After spending the last six years as a Chief Executive Officer in critical access hospitals in Kansas and Nebraska, Clay County Medical Center CEO Austin Gillard has become very aware of the challenges of providing healthcare in rural America. Now that he recently graduated from a year-long fellowship with the National Rural Health Association (NRHA), Gillard has also become more familiar with the political scene behind healthcare discussions on the national level and is becoming more involved in working to influence policy.
The NRHA focuses its efforts on rural healthcare and Gillard said healthcare policy is more of a federal issue than a state issue because the majority of payments to a critical access hospital come from the Medicare program. So this organization spends most of its time focused on the politics involving Medicare and how it might affect rural hospitals. Gillard has been a member of the NRHA for over eight years, but decided to pursue the association’s Rural Health Fellows program last year, since the major building project at CCMC was being wrapped up.
He understands part of making policy is the game of politics that is constantly being played in D.C., and he said he was actually more interested in that part of the effort than policy itself. During his two trips to D.C., he met with all of the Kansas legislators. He said he had already gotten to know them through his work in healthcare, but it was good to meet with them in D.C. and see them in their element.
“I thought it would be good to learn more at the federal level and how things flow with different policies,” said Gillard. “We learned how to meet with legislators and let them know how policies would affect our hospital.”
Gillard’s engagement in the legislative process is timely as struggles in the healthcare industry make headlines across the state. A hospital in Oswego, Kans., closed its doors on Feb. 14 along with two associated clinics. The board of directors for the hospital cited revenue problems and the decision by Kansas legislators not to expand Medicaid. This was the third hospital closing in Kansas in the last three and a half years.
Gillard predicted more hospitals closings would happen around Kansas as the industry struggles with revenue and the legislature refuses to expand KanCare, the state’s Medicaid program.
“More of the patient population is underinsured, cannot afford their deductible, or are uninsured,” said Gillard about why this situation may grow. He is concerned about wages in rural America and whether they’ll keep up with the rest of the nation. “The lack of Medicaid expansion for single parents with only one income, our working poor, or farmers who can’t afford insurance… Medicaid expansion could cover them in most circumstances.”
Financially, CCMC has been doing well but Gillard said he was not confident that would continue in the next 10 or more years. Of the 108 rural hospitals in Kansas, Gillard said 85 percent currently have a negative margin and 70 percent have a negative margin below three percent. It is not sustainable.
“There are a lot of things that will start impacting us,” said Gillard. “Charity care and bad debt continue to increase. Healthcare is not affordable. I’m concerned about Kansas not expanding Medicaid. That would add $500,000 net to our bottom line.”
On top of revenue issues, the lack of confidence in the viability of rural hospitals is causing struggles with recruiting providers. If hospitals can’t recruit providers, revenue also takes a hit. It becomes a sort of death spiral.
To this point, CCMC has avoided these problems. There has been a variety of growth and accomplishments experienced here during Gillard’s tenure, and two new doctors have signed on to practice at Clay Center Family Physicians when they complete their residencies over the next couple years.
This is very fortunate and atypical when considering something he considered eye-opening as part of his fellowship. He met with medical students in Kansas who grew up in small towns who were concerned about moving back to work in their hometown hospitals because they might close.
“We talked to five second-year students from KU Med,” said Gillard. “All were from small towns. Four out of five were nervous to move back home to practice. They didn’t think the hospitals would be open in 5-10 years. That’s concerning, because if physicians don’t go to some of these hospitals, what’s that mean for the future of healthcare in those communities?” For CCMC to have two commitments from young doctors is unusual.
As a progressive, young leader in healthcare in Kansas, Gillard’s presence as CEO of a hospital in a town the size of Clay Center could also be considered unusual. There would easily be room for someone with his capabilities in a much larger hospital system or even in the corporate business world.
But from the start of his administrative career, Gillard was specifically interested in healthcare in a rural setting, having started with a Rural Track Administrative Fellowship. Through the program, he met with over 20 CEO’s in rural hospitals and talked to them about what they did on a daily basis. He recognized there was a lack of proactive young leadership in rural healthcare and he wanted to be able to make a difference.
“On the rural, local level, you can have a larger impact on the community and that fills my soul,” said Gillard. “I wouldn’t be able to see that on a system level in Kansas City. I wouldn’t know the employees. I wouldn’t know the patients by name.”
In a rural hospital, Gillard said he could make a true impact and see the impact, like with the major addition and expansion recently completed at CCMC.
“You can build something and see people get excited about it,” said Gillard. He is seeing this happen in Clay Center and he continues to lead that charge, rather than coasting in his position.
When Gillard started his career in healthcare in 2008, working for a company recruiting physicians for hospitals, he said far too often, he noticed CEO’s at small hospitals in their 50s and 60s who were just placeholders. “Nobody gets behind that,” said Gillard. “You need a cheerleader, with the passion to get things started.
This sort of excitement has been happening since Gillard’s arrival in Clay Center in May, 2015. When he and his wife first starting driving around town, he said he saw a promising community where he could take a role leading the hospital’s progress.
“We went driving around when we got here,” said Gillard. “The city and community seemed to care. They had nice schools, a new pool and the parks impressed us. I had faith we could get something done. I thought it would take time, though. I didn’t think we’d be this far in four years. But I was confident we could do something.”
Already in his tenure here, Gillard helped lead the way to acquire the physicians clinic the first year, got a bond passed in two and finished the major addition and renovation project in three and a half years while arranging the two commitments from future doctors and Clay Center natives Allison Haynes and Eric Anderson for Clay Center Family Physicians. New services have been added under his watch, the specialty clinic has grown to feature 30 specialists and Gillard continues to work on developing a culture of progress and high quality care at CCMC.
Gillard said he will continue to be proactive in his efforts to bring on new physicians and mid-level providers as well as expand the specialty clinic base. There are plans for a new clinic building in Clyde, set for construction this year, and a new clinic building in Riley, which will be a first foray into that community. The hospital will also continue to develop new service lines like the recent new offering of comprehensive wound care at CCMC. “That is all key to our success,” said Gillard.
As for Gillard’s inspiration, it is simple, “I’m inspired by the dedication of our team members to our patients and community. I have seen our team members cry, laugh, hug, and attend funerals of our patients and their family members. The ‘heart’ and ‘love’ shown to our patients inspires me and keeps me pressing on.”