Hillsdale Hospital News

Mini-Sode: National Rural Health Day & RHR’s Anniversary!

In celebration of National Rural Health Day and the two-year anniversary of Rural Health Rising, hosts JJ and Rachel discuss what “The Power of Rural” means to them.


Celebrate National Rural Health Day using #PowerofRural and #NationalRuralHealthDay on social media!



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Audio Engineering & Original Music by Kenji Ulmer




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Rachel: Welcome to another Mini-Sode. Today we are celebrating both National Rural Health Day and the show's two-year anniversary. I'm Rachel Lott.

JJ: And I'm JJ Hodshire.

Rachel: And this is Rural Health Rising. JJ, today is National Rural Health Day, and it is only appropriate that we dedicate some time here on Rural Health Rising to talk about the power of rural. This is the official hashtag for National Rural Health Day, which is organized by the National Organization for State Offices of Rural Health. And it's also the official website Powerofrural.org. So, if you're listening today and you are just realizing that it's natural Rural Health Day and you want to celebrate, go to Powerofruoral.org and you'll find all kinds of great tools and ways to celebrate today. Now, JJ, we talk about the importance of rural healthcare all the time on the show. It's kind of the whole purpose of the show, right? But I want to ask you personally, when you hear the phrase, quote, the power of rural, what do you think of what does that mean to you?

JJ: You are honestly asking me that question today, Rachel on National Exam well, you know what? I can answer that. Probably we'll take another three or four episodes. But truly, the power of rule, we experience it here each and every day. And the 13 years that I've been here at Hillstone Hospital, there's not a day that goes by that I'm not reminded of the work that we do for the patients in this community. And what's so important is that when you look at a demographic like rural America, Hillsdale County, for example, the challenges that we have spoken about time and time again on this podcast, specific to transportation barriers and local economy, etc., is that patients in rural communities struggle to get quality, high level specialty care in their backyard. And so, the power of rule, as you look at it from our perspective, from my perspective, is the availability of providing services such as Neurosurgery, ENT, and the list goes on to communities like Hillsdale and into Branch and into parts of Lenawee County. That's for us. And you can put here, fill in the blank whatever community that is. The power of rule is the reality that we and many of these rural communities are the only hospital that operates in that respective community. Many times. Now, there are some bigger systems around those smaller rural communities, but again, what are the barriers? The barriers are getting patients to that care. So, the power of our hospital is that we're impacting and saving lives every day. Again, there is not a week that goes by in which I'm not hearing a story of how we save someone's life. Whether it was in the emergency department, whether it was up in the critical care unit, it could have been an office referral that saved someone's life, someone was having some type of heart event. And the list goes on and on and I just can't imagine where our communities would be without rural hospitals, because the patient that is experiencing those attacks pains, whether it's a heart issue or a stroke, to drive 45 or 50 minutes away, is life threatening. And so, the power is that we get to take care of those patients locally. And when I think of rural health, I think of how I grew up. I think about the care I received at the Country Doctor that I was able to have until I was about 14, who practiced in our small rural community. It was even much smaller than Hillsdale property. And so, when we look at from a historical perspective of where I was rule, to me, healthcare was that country doctor who I walked into the office and I went to church with his assistant, who also was his LPN, who was also the person answering the phone and who happened to be related to the physician and the care that I received. Those are the things those are the memories that come to me when I think of rule today, when I think of rule, obviously, in my role as CEO, it's quite a bit more diverse. It's not just that rural community, right.

Rachel: Health care has gotten a lot more complex, and rural health has, you know, as well, on some level.

