJ: All y’all and y’all. Yes.

Rachel: Your roots. That’s where you’re from.

JJ: It’s your roots.

Alan Morgan: Yeah, it is. And I think rural people identify the geography much more than urban people do. And I’ve really found myself a home at the National Rural Health Association, for obvious reasons. And my job really is to oversee our educational activities, our networking activities among our members, and what we’re most known for are lobbying, our advocacy efforts both at the federal and at the state.

JJ: Level, which you do an absolutely remarkable job of. And we’re going to talk about that here in just a minute. So now that we’ve established who you are and what you do, Alan, let’s start with the why. And we do this on every episode, so we get to know our guests just a little bit better. What I want to know and what our listeners want to know is what is your why? What motivates you? What gets you up out of bed in the morning?

Alan Morgan: Yeah, well, I think there’s three reasons for that, and I hope that everyone identifies all your listeners identified these three reasons. One, I mentioned one, stoplight Farmington in northeast Kansas. That’s where I’m from. And no matter where you go or what you do, if you’re from a small town you identify, you’re always a small-town guy. So that’s number one. Number two, my family and friends, they all still live in small communities across the US. Mostly among the Midwest. So, when I’m working on their behalf, I mean, that’s a huge why right there, wanting to make sure that I maintain rural America as a place to live and thrive. And then the third reason, which is surprising to urban people, is quite literally everything that’s happening in health care from an innovative standpoint is happening in these small towns. Hundreds of small towns across the US. Really are innovation labs. And so, we’re seeing the future of health care for our country happening today in these small towns. So that’s so, just really cool.

JJ: You know, Alan, we know that you have been fighting the good fight now for decades. You indicated in your introduction it’s been 30 years that you’ve been engaged at some level in policy development or leadership. And you have obviously, through those three decades, have seen rural health through many challenges and many successes. And I’m just excited to pick your brain a little bit about some of those things. You’ve lived through a pandemic, and you’ve experienced, obviously, financial losses in the market, hospital closure rates, which are the highest right now, very alarming. And we know all those stats. And so, what was a rural health environment like when you first started your position at NRHA?

Alan Morgan: Yeah, it’s amazing how much things have changed in the past 20 years that I’ve been at NRHA. And thinking back at that point, I know this is hard to believe, but that was the very beginning of the quality movement in health care.

Rachel: Oh, it was, wasn’t it?

Alan Morgan: Yeah. And I remember the discussions right when I got on staff, there was concern about measuring quality and will they adequately measure rural? That was our concern. And from an urban standpoint, they’re like, well, should we just exempt rule? Because obviously they have a lower quality. That was the misconception at the time. Yeah, it’s so amazing now over those 20 years, and we see those quality metrics and we see for primary care and general surgery, that rule has better quality, exceptional. Yeah. Better quality than urban.

JJ: Absolutely.

Alan Morgan: But that wasn’t known at the time. And so, number one on that, number two, I think a real huge issue is back then, it was the beginning stages of telehealth, and we really hadn’t seen the rollout of gosh, much of the telehealth that we see today that’s currently occurring. And it was the very beginning of what was known as the Critical Access Hospital program at that point as well, too. And that was a new program to help ensure access to care among small rural communities. So, it just literally was a much different time.

JJ: Yeah. And so, Alan, obviously, in tandem with that, throughout those decades, we have witnessed a lot of financial struggles for hospitals, but a lot of changes in payers. And then you throw in sequestration. For two decades now that you’ve been president of NRHA, you have advocated for rural health to get our fair share, because to your point, there was a misnomer that to be small means bad quality. I know that part of your responsibility and advocacy for the rural hospital also ties directly to congressional funding of healthcare in general. I just want to ask you; you’ve had a chance over the last few decades to work on these measures at a congressional level. What has changed in healthcare finance that you could highlight for us in that same time period?

Alan Morgan: Wow. There’s a lot and you know this personally, that misconception 20 years ago that rural is just a small version of urban. And there is a realization now that it’s really a unique healthcare delivery environment. And with that a recognition that there needs to be new payment policies. How do we pay for health care in a small setting? And for your listeners, I think it’s important to know. You’ve got a population nationwide in these small towns that are most in need for healthcare services, have the fewest options available many times for accessing that health, and many times don’t have the ability to pay for these services. And so, the recognition I see now at a federal level is understanding, okay, we absolutely need to treat rural differently than we do urban. Understanding that’s because we’ve clustered a population with high needs and a low ability to pay and put that burden on these small-town providers.

