Transcript
CHAD MULVANY
On today's episode of “Achieving Health,” I'll be joined by special guest JJ Hodshire, CEO of Hillsdale Hospital and host of the “Rural Health Today” podcast. JJ and I will discuss the outlook for rural healthcare and the issues facing the industry in 2026. It's a great conversation. Stay tuned.
ANNOUNCER
This is “Achieving Health,” a podcast from Forvis Mazars, where we delve into the topics that matter most to healthcare organizations across the continuum of care. Our goal is to help you navigate the dynamic healthcare landscape and achieve health at your organization. Here's your host, Chad Mulvany.
CHAD MULVANY
Welcome to “Achieving Health.” I'm Chad Mulvaney, director in the Healthcare Practice at Forvis Mazars. Thank you for joining me. For today's episode, we have a special guest, JJ Hodshire. JJ is president and CEO of Hillsdale Hospital, a rural, community-based hospital serving south central Lower Michigan. He's also the host of “Rural Health Today,” a fantastic podcast about healthcare challenges, successes, and opportunities across rural America.
And JJ, I gotta tell you, I'm incredibly impressed just by the fact that one, your day job is running a hospital or helping a team run a hospital and then off the side of your desk somehow, or another, you find a way to host an incredibly great conversation around the issues in rural healthcare. So, like how you manage to balance all that is just incredibly impressive, as I said. And I just want to welcome you to the show and glad to have you here.
You know, it's great to be here on your series, because we interviewed you on “Rural Health Today” and we had a great conversation, but I really feel it's critically important, where we are currently in the state of rural healthcare, to elevate our voices. And as we lift our voices individually, we come together collectively to try to save our rural hospitals across the country.
JJ HODSHIRE
And so, this one mechanism, what you're doing is another way that we get the word out to our respective communities across the country, to share our message. So, it's, I would say, as much as it's the most challenging of times, it's also the greatest times for advocacy for us in rural health.
CHAD MULVANY
I would agree, and I do think that, you know, the “Rural Health Today” podcast is a great vehicle for highlighting those issues, talking about where we can possibly make change with some help from regulation, some help from legislation, whether it be at the state or federal level, and just how to make changes that positively impact the way care is delivered, how access is achieved, and costs.
So, I really do appreciate it. And just, as you alluded to, for those listeners who don't know, I joined JJ on “Rural Health Today” a couple of weeks ago to talk about the current regulatory landscape and what it means for rural providers. You know, it was a great conversation; I enjoyed it. I hope everybody will give it a listen and enjoy it as much as I did taking part in it.
So, with that, JJ again, want to thank you for the opportunity to join your show. And also thank you for joining us here over on “Achieving Health” to continue this great conversation.
JJ HODSHIRE
Absolutely. I look forward to it. We're going to have a great discussion about some of the challenges facing our rural hospitals.
CHAD MULVANY
Absolutely. And maybe we can start at the beginning. Can you start by telling your listeners a little bit about yourself and how you came to healthcare?
JJ HODSHIRE
Sure. Well, I'm actually a newcomer, believe it or not. 16 years ago, I arrived on scene here at Hillsdale Hospital as a director of organizational and business development and then moved up through the ranks to chief operating officer and six years ago appointed as the chief executive and president.
Prior to that, I did have hospital experience, having served on the board. Our local board, we have a board that's comprised of Membership Corporation, 50 members, that really guides and picks their board seats from that respective board that meets annually. And had some introduction way back when about healthcare. And, you know, every year I would sit through those meetings going, wow, this is some complex, tough stuff that I'm just the assistant sheriff of the county, which I was at the time, just knocking, you know, down doors and arresting bad people.
But, prior to coming to Hillsdale Hospital, I did spend 10 years in county government, chief law enforcement-appointed executive of the county. Prior to that, served in the court system, where I was chief of staff for the circuit court. And then, believe it or not, I am old enough, prior to that, I was a school superintendent of a Christian school here in our community, the only United Brethren school in the country at the time, in fact. So, I've had a diverse background of administration.
Whether, you know, it's in the administration of schools, courts, police departments, or hospitals, it's working with people. It is building relationships. It's about engagement. And most importantly, it's about advocacy, in every one of those areas. And I've spent a great deal of my lifetime in advocacy, both at the federal and the state level and in county government at the local level, obviously.