JJ: Absolutely. And I'm going to ask you about that here in just a minute as well, Rachel. But I reflect upon the growth, even from my days of youth, in knowing that the center was affiliated at that time in Camden with the hospital kind of arm’s length away, but really didn't know much about the hospital. System or major components of health care because I received my health care by simply walking down the street into the building that was cochaired by a dentist. And those models are now they're going away in our rural communities. They really are. When hospitals are looking at cutting services, sadly, the services that typically get cut, number one is usually their obstetrics department. Number two is their psychiatric unit, and number three, they begin to look at clinics. And that's a concern because when we look at our clinics, when I say I want to reach each patient in their own backyard, that's what I mean. And the way to do that is you have to have clinics. And that clinic is closed, by the way, that I went to when I was just a youngster. And that community again suffered a significant loss because when the physician left, then shortly thereafter, the dentist left. And then access to health care is stymied and delayed, and individuals to drive to Hillsdale, which is a 20-minute drive from Camden in a small rural town, is very difficult because of the transportation barrier. So, when I think about rural health, I'm going back to those days. Now, we can still operate in the complex model that we are, but I also can never lose focus on the quality care and the close to home care and the accessibility that I have as a youth growing up in a rural community. And when I say rural, Rachel, I don't know if you've driven have you driven through Camden, Michigan?

Rachel: Oh, yeah. I'm kind of weird. I like to take different routes into Hillsdale sometimes. So, like, every couple of months, I'll pick a different route that I like because I just like to drive through different areas of the countryside because it reminds me of Texas, reminds me of home driving through the country. So, there was a while where Camden was on my route, and I drove right through Camden.

JJ: Okay, so you drive through Camden, there's no stoplight there are no stop signs on the main thoroughfare. There's a few on the side streets, obviously heavily populated by the Amish community. And let's just talk about that. So, when I think of rural, I grew up on a road that had Amish all around me. And so that was very natural to me. I mean, I fully understood. It was very interesting. We've had Nicole Mayor on this program before, and Nicole would visit when we were growing up. And Nicole had never experienced Amish because she's from a place called Troy, Michigan, which she had never been outrageous outside of Detroit. When they saw the horse and buggy, they're like, Wait, what is it like, what is this? Is this pilgrimage? No, this is what we live with every day. And so, then we think about that, though, in rural America, where horse and buggy are still the main transportation in these rural communities like Camden, Reeding, Montgomery, those places, and you can insert a name here for any rural community, right? It just doesn't have to be in Hillsdale. And Amish buggies are relevant. And so, for an Amish ride to Hillsdale, well, if the horse can go, let's say 3 miles an hour, which I think that would be like a wee ride, 3 mph, just imagine the time it takes to get to Hillsdale. It is a day's journey back and forth for the Amish population. And then we've seen many times the Amish parked out in our lots, and most of the time they're trying to obtain rides and vans and other things. But the reason I bring up the Amish community is because that is rural. And so, then I thought to myself, all right, how do we impact individuals in their backyard? The way we do that is that we provide services close to home. And we've been very successful at opening clinics such as Reading, which is between Hillsdale and Camden per se, but allows people in those areas to be able to get to a health care provider relatively quickly, even if it has to be a walk and Litchfield and Hillsdale. And as we look at expanding our services out the places that most hospitals are cutting primary care offices and services like that. We're looking at it.

Rachel: I mean, we've seen it. We're serving patient populations in communities nearby areas where we already had a rural health clinic at their clinic in their town, ten minutes away, closed, and now they're coming to us for that care. This is not some story that we are jumping onto. This is the reality of what we're seeing in our community and in other communities across the country.

JJ: Yeah. Rachel and to your point, when those respective communities that we know about, which we don't want to name on here, but you can just again, insert a name, if anyone's listening to this podcast today, think about your small rural communities and think, all right, what systems and businesses and industries and healthcare have out migrated? And so, when you think about healthcare moving, being out of communities, it's a huge risk to those communities. Now, the community I have been working with, unfortunately, their healthcare provider left. It was a hospital-based system. Once they leave, it's very hard to start up the practice again. And here's why. Simply because the cost of doing business today for healthcare is so high, you have to come in with your equipment, facilities, and that has nothing even to do with the real costs, which are staffing and then the challenges we face with finding staff. Rachel, I think we could probably spend a whole episode talking about the great resignation and how it's impacted us. And that the boomerang generation. They talk about that the retirees, you know, five or seven years ago are coming back to work. They're not we're not seeing not yet at least.

Rachel: If you're going to, hey, hurry up.