JJ: Yeah, absolutely.

Rachel: So, comparing that then, to today, how is rural healthcare different now than it was at that time? And I’m imagining there are some positive changes and some negative changes. So, I’d be curious to hear your perspective on what are the good things that are different today and what are the things that were maybe better ten years ago?

Alan Morgan: Yeah, so I’m going to have to start with the bad things, and this is going to sound really bad, so bear with me on this, but nationwide, life expectancy has tremendously dropped in a rural context as opposed to urban. The population is older, sicker in many cases, multiple chronic health issues, obesity, diabetes, hypertension, COPD. And again, these are communities that are clustered together and really attempting to seek care in their local communities. Number one, that’s just an enormous challenge right there. Number two, I think just the decreasing availability of services. You mentioned earlier, JJ, we’re in a hospital closure crisis. Nationwide, we’ve seen more than 140 rural hospitals close in the last decade. What I think most people don’t realize is we’ve also seen over the last decade more than 1000 rural pharmacies close. We’ve seen over 400 nursing homes close during that same period. And so that’s a lot. It’s a huge issue when it comes to decrease the access to care among a community that’s really in need of these services. That being said, wow, today what’s different? I really think you see such great examples of outstanding care being delivered in these rural communities and thinking outside the box, and that’s such a tired phrase, but thinking outside the box of how do we maximize and ensure we’ve got the best care there for our communities? And whether that’s through the utilization of community health workers, in some cases, the implementation of telehealth therapies and linkages between rural hospitals and urban centers to make sure we can continue to provide care there locally for our community members.

JJ: Alan, tremendous amount of rural hospitals are counting on you and your team to advocate for rural health. And when we cannot go to Washington, we had the distinct honor of being able to go to DC. And we had some folks that shepherd us through and helped set up some meetings, and that was great. But not all rural hospitals can or have the ability to do that, and we accept that. And so, we count on organizations like yourself who represent rural health at a national level. So obviously, you are torn in probably 200 different directions. I mean, there is everything from policy development to finance to hospitals, mergers and acquisitions to you name it. I can only imagine. So, I guess the question I have for you, such a demand of rural hospitals across America and such limited resources that you have as an organization, how do you prioritize the work that you do? And then I guess the second question, and I can ask it again, but what is your approach to serving the membership of your organization from a strategic perspective? So first, prioritize your work, and then how does it align with strategic plan?

Alan Morgan: Yeah, that’s a good question. I get that quite often as it’s probably not surprising. First and foremost, the good news is we only focus in on rural. If it doesn’t impact rural, we don’t focus. There are other organizations for that. So that does narrow it somewhat, but not a lot. A primary role for us is to identify all possible solutions and identify obstacles in the way, and that’s an easy way of saying what are the current regulatory and legislative barriers towards providing that are in the way of providing high quality health care services, number one, and then let’s lay out every possible solution to address those. We do that. It’s a menu of everything that can be done to improve rural health, number one. Number two, which gets to your point then, knowing all those options, it really is a matter of just what are the most likely initiatives that we can engage in right now that have the greatest chance of passing, that will have the biggest bang for the buck when it comes to small towns and their hospitals. So just three policies, let me give you three examples. What does that mean? Yeah, I think it’s kind of helpful to take a look at that. Number one, a huge short plate right now is extending telehealth exemptions that were put into place during COVID Huge issue when it comes to helping rural hospitals and helping communities, and this is low hanging fruit. We’re busy lobbying to make sure that we continue to have this availability. That’s easy, number one. Number two, something that we’re working on, it’s really important. It’s kind of in the weeds. It’s what’s known as the 340 B program. It’s discounted pharmaceuticals for rural hospitals and their communities. It’s really a huge issue, a huge impact issue. It’s a complicated issue, but that’s one that even though it’s complicated, it’s difficult, we’re focused in on right now, we’re hopeful, we’ll have success. And then you’ve got the issue where we care a lot about, and that’s a medical malpractice, physician liability issue. But this has been an issue for the full 30 years that I’ve been in DC. And there’s just been no movement on it whatsoever. So, we’re there to provide background information on what that means for rural communities, but we’re not going to spend a lot of resources on the actual boots on the ground lobbying for. There are other organizations that are lobbying on this behalf. And again, at the end of the day, we want to make sure that we’re working on things that have a direct positive outcome, immediate for our members.