But everything we do, everything that's local, is impacted by what the state's doing or what the federal government's doing. So, I'm having the time of my life, I would say out of all my careers, this is the best job I've held.
CHAD MULVANY
You know, it's funny, as you were sort of talking about your background, the thing that popped into my mind is, wow, you know, for someone who is relatively new to healthcare, you couldn't have picked a better set of experiences, kind of helping to sort of educate and manage diverse stakeholders to drive to an outcome, to create change, to create positive change. And probably occasionally the ability to kick in a door also maybe helps you around the hospital.
JJ HODSHIRE
It does. Yeah, it does a little bit. Every once in a while, some of those instincts come back. But you're right. You know, I firmly believe in a phrase from the Bible for such a time as this. And it's a story about how a people and a generation were saved. I believe we are all called with a specific purpose.
I believe in purpose. I believe in passion. And I firmly believe for such a time as this that we're facing in our country is that I've been called to this ministry, and I look at it from that lens, and it truly is a ministry. And, to your point, you know, coming in stock market crashes, you know, shortly after I arrive here, then we have, you know, a lot of challenges with reimbursement, then we have, you know, the great pandemic. And then now we have what Congress is doing and scaling back programs and funding.
So, yeah, it's been a wild time. It really has. But I wouldn't trade it. A lot of great things that are happening too. We’re saving a lot of lives, making significant impact in our community.
CHAD MULVANY
You know, the thing about the being mission driven and the impact on the community is the thing that I come back to time and time again with guests. That's the through line with all of our guests. And certainly, you know, I think the reason why we're all in this is we can see very directly what we do and how it improves people's health, people's ability to lead meaningful lives. And so, I think that's just really it's pretty easy to wake up in the morning, look in the mirror and understand why you're going to do what you're going to do for the next eight, 10, 12, how many ever hours a day you're working.
JJ HODSHIRE
That's absolutely correct.
CHAD MULVANY
You know, it's interesting. You've talked about all of the challenges that we’ve faced over the course of your career, and they are certainly formidable when you think back on them. From your perspective, what are the biggest forces that will impact rural hospitals and healthcare providers over the next five years?
JJ HODSHIRE
So, I'm going to challenge us to, you know, before I answer that, I want to talk about what we're facing across the country right now. Since 2010, over 150 hospitals in this country have closed. Just a few weeks ago, my friend Scott Becker, who we've had on my podcast many years, many times, and I've been a guest of his speaking at his conferences, actually just came out with some research. 734 hospitals are at risk of closing.
Now, he based, you know, that summary report off of some work that's been done by other third parties. But at the end of the day, he's elevating the awareness. What we know right now across this country is that within the span of the next five years, we're going to see a significant outmigration of rural health into urban areas.
And, the challenge with that is that those areas are not able to take the volume that we're going to have to send them when our rural hospitals close. So, knowing that, understanding that we're facing the significant challenge of closures at a rate we've never experienced before, we're called to action. Now, before we talk about slowing down that speed of closure, we first have to talk about, to your point, some of the issues that are of the day.
And I would tell you that some of the biggest challenges and the biggest forces we face right now are in the area of reimbursement; how hospitals are getting paid. And we're under significant scrutiny. Let's first talk about as it relates to rural health. You know, I don't have negotiating power. I don't sit down with Blue Cross Blue Shield, I don't tell them how much they're going to pay me. I have no negotiating power.
We talk about hospitals as price takers, right? I'm given what is given. And that's it. There is no negotiation. The federal government is a prime example. 72% of my payer mix is Medicaid and Medicare. I don't get to sit down with Medicaid and Medicare and say, you're going to pay me X. It's what they pay us. A percentage, you know, of Medicaid, a percentage of Medicare, etc.
And so, our only margin can really be made in the area of commercial insurance. But commercial insurance begins to evaporate when your community loses business and loses credible coverage for their covered lives. A company that goes out, and we've experienced that in Hillsdale and we experience it across the country, rural areas and rural settings, typically you'll find your hospital is the largest or second-largest employer. And that's not always healthy.
I say that when I speak to individuals, we need to make sure that we build our economic development, you know, program around bringing business and industry to communities so that way they have health insurance that can support our hospital. And so we've watched that reversal; industries, businesses close, and hospitals begin to evaporate.