JJ: Exactly.

Rachel: We could use you.

JJ: Get over here. But what we look at is you start a health facility, whether it's even an urgent care or just a primary care doc. Number one, recruiting to those areas is almost nonexistent. It truly is. I mean, I could start the practice where the other practice left off, but number one, it would cost me a tremendous amount of capital, which hospitals do not have today. Number two, where am I going to find a provider? Let's say I do find the provider. Let's say, for whatever reason, someone is willing to go to rural America into a town that has maybe a gas station and luckily, maybe a party store. And that's about it to set up.

Rachel: For those of you who are not from Michigan, that is a convenience store.

JJ: Yes. Okay.

Rachel: For the rest of the world, as far as I know, yes.

JJ: That's what we call a party store.

Rachel: It's not Party City.

JJ: Good point. Thank you. Rachel so ultimately, when you look at the cost of doing business, it's high. And so, you look at, all right, what economies of scale, you look at it and say, all right, well, if we own a clinic 10 miles down the road, does it really make sense to put a clinic in this community, and then that community suffers. So, the cost of doing business today because of the labor shortage, finding a provider who would actually be willing to come to a rural community and then finding the staff that would staff the facility, all of these are significant challenges. And then the last challenge in most of our rural communities, we know that they are very poor and the population is comprised of government payers. There's no mistake about what we witness here. 70% of our payer mix overall as a health system, not just talking about clinics, but overall health clinic and hospital altogether. 70%. Rachel of our payer mix is a federal government or state government or Medicaid, Medicare, right? And so, government payers pay us at a fraction of what commercial payers pay. And as a result, hospitals and clinics struggle unless they're in some kind of sense or some type of underserved area and can get an uplift from what's called a rural health designation, which again, is a process to go through. It's really.

Rachel: You know, there are a lot of those there are different world health designations. We talked about a lot of them before here on the show. But those individual things don't necessarily solve the problem, right? I mean, they help plug the leak in the boat for a little while, but you've still got something that needs fixed, ultimately.

JJ: Well, absolutely, when you consider Rachel so let's say I want to go into that respective community because we want to provide care close to home. And let's just say that everything lines up. You get the doctor, you get the staff, you are able to afford the equipment, you're able to put the rooms together, you're able to have a beautiful building, a nice parking lot. Then you bring your payers. Then they're all government payers, which means that you're getting a fraction on the dollar. And then you try to get these uplifts. And these uplifts are contingent upon a lot of things. The fact that the patient will go through their annual wellness check, it's contingent upon that. You will have the volume, and you are never going to make up the difference strictly in value. Right. So, it's not you've often heard the phraseology, well, I'll make it up in value. This is an industry where you don't make it up in that value.

Rachel: That's precisely the problem, is the volume.

JJ: Exactly. And so, the reality of it is the payer mix being the government you have to look at as a hospital system like ours, where are we willing to make a community benefit investment? Now, what is community benefit? Rachel well, what that means is, all right, I'm willing to trade the financial losses of that community for the greater good of that community. In other words, I'm willing to take an operating loss. Now, if you were to speak for every clinic, what would you have a.

Rachel: Loss for your whole organization.

JJ: Absolutely right. Absolutely. Your whole organization would suffer. And so, when we as executives make decisions, they're very tough. We want to be in rural communities. We want to be able to have those primary care offices. But they're starting to shift and look a little bit different. Before we talk about the shift of those clinics and what it looks like with providers. I just want to hone in on this point. So, we look at the challenge associated with getting it all set up. So, it's set up, we say, well, its volume, we can get value. Well, when we trade the loss of that, let's just say it's a wellness clinic. Science. Say it's an urgent care, it's a wellness clinic. Let's just say it's a provider office.

Rachel: Primary care, primary care.