JJ: So, Alan, in context of that, could you explain the relationship between your organization and each of the state hospital associations? In many states, I would assume all states, but many states there is a hospital association, and then there’s typically you find some form of rural health association, like the state offices, like the state office. And so obviously they are two very unique, dynamic groups in every state in our union, practically. And now you have to coordinate and work with those, each of them with their own respective goals and needs depending on the respective state. So how does that work? For you? I mean, are you in constant meetings with other CEOs of these associations? And how do you prioritize, I guess, based on their needs, with your strategic plan as an organization?

Alan Morgan: Yeah, that’s something you learn right away when you become a member of the National Rural Health Association. At the federal level, we prioritize collaboration, and at a local community level, you see that every day, I think for delivering high quality healthcare services among small towns, you have to collaborate with other entities in your community. And we do the same every day. I think it’s safe to say every day. I have some form of communication with American Hospital Association, the American Medical Association, the American Public Health Association, and AARP. There’s a lot of communication and collaboration going on at that level. And then, as you mentioned, we also have partnerships at the state level. The state hospital associations are tremendous resources for ours. I believe almost all of them, there probably is one, but almost all of them are members of ours as well too. And it’s just really helpful for them to be able to share real time here’s what we’re seeing at the state level from state issues and then finding out where the intersection is for partnering with them at the federal level. I got to tell you, I love the interaction that we see between many state associations, state rural health associations and state hospital associations. I’ll tell you why. Because you really need to have other entities lobbying on behalf of that hospital. In a rural context, you’re the largest employer and really, you’re the hub that keeps all of the healthcare system together in a community. And being able to have state rural health associations, which includes long term care, public health, many different entities, all lobbying on your behalf, that’s just such a great resource to have. And policy makers want to see the big picture. How does the rural hospital fit into our overall rural community?

Rachel: So, we know that there are probably times, there have to be times where your members have competing interests or competing perspectives on certain issues. One, for example, we take a very clear position on mergers and acquisitions and that we believe the best health care is locally owned, operated and governed. And so, we have concerns about that and concerns about how that affects rural health overall. But there are going to be folks within your association that are rural hospitals that are owned and operated by a large health system or an academic health system or something like that. So maybe not with that example in particular, but how do you, when you have that situation where there is an issue that’s important, but there are competing perspectives on it within the association, do you just say, hands off, we’re not going to touch it? Do you take a neutral position and put out some information or some work on both sides of that issue? Or do you take a stance that might not please one group or another within the association?

Alan Morgan: Yeah. At the end of the day, no pressure, easy question. At the end of the day, it really isn’t rocket science. If it helps rural communities, we support it. If it doesn’t, we don’t. And it’s surprising when you take that approach, how easy everything falls into place. And to your point, affiliation, ownership, I’ve seen great examples of that working, and I’ve seen terrible examples where that’s working. And I think for that in particular, as an organization, can we identify good practices and can we identify not good practices? And I think that’s where we can step in on it. I think that’s a tough one. One of the more difficult ones we deal with is scope of practice as well, too. And how we always deal with that is we believe that if you can demonstrate that a provider can provide high quality health care services safely and effectively, they need to be doing that. And that puts us in opposition to some of the other major trade clinical organizations. Again, at the end of the day, does it help rule or does it not? And following that very easy guideline keeps us on track 90% of the time.

JJ: Well, let me ask you a question. We let’s transition a little bit here. We have a new Congress that is in place, and I think we do we have a speaker of the House yet? I think okay, after version 800, I.

Rachel: Think we but who knows for how long, because isn’t it like one person.

JJ: Can now put this to a vote? Again, it’s going to be interesting, but truly a new Congress, and this is nothing new to you, right? Every two years, every four years. So, you’re dealing with these issues. It’s interesting what has happened in the last election. And I serve on the Michigan Hospital Association Board, and we have to talk about the political dynamics of what we deal with because it really comes back to funding, right? Who holds up her strings and what are the regulatory bodies going to say about scope of practice, practice at the top of their license? Are they going to pass legislation for CRNAs to be independent, you have to have collaborations, all of those things that we deal with. But they’re all politically motivated. They truly are. I mean, we have to accept that. So, it’s going to be a busy time for you in the next two years. We were in DC. Right, when it all went down, literally like days after the midterm, days after the midterm election. And there was a buzz.