And that is only accelerated by what's happening in the world of payment. As we look at insurance companies in the small, the very small percentage of commercial that we do have is that payers are now requiring us to go through so much to get paid. You look in the backroom functions of hospitals today, and the time we spent, and will spend, with physician peer-to-peer conversations and interviews and all of the billing and on the front end, getting the authorizations done and then not meeting that authorization.
The surgery gets done and you don't get reimbursed. All of these, what we call administrative burdens, that is a significant challenge for us. Now, let's not forget, on top of all of that, we're experiencing Congress getting involved in healthcare, you know, mandating how much we can get paid from programs such as Medicaid and Medicare, specifically Medicaid.
Many states expanded their Medicaid to what's called the average commercial rate, where we would receive a percentage of Medicare. And that helped hospitals sustain through some of the roughest times. But now, under the One Big Beautiful Bill, the challenge that we face is going to be the scale back of those ACRs. And what's going to happen is you're going to have hospitals that are going to be posting millions and millions of dollars in losses to take care of that population.
Now, why rural communities are going to suffer the most is because we find in rural communities, they're the poorest among us. We find that there's a high incident rate disproportionate to commercial insurance with Medicaid and Medicare. It's a population that gets older so they're getting on Medicare. It's a population that's not growing in a lot of our rural communities because you don't have a lot of that industry and you don't have a lot of that economic development.
So, as a result of that, our rural communities are getting hit hard with the realization that with the scale back of the average commercial rate, we're going to lose millions of dollars, but yet we still have to take care of that patient panel. How are they going to do it? And then this is where we get into the conversation of the tough decisions we have to make.
Do you shut down your obstetrics unit because it's a cost? OBs are a strict cost in rural health. Do you shut down your psychiatric unit? We have both today. I cannot say that I'm always going to have both. It depends on what happens, when this really comes to fruition by 2032, in terms of the One Big Beautiful Bill. If we scale back just from Hillsdale alone, it's $6 million that we're going to lose. That's well beyond any profit margin we've ever held here at Hillsdale Hospital. So, those are the challenges.
And then, you've got this whole issue of recruitment and retention that's heavy on my mind. How do we find a generation of providers who want to come to rural America, where 72% of your payer mix is the government and many of our primary care docs are saying, you know what, we can't do it anymore? Buy us out or we're retiring. We do not find new providers that come to Hillsdale saying, we want to start our own independent practice. They're coming in saying we want to be employed. We don't want to be on call, we want to be paid at the 50th percentile, we’ll work for an RVU.
And we have all these challenges. But how do you do that with a payer mix that continues to take more and more away from us? Those, I would say, are some of the most significant challenges and the biggest factors we're facing right now as we try to save rural healthcare.
CHAD MULVANY
You know, there are so many threads here that I want to pull. So, just going to kind of like run through them quickly. One, you know, the assumption that when the rural hospital closes or is downsized, even beyond whether or not there's access in the nearest adjacent suburban or urban community for people to go get care, you're assuming that the individual that lives in that rural community has reliable transportation to get there.
And like when you look at the Rural Health Transformation Program applications across the states, one of the common themes across most of them is funding for transportation. So, that would suggest to me that reliable transportation isn't there, even within the rural community, much less to go to a community 20-30 miles away.
So, I think the other part on the closure that really keeps me concerned, and you touched on it, right: no one's going to put a business in a community that doesn't have a hospital. How are you going to attract a workforce? I wouldn't move my family somewhere where there wasn't, particularly if I was young and my wife and I were planning on having children. Not going to do that. So, the moment that hospital goes, you've pretty much limited the economic growth prospects for that community.
You know, you also touched on being a price taker from your payers, but you're also a price taker from your suppliers.
JJ HODSHIRE
Absolutely.
CHAD MULVANY
I mean, you don't have leverage.
JJ HODSHIRE
None.
CHAD MULVANY
Even with GPO participation, your leverage isn't great with drugs and devices. To your point about physicians and other providers, to get them to come to a rural community, there is essentially a subsidy that you're going to have to provide, and they're not going to be sustainable given the payer mix. And typically also, when you think about, the RVUs and the way they're set up in rural areas, those RVUs, even with the floor, aren't adjusted to make the payment commiserate with what you're having to pay to support them.
JJ HODSHIRE
Absolutely.