JJ: Let's just call it what it is. It's not specialty care. So, we're willing to take the loss and we're willing to eat that loss. Let's say the loss, and it has been in the particular clinic that I'm referring to, is over $400,000 a year for almost the last decade that that hospital system had had losses, that's a $4 million loss. If you were to total it for those twelve years, that's huge. That impacts your day's cash on hand. Now, if you're a big system that can weather storms because you have a very good reserve, that could be seen as a drop in the bucket cost of doing business. But when you get into rural hospitals running clinics, $4 million is a make-or-break proposition. It truly is. And when some rural hospitals have less than 50 days cash on hand, Rachel, that's a no go. And so, what we look at is, all right, I'm going to trade that loss in knowing that that community needs services. And as a result of that, I have to find the revenue from other sources, both inpatient outpatients driving the ancillary. When I say ancillary, that means a physician refers the patient to our diagnostics, Xray, laboratory, specialty care, surgeons, etc. So, when we look at it from that perspective, we can weather some of those losses, but you cannot do that for all your clinics, number one. And you cannot do that over a long period of time. And so, what we have to look at is when we talk about the economies of scale, all right, as I shared earlier, where can we send those patients? Now, let's say that the patients are unable to get to another location. Even if it's seven to 10 miles down the road, then it is my duty and responsibility as the president of this hospital in my mind, and not all CEO think this way. To make sure that there's access points for everyone in our community, I firmly believe that that is my mission, to make sure that we have access points. Now, what that could look like is a little different. It doesn't mean in everybody's backyard we place a clinic. What that means is maybe what we do, as I have when I was able to reach out to the Department of labor to get a grant that provides transportation, right, those type of innovative steps that hospitals have to take. And so, what does rule mean to me has changed since when I was a young boy to where it is today. It's still rural, obviously, but how that looks is a little different. It may not be serviced in that small respective community, but it may be in the communities next door. And so, the cost of doing business in that particular community, we have to look at it as a business proposition. And if we're willing to lose, is it going to be a loss that we can sustain long term? And that is the question of the day. Today, all hospitals are asking us, and you and I both know that we've had Scott Becker on this podcast and he has shared with us that hundreds and hundreds of hospitals are at risk of closing over the next few years. And that is because they're looking at dire situations like this in which you do not have primary care in those respective communities and you're not driving your ancillaries yet. If you have primary care in those communities, you're going to have a significant loss. How do you do that when you have no operating cash? It is a major problem right now for health care. So, I know that was a rant, I know that was a long way around. I do want to touch on another point, but I want to ask you a question first. So, the point I want to touch on after I ask you a question is the point of how do you have those clinics in and how do you contain your costs? What I want to talk about is the development of advanced practice providers. But before we do that, I want to ask you the question. When you hear the word rural health, what does it mean to you? You have been in a rural health center before. What does it mean to you and what does rural health mean in general?

Rachel: Well, when I think about rural health, I think about rural Americans and rural America. And when I think about that phrase, the power of rural, it reminds me how important it is to advocate for rural health. And also, it reminds me how frustrated I sometimes get when I see a lack of concern or even a dismissive attitude toward rural health care. Because whether you're in a large hospital system and you are sitting in a leadership position and you have rural hospitals, but they're far away from your office and from where you work, when you don't give that the same. Weight in the same importance as the care that you're providing in urban communities and also when you don't have the same level of respect for rural health and for what we do in rural health. What that tells me is that you just don't care about rural Americans, and maybe you are in a government position, maybe you're a legislator, maybe you have some leadership in that regard. If you don't care about rural health and you're not willing to prioritize it, you don't care about rural Americans, period. There's no way around that. And so today, being National Rural Health Day, we were just in Washington, DC. A couple days ago doing some advocacy on behalf of rural health because it is so important if roughly one in five, one in six Americans lives in a rural community. We have to care as a nation and as a society and also as a health care industry. Again, it's like we rural shouldn't be this carve out like, oh, look at those cute little people trying to run their little rural hospitals.

JJ: Right. And you've experienced that gravy.

Rachel: I know you have. I have too. And it's appalling sometimes, its infuriating other times, but health care, yeah.

JJ: The situation that happened to me is I had someone ask me, I don't know, it's probably a couple of months ago, it's after you release that I was appointed to the Michigan Hospital Association mission Health and Hospital Association Board of Trustees. I had actually a very well-respected friend, government leader approached me and said, how did you get a seat at the big kids table?