Rachel: I talked to somebody the other day, one of our partners in DC who said, yeah, because I was like, man, this has been kind of wild with this whole speaker of the House thing. And she said, yeah, sometimes you get involved in DC and you think it’s going to be like The West Wing and it turns out to be like Veep.

JJ: My favorite episodes of Veep. But when you look at the new Congress, the dynamics are a little unique than historically because you have such a slim majority in both. Right. And what we anticipate is that there’s going to have to be and this is where I want your perspective there’s going to have to be some type of compromise in order for each party, and maybe it’s a good thing. Alan, I don’t know. I just wanted your perspective because you have to push a lot of the agenda to the legislature, and so you have to work with the representatives and the senators to push that and then to a certain extent, the executive branch to make sure that everything is executed, signed, sealed and delivered. So, my question to you is.

Alan Morgan: It’s.

JJ: Going to be interesting and how are you going to navigate, in your mind, your strategic plan for how do you navigate that in this new environment?

Alan Morgan: Yeah, I’m pretty excited with how this all played out, and I’ll tell you why. Yes, if anything happens, it has to be bipartisan, a compromise. I love that personally because and you know this from working with NRHA now, we are nonpartisan. A lot of organizations, they were nonpartisan, they’re not. We are nonpartisan. And we always work. Almost every piece of legislation we introduce has a Republican and a Democratic co-sponsor in some regards. It takes a lot of heat off of us when they have the only way, they’re going to get anything done is in a nonpartisan standpoint. That’s good. Number two, the Senate does remain barely in Democratic control. The House and Republican control. I love the House in Republican control because they’re going to do a lot of oversight. And for us, there are things we would have liked the Biden administration to move forward in the last two years. They haven’t. So, it’s nice to be able to work with our Republican partners in the House now to do oversight and see if we can’t move things along. It’s really about playing with the hand that you’re dealt. And so, I am hopeful and optimistic we’re going to see some movement on some administration initiatives that may not have moved forward, number one. Number two, we’re going to see for whatever does pass, it’s going to be bipartisan in nature, I think. Mike Gut tells me we’re going to see a lot more action on the regulatory standpoint as a result of it.

JJ: Agree.

Alan Morgan: I like that, too.

Alan Morgan: I mentioned earlier, you’ll fight legislative battles for 20 years and not get anywhere. But if you can make changes in the regulatory component, you can have immediate impacts positively on rural communities and rural providers. So, it’s a crazy time, without any doubt. But I like the way it’s shaped up for us.

JJ: Yeah. And I think there’s a lot of great opportunities that hopefully we can push forward the Rural Hospital Closure Act, right? And that was, again, bypass America’s rural hospital.

Rachel: Three or four of them I can’t keep straight. But they’re all like, yes, could be critically important to the long-term future and codifying into law some things that we have to, you know, desperately at the end of every year when they’re working on passing the budget, say, please extend this, please extend this. And some of those things that we could hopefully, when there is not a lot of opportunity for each party to push through legislation that is more controversial that’s something like rural healthcare, that’s not quite as controversial. A lot of stuff we want to do that maybe it will get more oxygen.

JJ: Right. And the other issue is, for us, maybe it’s going to take that to finally move these through. Because I can tell you, Grassley has been talking about this Rule Hospital Closure Act for four or five years, a while. We have met with Wahlberg and he has cosigned and signed on, but maybe we can get that push that we need to take it over. The other issue is, Alan, I think it’s alarming to you because it’s alarming to us. And Scott Becker, when he was on our program not too long ago, talked about the number of hospitals that are at risk for closing in 23, and they’re in the hundreds. And the impact of those closures to our respective small communities for economics, obviously, when you look at what happens when your hospital closes, employment you have then jobs that are lost, then you have the economy in that respective community is basically nonexistent because we are the second, sometimes even the leading employer in those communities. So that is when I contemplate the work that you do, I look at that as probably to me, one of the most important advocacy tools that you have for me is to make sure, how do we keep the Hillsdale Hospitals of America open? And can you talk to us just a little bit about your experience with advocating for ensuring no closures of those rural hospitals?