CHAD MULVANY
So, I mean, there are all kinds of policy issues here that, you know, make it an uphill struggle for rural providers and sort of disadvantaged urban areas. I guess we've talked about the challenges. What advice would you give other executives, your peers who are navigating this set of somewhat daunting items?
JJ HODSHIRE
You know, it's going to sound very simple, but I'm going to give a charge to your listeners. It's stand up, step up, and speak up, because this is what we need right now, because our fight is not just dealing with the labor market. Our fight is not dealing with talent pipeline. Those are all challenges that will we'll all have to collectively try to resolve.
But the issue becomes the involvement that state and federal governments have had on healthcare right now is I've never seen it this tumultuous. I will tell you that I think the greatest advice I could give, and I would encourage our listeners, you know, if you're a rural hospital today listening to this, is that you need to contact your state representatives.
You need to contact your congressional leaders. This is a fight that is happening right now in Washington and in your respective state capitals. It really is. There's very little we can do when they take away the tax credits. Tax credit removal under the market, is going to create some uncompensated care. It's going to create bad debt.
We'll talk about how that impacts it, but that's a congressional decision to do that. When they cap how much we can get paid, even though prices and supplies are skyrocketing and labor costs are exponentially increasing month-over-month, we're not talking year-over-year, your listeners have to understand, we're in an industry today where my competitor will say, I'm giving a $50,000 sign-on bonus. And if that doesn't work, Hillsdale then will try to raise it to 50.
Then they're going to raise it to 75. And now all of a sudden we're competing for a very limited number. And that speaks to the issue of not having a talent pipeline ready. That speaks to the issue of the physician shortage areas. That speaks to the issue that when we scale back reimbursements for loans for providers, which is being done, who wants to go in this industry?
I was just speaking to a physician this morning. She told me she has $520,000 in debt to get here. $520,000. It's unimaginable as you think about these challenges, but these are things that are happening in Congress. They shut down this program, they shut down this one, they scale back this program. We have, we're still expected to deliver services, notwithstanding the fact that we have an infrastructure that's crumbling in many of our rural hospitals. We're blessed because we've invested in ours.
But look beyond that. Look at your infrastructure for even technology. There's remote parts of my community we don't even have cell phone coverage. So, we have to talk about what Congress is prioritizing and how we can get it back into our local economies.
What that means is, people argue with me, well, you'll just have telemedicine. Really? In remote areas that have no connectivity? How are we going to do that? Well, they can just drive to the tertiary center 50 miles away. To your point, there's no transportation. How are they going to accomplish that? So, what I would say is when we stand up, we step out, and we step up to the plate and we say, you know what?
We're going to be advocates and champions. And part of it is just advocacy, making sure that your elected officials and your representatives know where we stand on this because it is so important what one decision, at the state or the federal level, how it can dismantle healthcare for generations to come to receive that great care.
I've watched many hospitals close. Most recently, hospitals are shuttering their services such as obstetrics. The impact to me now, when a hospital just did that 26 miles away and they did it, is now I take on that population. Now if the government comes in, which they are by 2028, and are saying we're going to scale back how much we pay you for Medicaid, now we're delivering services that cost more than we get for reimbursement. You can only do that so long before your hospital doors close completely. So, there has to be some advocacy that's being done.
CHAD MULVANY
And to your point about advocacy, you know, you named two services that are at risk, psych and OB, and the common thread across both of those is it's a heavy Medicaid mix and with psych, Medicare.
JJ HODSHIRE
It is.
CHAD MULVANY
And so, I think to just really double-click on the need to start having conversations with policymakers at all levels. And it's something that we talked about on “Rural Health Today,” I think it’s historically, and from my perspective as a former hospital association employee, people are hesitant to go in and explicitly say, look, this is what the pro forma looks like in our organization. Here's where we're losing money. We know these services are necessary, but we can't sustain them and the rest of the organization.
JJ HODSHIRE
Correct.
CHAD MULVANY
So, unless something changes, we're going to have to make some tough decisions that will impact access to needed services in our community.
JJ HODSHIRE
Absolutely correct. And think about this. So, we count on these programs for downstream revenue as well. When you go into your OB, you need, you know, sonography. You need to make sure that you have, you know, radiology on staff. You need to make sure that you have laboratory ready to serve this population.