Rachel: Oh my gosh, yeah.

JJ: What? How did you get a seat's table? In other words, that is some of the mentality out there. That rule is just like your rule.

Rachel: And whether that individual had that perspective or they were using the language of people who themselves have that perspective in a tongue and cheek way, it's still to your point, it illustrates the attitude that is out there sometimes about your health. We really do.

JJ: We struggle with it, and especially when we go to conferences or events and we explain it like, oh, so your critical access. No, we're a rule hospital. Hospital a system, a hospital system with lots of folks that are practicing specialty care and full continuum of care. And then you explain it to them, and it's like, well, wait a minute.

Rachel: And they're like, oh, who are you?

JJ: What system do you belong to? No, we're independent on our own. So, then you are a critical access? No, I'm not a critical access. I just don't understand and they don't the reality of these hospitals like ours, small rule, independent, non for profits that have operated we've been around for over 100 years. Rachel right. And they don't see that because it's uncommon. And so, it's one and I didn't need to interrupt you, but this is just a point that I think we have to raise. We're oftentimes just like, oh, your rural health, but think about where do rural health patients, you know, they're not getting their high-end care here. We have to have affiliations and partnerships with big systems. They shouldn't big systems should not treat us in that manner. They should look at us like a very good feeder and a very good partner to them. Instead, they treat us very poorly. And I'm just going to be very honest, we're very easily discarded and information sharing does not slowdown in attempt on their part because they do not see us as really competitive in the market. Well, at the end of the day, yeah, I'm not going to be doing hard surgeries, but that's where the affiliation relationship and this is where big health system should see their relationship with us that would be very beneficial to them. But again, to your point, just that feeling of we're not grownups, we do not have a voice in going to DC and lobbying Congress and congressional members for healthcare in general. Not anything specific to Hillsborough, just rural healthcare in general. Right. I think that's a noble cause. I think that what we're seeing right now in the statistics and demographics presented to us by as I indicated earlier, folks like Scott Becker, is that if we do not resolve this issue of hospital closure right now in America and we forecast that hundreds of additional hospitals closed. Rachel the devastating impact to those communities are just you cannot comprehend it because they will lose their economic engines, they will lose one of their largest employers, and everything else from auto sales to grocery stores will suffer. And so, this concept that being small is an embarrassment or being a small rural hospital isn't good is really such a devastating blow to every one of my staff and providers who come to work every day and work very hard to make sure that we're providing care to what some would maybe go, oh, well, we don't serve that population. Excuse me, that is our patient base.

Rachel: Or if they do, it's a small population. And it's like, well, look at how generous we are.

JJ: Oh yeah, it's like, oh, pats on the back. I didn't mean to catch off. But I just wanted to accentuate that issue that I've personally faced with this idea of looking down upon rule. They should be looking up and saying, you know what, thank you for the referrals that you're sending to our respective hospitals. Thank you for building a partnership through a joint venture or through a referral and sending your patients who need advanced care to our hospitals. And all along Hillsdale is taking care of their blood, resulting their Xray’s, their general surgeries orthopedic surgeries. But that high, high, high-end stuff, brain surgeries, heart surgeries, those type of things that we would never even contemplate doing here is something that they pick up which has a far greater reimbursement than what they would get from 20 or 30 of my blood draws. Right. So that is they just haven't learned the lesson yet. I've said it before, right? It's like the dog that runs after the car. Once they get the car, they're like, what do I do with it? I don't know what to do with it. And it's what happens right now in our industry. Big health is chasing us. We get emails, calls, mergers and acquisitions. This group, that group, they're all sharks in the water. Every one of them. Every one of those groups are sharks in the water and they are simply profiting off of the sale of a hospital. They don't care about those respective communities. They don't care about the economic engine of that county or community. They don't care about health care. They care about brokering the deal and getting their millions and millions of dollars to broker that deal. That's all they care about. When I see those deals occur and the brokerage of those deals, community suffer. These people fat cats get their pockets lined up and they're marching themselves off to islands and exotic vacations while the community members are suffering because they do not have health care. It's absolutely wrong. There should be caps set on any company that can try to sell a hospital to another hospital. That's for another podcast. But at the end of the day, we've got to stay ultra-focused on keeping rural hospitals viable. And that's the work you and I have been doing, right?