Alan Morgan: Yeah, I think I hope we’re at a point now, as a nation, we understand the role and the importance of rural hospitals and maintaining that access. Once you shut down a rural hospital, it is incredibly difficult to reopen that facility. In fact, over the last ten years, it’s less than 6% of the rural hospitals that have closed have reopened. You shut it down, they don’t come back. So, we don’t need to get to that point, number one. Number two, to your point, good news is we’re now, in that cycle, ramping up to a presidential election. And the bad news is we’re going to see rural hospital closures in this first quarter. It is going to happen, and the number is going to be significant. The timing, if we’re going to have a bad thing happen, the timing is good because this is this first half of the year, the window, we could potentially see some legislation finally passing to address this in a meaningful way. So, I am incredibly optimistic, as I said, with the makeup of Congress, the fact that we’re in the front end of a presidential cycle, and unfortunately, we’re going to have this wave of rural hospital closures, that this is that time and space where we can finally see some legislation passed on this.

Rachel: So, as we look to the future, what trends are you seeing in the healthcare industry that excite you? And what is the future of rural health care in your mind, maybe both aspirationally and then realistically, right? What would we love to be and what do we think we can become?

Alan Morgan: Yeah. So, I’ll get three items for you now that you mentioned them. Number one, I’m hopeful and I’m optimistic that we’re really going to see telehealth take off from a rule standpoint. And we all say telehealth. I’m not talking about teleradiology or teleconsultation. I’m talking about primary care. A clinician in your facility actually talking to a patient in their home. I mean, that’s the holy Grail. So, I’m hopeful for that, number one. Number two, and I want to get on this again, that we’ll be able to see more facilities, utilize community health workers as a bridge, perhaps, to be able to work with the primary care clinician. How do people find transportation to your facility? How do they know they need to get to the emergency room or not? And being able to have a trusted member of the community help them, I think that’s important. Number three, this gets to where I think we’re seeing and what I’m hopeful will happen going forward, and that is a reimagining of how we actually pay rural hospitals. I would love to see rules. Yes. I would love to see rural hospitals paid and reimbursed and there to keep patients out of their facilities. Right now, if you don’t have heads and beds, you’re not going to make payroll. And we see rural hospitals close. I think that works in an urban setting. It just doesn’t work in a rural setting. It just doesn’t. We need to make sure that you’re receiving payment at the state and federal level to make sure that you’re providing the tools to your community members to keep themselves healthy and out of your emergency room.

JJ: Absolutely. Well, we can we could close in prayer right there because I tell you that is the crux of the issue is that when we look at the volumes requirement for being able to keep our hospital sustained, we do not have the population in rural communities that the rural communities have to support the hospital operations and all their ancillary services. So, we are doing, many times I say this, we’re doing God’s work out here in the country, and we are spending a lot of our time and resources in what we. Call free care or charity care for services such as mental health. And speaking of that, Alan, I’d be remiss if I did not have the President on the podcast with us today who’s advocating for rural health care and did not encourage you to continue the good fight on advocating for mental health services in our rural communities. One of the biggest barriers that we have right now is patients who are just boarded in our emergency department for weeks because there is no access to mental health services in our state. And this is a problem throughout the country, obviously, but here in Michigan, it is a significant challenge to find beds for these patients and to find the adequate care for them in respect to many reasons, mental health services. But also, what plays in tandem with this is we are struggling with ambulance transport services, believe it or not, in rural community. We have patients that are waiting in the Er to be transferred out of here that have significant health care issues and concerns, heart attacks, aneurysms that are waiting for either a bed to open up, and mainly they’re waiting for that ambulance transport. So mental health services again. I’d be remiss if I didn’t have you. And be able to advocate mental health services have to be a priority for rural health as well as some type of support for transport and ambulance. Services to get our patients to tertiary centers and to make sure that they’re going to the highest level of care that they can get to. And then third is advocating for providers to practice at the top of their license. When we look at those three, those three-impact rural health more than anything. When a patient is boarded in my Er for days and weeks, it eats up that room. It eats up the resources of the nurse. We become frustrated. We don’t have law enforcement here. I mean, they’re very sporadic. So, a patient acts up or acts out, it’s on the backs of the nurses and the staff to be able to deal with and to manage that situation. And then the issue of the transport is getting them out. And then the most important for us is looking at providing advanced practice providers in a rural community. We cannot attract physicians to rural communities. You know that, you know, the struggle is real. You’ve advocated for legislation that will help reimburse to the rural communities, and I appreciate that. And the problem is we just cannot recruit. But what we can do is we can provide this advanced practice provider model, which is very effective for us. Rachel, I would say I am employing more advanced practice providers now than I am in total of physicians, because every practice in our outpatient for primary care is staffed with four or five Pas or NPS. And so, each of our other offices, whether It’s orthopedics or OBGYN or surgery, also have apps supported. So, all of that to say while I have you here, is the advocacy for those three areas are significant for rural health. They really are. And I know you’ve been working in each of those areas. Do you want any words about those areas or passion that you have?