Now, when one service line goes away, the impact to the organization is beyond just that service line going away. But let's talk about the service line going away. When I cut obstetrics because Medicaid can't cover the cost of delivering service, I'm cutting it for the commercial insurance payers as well. It's not just eliminating for Medicaid. So, it means everyone. Everyone feels that shuttering of the service.
Then you talk about, okay, how are we going to try to revive a program. You're not. Once a program shutters you don't restart it. Now you have to think about what happens now downhill. Well, now in the E.R., you're going to be delivering babies. So, you have physicians in the E.R. who are saying I'm not delivering babies. So, now you have a recruitment issue.
This is the very terrible thing that happens when we look at having to look at program closures. But we have to look at it. We have to be realistic. What are the community needs assessments when we do those across our hospital systems, what are the top priorities for our communities?
What do I see all the time? Psych services, obstetric services, right? But they are the most costly. And when you've cut your staff to the bone and we have here as many rural hospitals have, how do you prop up those programs? The only way that you can prop those programs up is reliance on government funding to help supplant those costs and to supplement those. And when that doesn't exist, you have to cut the cost.
CHAD MULVANY
You know, we've talked about the challenges. We've talked about some of the responses. Where do you see areas to collaborate with other providers or entities to address some of these challenges, or take advantage of some of the opportunities?
JJ HODSHIRE
So, I would say that I often tell people that, yes, Hillsdale’s, you know, we're independent, we're a 501(c)3 independent hospital, but we're interdependent. What that means is I can't do this alone. There's no way that I can be an island. I'm not putting sandbags up around the hospital. We believe in our independence for many reasons. The autonomy we have to make the decisions that we need to make. I can make decisions in real time. I just did this morning. I implemented something that's already been put into effect. We have that flexibility. But I would say the opportunity is to build alliances. So, let's talk about it.
Let's talk about it from the pricing standpoint. Alliances in a GPO. As simple as that. All right. You can save money. You can potentially negotiate better contracts. But then we start talking about alliances for tertiary centers. Where are we going to prioritize our stroke care? We don't have a cath lab here. Who are we going to partner with to have a cath lab? Those conversations have to occur. So, that's why you can't be, you know, putting, sandbags around your hospital and trying to, you know, keep everyone from coming in. Build partnerships and alliances—still maintain your independence—with centers of excellence and care for those serious, whether it's heart, whether it's stroke, whether whatever it is, cancer services, where you know you can't serve that population.
And we've tried it. You know, we've started oncology programs. People aren't waking up in the morning saying, I want to go to Hillsdale for my cancer services. They're not. They want to go to a center, a teaching university. A hospital setting where they're, you know, there's great research going on, and I get that. But what can we do to maintain a relationship with one of those centers?
And we do it. So, we bring a PET trailer in every week to make sure that we can service that population so they don't have to travel. We have an infusion center to take care of them. But high-level surgical intervention? That occurs because of a relationship that we have with a tertiary center, that's how we're going to do it. It's going to be building alliances, and understanding that we can be independent, but we have to be interdependent.
CHAD MULVANY
And I think that's a great answer. And I think the right answer, and it's sort of figuring out how you build that network of what you do internally yourself. And then where do you find partners to help with other things that you may not have the volume to do at a high level? And so, I think that's the right balance.
You know, with the Rural Health Transformation Program, there's been a lot of talk about innovation in rural care delivery. So, kind of building off of that, what innovations do you think hold the most promise for rural hospitals over the next five years, whether it's improving some aspect of care delivery or, and we talked about earlier, reducing administrative burden?
JJ HODSHIRE
Well, we're trying to do both every day, right? I mean, that is, I think what's been heavy on the minds of all of my predecessors is how do you get to equilibrium with your local hospitals where, you know, you're not going to spend more than you make? And that's a very tough proposition today, especially with all the things we've already talked about. So, I won't get into that.
But, you know, it was about 15 years ago I was sitting in Chicago, Illinois, and I had just been here at the hospital for a year, and I listened to a Becker's presenter, and I started to hear about this concept of social determinants of health. And I thought, oh, this is just another, you know, acronym that hospitals use.
And I didn't understand what was really at play here until a few years later that I realized that what we're looking at, you know, systemically when we look at an individual's health. What are the social determinants that impact their health and their wellness, whether it's physical health or mental health, and their environment, their surroundings, right? So, we as healthcare officials, have had to change our approach.