Rachel: Well, and don't apologize because as soon as I get on a soapbox, believe me, there's plenty of room for whoever else wants to join me. And you are welcome to get on it with me. But, you know, yeah. So, I think to your point, the power of rural is that there is an entire population of people in America who rely on rural health care for their life and also for their quality of life. And so, if this, you know, if we don't figure out how to solve the rural issue, we're going to have a real problem on our hands and another 10, 15, 20 years, maybe even five years based on what's going on right now with the industry.

JJ: Absolutely.

Rachel: But if we're already seeing difficulty in the larger systems right now, having capacity and overflowing, what would happen if all the rural hospitals around them within an hour or 2 hours’ drive close? Well, then anyone that is able to drive to those locations, are they even going to be able to access that care? And then they're just dealing with more and more of a backlog and more and more people boarding in their emergency departments and more and more staff leaving because of higher levels of burnout. So, it'll become a self-fulfilling prophecy. If rural healthcare, for whatever reason, were to implode, that would be the basically straw that breaks the camel's back for the entire industry, in my opinion. And that to me is the power of rural, is that if you don't have rural health care, the entire healthcare industry in this country will crumble.

JJ: And.

Rachel: I just don't think people recognize that because it's out of sight, out of mind, right. But for the patients we see every day, walking into our hospital, walking into our Er, walking into our Obstetrics unit, it's not out of sight, out of mind. It's right here and it's our community. So that the power of rural is what we do and what our staff do truly, every day very well. So, with that very new, let's segue real quick into, because we don't have a whole lot of time left. But today is also the two-year anniversary of rural health rising, if you can believe it, because we started on National Rural Health Day back in 2020, in the midst of the pandemic.

JJ: What were we thinking, Rachel, what were we thinking is the question. What were we thinking? Well, we were thinking about how do you get information out to communities about the major pandemic that was our first priority and the focus, but then transition quickly into how do you accentuate the role of rural health? And that's what we're thinking now. It's been a lot of work, mainly for, you know, seriously, creating every dialogue, reaching out to prospective presenters and speakers, tremendous amount of time on creating the script, putting the original footage together. You were doing it all by yourself before we had an audio engineer, you were doing it all?

Rachel: No, I used him from the beginning. I did all the editing and still do for our video segments. We started with Kenji because I was not about to try and do this by myself. Can you imagine how horrible it would be?

JJ: Well, I mean, it would have been very rough, but I do remember the first recording in which we were going to try to do it ourselves, and that's when you're like, oh, no, we were going to help. We're going to have some help here. And we agreed we've got to find somebody. It worked out that you had a friend etc. For but truly the impact and I forget you an email last week from a CFO of a hospital system in the country who is listening to our podcast that said I want to connect with my CEO with you. So, you can talk to us about how do you save real health, basically, how are you controlling your margin and those type of things. So, we know where there's that story, there's many others of people telling us how it's impacting and changing lives by giving this great awareness. And truly, the speakers that we've had on here, Rachel, and presenters ranging from the national, state and even local level, they've been great. I mean, I can't there's not an episode where I go, ugh, that was awful, or, you know, oh, man, that was a challenge to get through. Seriously, everyone has been, I feel like.

Rachel: Most of the time, and you always laugh at me about this when I was like, oh, I think that was my favorite episode. And you're like you said that last week.