Alan Morgan: This is good news for me, bad news for you. You are absolutely right on the mark. What you’re seeing there locally in your community, unfortunately, is what we see is the top three issues across the US. When people ask, what are the top three issues that I’m hearing nationwide? Number one, workforce. Number two, mental health. And number three, surprisingly to me at least, it’s EMS. This last year, it didn’t matter if I was in Washington State, Colorado, Tennessee. EMS and availability always placed within the top three concerns. Five years ago, it was reimbursement, reimbursement, reimbursement. And those still are front and center, but these three issues are now at the top. I love your approach. It’s right on when it comes to workforce and allowing clinical staff to practice to the top. That needs to happen. And I love that because it’s an immediate impact. But I will want to say as a nation, we’re doing this wrong. We pick kids who score the highest on their scores, which oftentimes, almost always urban kids, upper income families, and then we train them in urban areas and then we’re unfounded. They don’t want to work flush Kansas.

JJ: That’s right.

Alan Morgan: We need to be able to let our kids and our communities know, hey, there’s a home for you here. There’s a great career from you here, and you can stay with your friends and family. And that is a message we’re not conveying the way we should.

JJ: Absolutely. I would agree with you on that.

Rachel: And to JJ’s credit and also Seth, our practice administrator who has been on this program before, our director of outpatient services. We actually have two provider, two physicians right now who that is kind of their story. I believe they graduated high school together. They did, right here in Hillsdale County. And now they are both practicing OBGYN with our OBGYN practice.

JJ: Absolutely.

Rachel: We’ve been able to prove out that concept here.

Alan Morgan: I love hearing that. It makes me so frustrated when I hear people say, what’s wrong with rural America? We can’t get people to practice her. Not a darn thing is wrong with rural America. It’s the kids who are getting into the program.

JJ: I agree. I 100% agree with you, Allen. Well, we could spend hours, but believe it or not, our time has come to a close today, and I want to conclude by thanking you and your team. Now, I’m not going to be able to name all your team members, so I don’t want to single any of them out. But we’ve had several on this podcast before, and I’m going to tell you, you are an incredible group to work with. You truly are. You are. My second favorite. My first favorite is the Michigan Hospital Association. Right? But I have to say that because I’m a paid board member. No, I’m not even paid. I’m a board member. Yeah, I do get a free meal every once in a while, box lunch. But beyond that, you are right there on the top of our list as our favorite advocates for rural health, and you’re doing it at a level that’s so important to us at the national level. And we have enjoyed getting to know you and your team, and I just want to thank you. This podcast is listened to across this country by rural hospitals and rural communities. And they also need to know the important role that you play in making our lives better in rural health. And I want them to know. And if you are listening today and you’re not familiar at all with the National Rural Health Association, I’d encourage you Google it. Get an opportunity to see some of the great work that they’re doing in.

Rachel: Power Health US rural Health.