And now when you come into a primary care clinic, some of the first questions we ask you, do you have food on your table? Were you able to pay your rent in the last month? Were your lights ever shut off in the last 30 days? Have you had any major incident since your last visit here?
Having those types of questions, were you able to meet all of your bills? I never understood the value of that 15 years ago, but I so much understand the value of that now, and I bring that up as a point. You know, we talk about innovation, but let's just start with the basics. You know, before we get to innovation, we have to talk about the true social determinants of someone's health. Making sure that we, as hospitals, as communities, are solving some of the food insecurity issues. That were resolving some of the issues of access. Access not only to primary care, but access to behavioral health.
Because if an individual is properly medicated, they will function highly in society. But once they go off their meds because they can't afford it or they're trading that that for food, then we find them in our E.R.s waiting for weeks and days and outbursts and behaviors. And when I was in law enforcement, we'd respond to those people. But when we look at the social determinants of health, we can use that as an example of how we're fixing some problems. Right?
We're addressing systemic issues in communities. We're finding better ways to have food sourcing. We're finding better ways to try to find individuals housing. And we're addressing those issues. Now, when we start talking about innovation and technology and some of those things for healthcare. Well, I mean, we're always asking our questions, how can we do this better?
That should be one of the questions. It's the five whys we ask, right? Why are we doing it that way? But why? And we get to the bottom of it, and we find that maybe processes are old and we could be doing things a little bit better. EMR has taught us how we can reduce, you know, times and how we can just ensure that the physician isn't spending all their time charting. We call it pajama time now; how do you reduce that? Ambient listening, you know, removing some of the barriers to care. Those are all great things.
But we talk about innovation. We start talking about, all right, we've got this thing called AI, right? It's scary. We all don't know what it is. We're learning it in healthcare. But let's start with the application of AI for just billing and scrubbing bills and looking at some algorithms in our billing procedures. You could potentially clean up and have a decent margin at your hospital, because if you follow the algorithm, how should we have got paid? Why didn't we drop that code? That code should have been dropped. That's great technology.
AI is not going to be at the bedside taking care of patients. We have to recognize that. So, putting it within the scope of how do we do our jobs better? I think we have to leverage technology. There are things right now where we're measuring. I was just at an event last week in Detroit, and it was a group of healthcare leaders talking about some of the challenges of healthcare.
One of the issues that we got into was innovation. One of the hospitals in Detroit, it's a Henry Ford Hospital, is putting equipment in rooms, technology in rooms where it's observing the respiration of a patient. And it's for patients who are fall risks. And it will detect movement, and when it detects movement, that's going to result in hyper, in other words, hyperactivity of the patient where they're getting up with excited utterance and they're starting to move.
It will alert the front desk that the patient who's a fall risk is actually at risk of getting up. We stop the fall from occurring. Now, that helps us in many areas. Number one, if an 87-year-old patient stands up on their own and falls and breaks a hip, what happens to them? They die. We know that; there's no other outcome. So, if we can prevent an avoidable fall, we do that.
Second of all, it helps the hospitals because if you can avoid that fall, you also avoid a potential lawsuit. So, innovation can have all of these applications that could help our hospitals long-term. And some of the challenges that we face using technology to determine rhythms, and to determine when there's abnormalities in our patients’ rhythms or whatever it is that we're utilizing and deploying the technology.
I think we're going to see more of that into the future. But how does it have to come? You can't afford it. So, there's going to have to be a priority by Congress and state legislatures to prioritize technology, to help the workflow, to help the patients at the bedside, to get rid of that administrative burden that we're facing with billing and dropping codes.
If we can use AI to leverage that and not have 15 people in the background dropping a bill, and that can be done, I'm all for it. But we have to buy the technology and we have to invest in the technology. Rural hospitals do not have the funds to do that right now, but we need it more than ever.
So, we have to lobby our congressional leaders and funding sources to get that done. Payers have to look at us differently. I think our costs are a lot lower in healthcare in rural America. They are. We don't have that high overhead. We generally, if you look at the numbers, we have some better healthcare outcomes.
