Counter-Intuitive Consulting for Rural Hospitals

Counter-Intuitive Consulting for Rural Hospitals

According to Becker’s Hospital CFO Report of May 22, 2023, the Center for Healthcare Quality & Payment Reform reported that there are 646 rural hospitals at risk of closure due to financial shortfalls. This is 30% of all rural US hospitals. Far more hospitals under $100MM in net patient revenues face risk of service closures or severe reductions.

Conventional consulting components such as: analysis, assessment, collaboration, comprehensiveness, customization, evaluation, focused research, goal setting, in-depth exploration, “no pain, no gain," opportunities identification, etc., etc., have not been adequate to the task of reducing existential risk for rural independent hospitals. And that’s putting it mildly. 

Rural hospitals have endured many consecutive years of negative ops margins no matter which or how many of the above components of the conventional consulting menu they have implemented. Yet, how can you argue against these “tried and true” approaches? Is there anything better and more effective or counter-intuitive?

Briefly, these conventional components are too expensive, too time-consuming, too risky and unproven, despite many decades of use and misuse. These components require experienced/expert staff not internally available in sufficient numbers in and for today’s rural hospitals.

For example:

  • Analysis and Assessment for rural hospitals lead to “analysis paralysis”, when speed and dollar-directed implementation is immediately necessary. 
  • Goal Setting and Evaluation already has a clear immediate goal: Convert negative ops margins to positive margins. Evaluation is only to reach that goal of positive margins and is thus unnecessary. In other words, stop analyzing, assessing, evaluating and goal setting. Instead, start growing cash.
  • In-Depth Exploration is not needed. The answers are on the surface.  You don’t need to dig deep for higher dollar results.  
  • No Pain, No Gain is not wanted or needed in any form. You do need proven-in-practice, easy-to-implement solutions, not pain. Pain doesn’t translate into gain.
  • Research and Comprehensiveness both cause delay. Days delayed = dollars delayed, and eventually dollars denied. Avoid the perils of comprehensiveness by applying the 80-20 rule. 20% of the solutions solve 80% of the problems. Be quick, nimble and effective, not comprehensive.
  • Customization: Don’t forget, while all rural hospitals are different, their similarities are far greater than their differences. Take advantage of their similarities to use proven-in-practice solutions for rural hospitals, successfully creating high dollar results, faster. Don’t experiment with customization on your rural hospital. Use what works and has a history of working, moving from red to black. 

Overcome the chronic emergency of rural hospital negative ops margins. Move beyond conventional, questionable consulting components. Convert a vicious cycle into a new virtuous circle, by using these top 8 counter-intuitive Success Practices for rural hospitals:

  1. Go External: Use external-to-the-hospital consultants. 
  2. No Work: External consultants do 95% of the work faster, better cheaper, not the hospital. 
  3. No Time: Don’t use valuable hospital time
  4. Always Affordable: Always demand zero up-front fees and zero out-of-pocket fees.
  5. 100% Zero Risk: Your hospital dollar is never at risk.
  6. Proven-in-Practice Solutions: Use these solutions only and always with no exceptions.
  7. Countable/Accountable Net Dollar Results: Have no doubts about the dollars. Always require new, net countable dollars
  8. No Pain, Yes Gain: See the above 7 components.

To learn more about ourMargin Solutionsand how we can help your organization, please reach out to:

Richard Kunnes, MD- rkunnes(at) 

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