JJ: There you go. And Google that. And if you’re a hospital listening today executive, I would encourage you. If you do not belong to them and you have not engaged in conversation or work groups or participated in their legislative calls, you need to do that. You need to sign up, because they can be a tremendous asset and resource for you. We experienced that, Rachel. When we went to DC, we had a sit down. We had an opportunity to learn about some great opportunities and programs, and then just getting in front of them, I think was so important. I think you would agree with that. So, if you’re listening today as a rural hospital executive and you’re looking for resources, look no further. Alan, you and your team, I want to thank you for the great work that you have done. I want to thank you for joining us today on Rural Health Rising. It’s been great to learn your perspective, and we’re excited about what the future brings. While it’s scary because we’re one of those rural hospitals that is between the critical access and the big system, and these are the hospitals that they tell us we’ll be the ones closing, we’re fighting. We have good days, cash on hand, but we struggle with workforce, we struggle with recruitment. And while our finances are great and we’re bringing new services here never seen before, neurosurgery, ENT, all of those things, it’s still a very scary and challenging time, even as well positioned as we are financially, to consider what the near future could bring with the substantial losses that hospitals are facing. I want to thank you for that contribution, for fighting for hospitals, the tweeners like us, the critical access hospitals, the rural hospital operating in rural America, because you are truly making a difference in the lives of our patients. Because without these hospitals, without ours, patients’ outcomes will be worse. We know that their travel time is longer, which means the outcome for them is going to be worse. We know that. We know that tissue seconds count and time is tissue. And when that patient cannot get to a facility to administer the TPA and to have that life sustaining services rendered, that the outcome is up to and including death. And so, this is why we do it. We do it for the patient. I know that’s why you’re doing it. You are not where you are because it’s something that you just have to do. It’s a passion. And I want to thank you and your team. I know that was an infomercial for your organization, but it’s much needed for what you and your team do. So, thank you for joining us today on Rural Health Rising, and thank you so much for your advocacy.

Alan Morgan: Oh, I really appreciate the opportunity to join you. And it really is our members, just like you, that help our organization have the success that we have today.

JJ: And before we close, we like to do a fun segment with each of our guests. So, Alan, we want to know what is your most unique rule experience or one of your favorite memories that is unique to rural life? And listen, we’ve heard it all. We’ve heard chasing down Amish buggies to cow tip, and you name it. So, what is an experience that you had? And you were from Kansas, right? So, I mean, you’ve got to have some kind of experiences out there. It may not even be specific to healthcare, but just to the rural life. So, someone listening today, maybe in the big city, tell them a little bit about that.

Alan Morgan: All I have is our rule stories on that coming from northeast Kansas. I will say this. I married an urban girl, and so we’ve been happily married for 30 years. So, all these stories are rural stories. And the one that I think still befuddles her is the concept of hand fishing, which hopefully some of your listeners know that is actually going into the river beds and pulling cap with your hands, which once you start trying to describe that to a non-rural person, you realize how incredibly dangerous and insane that is. But it is a uniquely rural experience and part and parcel of who I am.

JJ: So, let me ask you this. Let me follow up on that, because I have lived rural all of my life and we have fished, obviously, but in this particular strategy, you’re putting your arm in the fish, is that correct? We need to know a little bit more because this is becoming a YouTube sensation right now, because my daughter did send it to me on YouTube with some characters trying to do this. So, what’s the key? Do you have bait in your hand? How do you no.

Alan Morgan: So, the key is you walk along the riverbank and you kick until you find a hole, and then you either stick your arm in it or if you’re lucky and it’s a big enough hole, you have your two friends hold you while you stick both legs into it. Once the fish comes out, you grab on and hold on again. I think this is particularly a rural experience. There’s so much you can draw from that.

JJ: Wow. And on that note, Allen, all I can say is thanks for joining us today on Rural Health Rising, and may you have a great fishing expedition in the near future.

Alan Morgan: Never a dull day. Thank you so much. I appreciate the opportunity.

JJ: Next time on Rural Health Rising, we’ll have another great conversation with another great guest, so be sure to tune in.

Rachel: And with that, don’t forget to subscribe wherever you get your podcast. And if you like what you hear, leave us a five-star review on Apple podcasts and tell others why they should listen to your feedback helps more listeners find Rural health Rising.

JJ: And you can now find us on Twitter. I’m at Hillsdale. CEO JJ. Rachel is at rural health Rage, and you can also follow the podcast at rural health pod. Until next time, stay safe, stay healthy, and stay strong.

Rachel: Rural health. Rising is a production of Hillsdale Hospital in Hillsdale, Michigan and a proud member of the Health Podcast network hosted by JJ. Hodshire and Rachel Lott. Audio engineering and original music by Kenji Olsen. For more episodes, interviews, and more information, visit ru