And so, let's leverage that when we negotiate with payers. Why are payers only sitting down at the table with the big health systems? Why don't they see the intrinsic value that rural health brings to prevent the cost of the higher care that would happen if your lower cost hospitals, like rural hospitals, were to close. It's going to shift that cost. Patients are not going to get the care they need immediately. They're going to wait longer. You're going have a higher cost of care. So, deploying all of those is just a small percentage of how you leverage innovation, in my opinion.
CHAD MULVANY
You know, what I liked about, I liked all the examples, but what I really liked about the fall example and the monitoring technology is if you think about nurses and their scarcity, that takes something off of their plate that they don't have to continually monitor and frees them up to do other work.
JJ HODSHIRE
Absolutely.
CHAD MULVANY
And so, that takes stress off of them, it improves their work environment, it makes them feel more comfortable that they're not going to miss Mr. or Mrs. Jones getting up and falling. And so, gives them peace of mind and enables them to do their job better. So, I really do like that example. I think the last question I want to ask you, just given your deep experience and leading across a number of different settings, what advice would you give someone who is moving into an executive role for the first time in 2026?
JJ HODSHIRE
It is of the most difficult times in our industry, in healthcare. And maybe every generation has said that; I'm not sure. But I can tell you in the short span of my career that these are very difficult, difficult times. I would say what's critically important, because there's so much coming at us, especially in rural health, and many times the CEO is truly doing the job of five or six positions or roles, is we need to ensure that we properly step away from our everyday grind and make sure that we have balance in our life. I would find that there's spiritual balance. There's physical balance. You know, we have our mental well-being.
And I bring that up because just recently in our community, we had a provider who committed suicide. And it was tough to go to the E.R. that day. And the comments that I heard, from the people that he worked with to his supervising physician, were, man, we never saw this coming. People are hurting.
The advice I'd give to a leader is we can compartmentalize this stuff so much, and we can put this burden on our shoulder, and we take it home, and we might try to shake it off, but we can never really do that.
Incrementalize your time at work. Understand the importance of balancing your life with your spiritual, your mental, your physical health to make sure that we can keep you around for a very long time to fight this very tumultuous fight that we have in the most difficult of times. And the way to do that is to balance yourself. I would just encourage it. Talk to, don't be afraid to talk to someone.
Don't be afraid to, you know, go to your church service. Lean on your pastor, lean on your psychiatrist, lean on your psychologist, whatever it is that you have in your life, just to lean on those people. But to compartmentalize the things that we do each and every day. And don't let it eat your life.
CHAD MULVANY
Well, JJ, first, I'm very sorry for your loss, your community's loss. That is not, that's a horrible thing.
JJ HODSHIRE
It is.
CHAD MULVANY
And I think that's great advice. That point, balance. Don't be afraid to ask for help, right? Like we're all carrying a lot and there's no shame in it. There's none whatsoever.
JJ HODSHIRE
None.
CHAD MULVANY
Well, JJ, thank you for joining us. It's always great to talk with you. I enjoyed the conversation immensely and certainly looking forward to the next opportunity.
JJ HODSHIRE
Well, we're going to have plenty of opportunities. We got you coming back on the podcast for several episodes. So, I'm excited. And I really thank you for elevating this discussion, you know, across the country. And I would encourage your listeners to please, if you don't subscribe regularly, subscribe to the show, because it's very important to get this message out to our communities.
CHAD MULVANY
Absolutely. And certainly for those in the “Achieving Health” universe that aren't listening to “Rural Health Today,” certainly strongly recommend it. It's another great one to add to the playlist.
Well, again, I want to thank JJ for his time and the conversation. It was certainly a great discussion. I also want to thank our listeners for tuning in and following “Achieving Health” wherever you listen to podcasts.
If you want to learn more about the topics we discuss here, be sure to check out the show notes for related content and information about how to get in touch with me and the team at Forvis Mazars. We'll also have a link for you to check out the “Rural Health Today” podcast, and my episode with JJ from a few weeks ago.
I hope you'll join me next time on “Achieving Health” for our regular “Washington Watch” updates on Wednesday, March 4th. Until then, here's wishing good health for you and the communities you serve.
ANNOUNCER
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The information set forth in this podcast contains the analysis and conclusions of the panelists based upon his, her, or their research and analysis of industry information and legal authorities. Such analysis and conclusions should not be deemed opinions or conclusions by Forvis Mazars or the panelists as to any individual situation as situations are fact specific.
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