Managing a rural hospital is no easy task. The American Hospital Association (AHA) has reported that rural hospitals represented 71% of the decline in the number of U.S. community hospitals between 2017 and 2021.a
Rural hospitals’ susceptibility to financial instability is a consequence of a number of disadvantages they suffer compared with their urban counterparts. Chief among these disadvantages are:
- Staffing shortages due to low population
- Lack of size, which can limit negotiating power with payers and vendors
- Difficulty in recruiting clinical providers
These realities are all too familiar to Jana Cook, MBA, CPA, senior vice president and CFO of Phelps Health in Rolla, Mo. In dealing with these challenges, Cook has assumed a place in the forefront among rural hospital finance executives who are achieving success in their efforts to maintain and grow their organizations. Undaunted even by COVID-19, Phelps Health, a 240-bed county-owned healthcare system, was able to grow during the pandemic, providing more clinical services to a growing population in the region.
Rolla is located about 100 miles from the Missouri population centers of St. Louis, Springfield and Columbia, or as Cook jokingly says, “we are in the middle of everything.” That proximity gives Rolla’s residents some access to larger hospitals in those cities. But that assurance is not enough for leaders at Phelps Health. They are determined that the residents of Rolla and its surrounding counties have vital 24/7 access to advanced care. And Cook is charged with ensuring that the health system maintains financial viability to make that happen.
“It is an imperative that we remain independent as a county hospital so that we can make our own decisions in regard to how we deliver care to our patients,” Cook said.
A focus on cost-effective health
Meeting that imperative has required a readiness to pursue extraordinary measures, including recent participation in a groundbreaking Missouri Medicaid primary care case management model called Transformation of Rural Community Health (ToRCH) designed to improve health outcomes while reducing costs.b
Phelps Health is one of six rural hospitals selected in July 2023 in the first cohort of the model.
ToRCH funding will enable the hospital to act as a central community “hub,” bringing together partners to implement strategies that address community needs around social determinants of health (SDoH).
The model creates incentives for participants to achieve goals for enhancing population health within the served community offering shared savings for reducing the following:
- Avoidable hospitalization rates, including readmissions, at participating hospitals
- Avoidable emergency department use at participating hospitals
- Overall hospital utilization for all Medicaid recipients in the served community, irrespective of where the hospitalizations occur
Regarding Phelps Health’s participation in the program, Cook said, “I am certain that ToRCH will bring about much needed positive change in rural healthcare operations and financing. It is exciting to be able to work with these other rural providers, understand their needs as well as ours, and hope to change outcomes for the better in the future.”
Cook also urged her colleagues in healthcare finance leadership to take a lesson from Phelps Health’s participation in the ToRCH model.
“The industry is moving really fast,” Cook said. “If we don’t keep moving forward, we will be left behind. Between current issues of AI, consumerism and cybersecurity threats, there are so many challenges to work through and overcome. But it has been so rewarding, seeing the hospital, the community and the finance team make its way forward through by confronting all the internal and external issues that have presented themselves.”
The benefit of building a career in one place
Cook is somewhat of an anomaly in that she has spent her entire career at Phelps Health, starting with an entry-level position as payroll specialist. Along the way, she was able to make use of the hospital’s tuition reimbursement program to obtain an MBA degree.
“Five years in payroll, led to five years as a financial analyst, which in turn led to five years as controller,” she said.
After that it was a quick rise to administrative director of finance and, ultimately, to CFO in 2016.
Favorite HFMA memory
Cook has been involved with the Greater Heartland Chapter of HFMA for more than 10 years. She was the Chapter President in 2022-23 and is on tap to be the Region 8 Regional Executive in a couple of years. Of the many people in HFMA she has met over the years, many have become lifelong friends. She is a huge University of Nebraska volleyball fan, and at this year’s Region 8 conference, she was able to meet John Cook, the volleyball coach.
“I now have a volleyball signed by him sitting in my office,” she said.
Footnotes
a. AHA, “Fast facts: U.S. rural hospitals,” 2023; rural hospitals are defined as those not located within a metropolitan area designated by the U.S. Office of Management and Budget and the Census Bureau.
b. For details about ToRCH, see The Missouri Department of Social Services, “Transformation of Rural Community Health (ToRCH)” (mydss.mo.gov/mhd/ToRCH); page accessed Oct. 9, 2024.
5 leadership tips from Jana Cook
Jana Cook, MBA, CPA, senior vice president and CFO of Phelps Health in Rolla, Mo., offered the following five pieces of advice for her peers in healthcare financial management.
1 Take care of yourself. “Don’t let yourself get burned out,” Cook said. “That means growing your knowledge, through professional and personal experience. HFMA has helped me with this by providing an outlet for educational and networking growth.”
2 Build and invest in your team. “Helping my team members grow through mentoring, delegating and giving them leadership opportunities has given them chances for advanced knowledge and upward movement,” Cook said.
3 Build relationships across the organization. Having a strong connection with other system leaders, especially clinical leaders like the chief nursing officer, helps further a finance leader’s understanding of the entire operation, Cook said, noting that this knowledge can be used when crafting short-term and long-term financial plans.
4 Set a strong vision for the finance team and organization “We use a two-year goal-setting structure, where we set goals and continually monitor the results,” Cook said. “Because things are changing so fast in the healthcare industry, we check in and adapt the goals, as necessary, based on new facts as they emerge.”