JJ: That's pretty much all before and the week before, but they're so good and the people that we bring in are experts in their field. The conversation naturally flows. And we're touching on such a variety of issues that are impacting not just rural healthcare, but healthcare in general. But it impacts rural the most because we often find ourselves with lower cash on hand, access to staff is not readily available. We can't offer $50,000 sign on bonuses. So, the struggles real for us and other rural hospitals that pick up this podcast realize, you know what, we're right there with you, and what we're trying to do is give them examples of how to make it work. Not that we're experts in that area, but we've had some success. And it's through partnerships. Whether we bring on the local economic development, the statewide party for the Michigan Home and Hospital Association, whether we bring together national congressional leaders to interview and talk about the issues facing rural, we have been able to really get out into the mix and into the podcast land. The idea that rural health has to be saved in America or communities will die, and we can name those communities off. Right now. You can go to a Baker's Health report and you can see which hospitals are closing this week or that are affiliating or being sold.

Rachel: Yeah, and I believe just last week or the week before, Becker put out the updated list from there's actually a specific organization entity that compiles that list, and Becker’s reports it out. But those numbers have just recently been updated and they're not really encouraging at all. But I want to ask you, JJ, what has been either like most surprising or most unexpected to you about the process of creating and building up this podcast from when we started to where we are now?

JJ: Well, I never thought that it would be recognized at the level it has been across the whole healthcare continuum and throughout, really, this country. As we are raising awareness, I thought, wow, maybe we would do four or five or ten of these, talk about pandemic, get the information out, but then it just, wow. Next thing we know, we're buying some nice equipment, we're getting some donations for a new studio, and we're really finding that there is a need to be advocates. And so, we're filling that gap. And I'll tell you, it's a lot of work for you. It's a ton of work for you. More work for you than it is me. But it's still work. I mean, it's the interviews, the time spent, the prep, while at the same time we're doing our other ten duties. And so, we're not doing this because we like to hear ourselves talk. We can just sit around the office and do that.

Rachel: I like to talk. I don't have to hear myself talk.

JJ: I can just talk. I can just talk. And the fact that we have sponsors now for the program, that really shocked me and surprised me, really did, when we got our first hey, can we sponsor when we got our first advertiser, really? And so, I think that was eye opening for me. And then I'll opening for me was just getting a few emails early on about those who had picked up the podcast. They weren't even in Michigan. That said, I really was moved by that presenter or by your presentation. And Rachel's, on this particular issue, I'll tell you, I think our Mini-Sodes oftentimes get more traction and I get more comments of those than I do maybe a national guest and maybe it's just me, but I just seem to get a little bit more of that. And so that's been eye opening for me. And just the availability to operate in this space of rural health, I think it's just been an awesome, powerful experience.

Rachel: And you know something I want to say directly to our listeners if you're listening to this right now, and you are in rural health, if you are in rural business, if you are in rural government, if you're in rural nonprofits. Whatever you do if you work in rural America and are making an impact in a rural community in some way, and what you do has a relationship, even indirectly, to health care. We want to talk to you. We really want to have folks on this show who are experts in what they do, but who are also the boots on the ground in the rural communities. You guys have heard we've had quite a mix of different types of guests on the show, but we are always looking for people who are passionate about what they do, are passionate about rural America and rural health care who want to join us and have a conversation with us. So, if that's you please reach out to us, you can email marketing at Hillsdale Hospital.com, you can tweet us at Hillsdale CEO JJ or at Rural Health Rage or Rural Health Pod. And we would love to connect with you and potentially have a conversation here on the show. Because I think, JJ, to your point of being surprised about the traction that the mini sews tend to have, I think it's because a lot of our listeners relate to the rural healthcare executive who's in it every day. And I think that's part of why, because they hear you talking and they're living the same life you're living as a CEO or as an executive in a rural community in rural healthcare. And there's some solidarity in that. So, to continue that trend, if you're also someone who works in rural, please reach out to us, because I imagine our listeners would also benefit from a conversation, we can have with you on our show as well. And with that, happy National Rural Health Day. Happy two-year anniversary. Rural Health rising. And we will see you all back for a regular episode next week.

JJ: 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 podcast and tell others why they should listen to your feedback helps more listeners find Rule Health Rising. You can also find us now on Twitter. I'm at Hillsdale CEO JJ. Rachel's at rule health rage and you can also follow our podcast at rule 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 Omar. For more episodes, interviews and more information, visit ruralhealthrising.com.