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Practice area · Rural Emergency Care

A rural hospital’s future is an emergency care question.

Strategy and governance for rural hospitals, and for the systems, associations and sponsors that stand behind them.

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The decision is being made by the wrong discipline

More than four in ten rural hospitals lose money on patient care, and Tennessee has a higher share of hospitals at risk of closing than any state in the country. Boards are being asked to decide what their hospital can still be — keep the beds, convert to a Rural Emergency Hospital, affiliate, or close — and the advice they get is financial and regulatory.

Those answers matter, but they are not the question. The question is what the community needs the building to do at two in the morning, and whether the hospital can deliver that safely and sustainably. That is an emergency medicine operating question, and only about a third of the hospitals that model a conversion find that it pays. The ones that get the decision right start with the operating answer.

What we do

Page III Partners brings an operator’s answer to the decision, runs the emergency department review that the financial model cannot, and stays through the transition — so the board votes on what the hospital will actually be, not on a spreadsheet.

01 · Decision
REH decision analysis
The financial model under REH, critical access or PPS status; the service lines kept, lost and stood up; community access; workforce; and a board-ready recommendation that frames the vote as an operating decision. Four to six weeks.
02 · Operations
Rural ED operating review
Coverage model and the physician and advanced-practice standards behind it, tele-emergency, transfer agreements and the receiving network, EMS integration, throughput and quality — reviewed by someone who has run rural emergency departments at scale. Standalone, or inside the decision analysis.
03 · Transition
Conversion and transition
For hospitals that vote yes: the twelve-month operating plan. Services sunset and stood up, the staffing model, the transfer network, medical-staff and community communication, and the compliance milestones. Project leadership or interim leadership, depending on the team in place.
04 · Contracts
Affiliation and contract advisory
System affiliation, management agreements, and the physician services contracts a rural hospital lives and dies by — and what the other side of the table is solving for. Short engagements, often triggered by the decision analysis.
05 · Education
Governing the Rural Hospital
For trustees and executives: what a rural hospital is for now, how to read its numbers, why the emergency department is the hospital, the REH decision, affiliation, governance at this scale, and workforce. A board session, a trustee workshop, or a full-day retreat for one hospital or a cohort.
Who it is for

The people who have to decide what the hospital will be.

Health systems with rural affiliates and the executives who oversee them
Rural and critical access hospital boards and their CEOs
Sponsors, lenders and investors with rural hospitals in the portfolio
State hospital associations and offices of rural health
Counties, authorities and foundations that own or fund a rural hospital
Why Page III

He ran emergency medicine across the largest hospital system in the country.

Robert R. Page III, MD, MBA, spent his clinical career in emergency medicine and went on to lead a national physician services platform and serve as chief medical officer for hospital-based services at one of the country’s largest health systems — 180+ hospitals and 200+ freestanding emergency departments across 19 states, including critical access and rural EDs. He has staffed, governed and renegotiated the emergency department contracts that rural hospitals depend on.

The advice a rural board usually gets is about reimbursement. His is about what the emergency department has to do, what it takes to do it, and whether the hospital can — and that is the answer the vote depends on.

Full biography →
Start here

The board session.

Ninety minutes with your board or leadership team on what the Rural Emergency Hospital decision actually turns on, what your emergency department has to be able to do, and the questions to settle before anyone votes. No charge, and a frank read on where you stand.

Request the board session

Or reach us directly: robert@pageiiipartners.com

Other practice areas
I
Physician Services & Clinical Operations
Operating judgment for physician services platforms, health systems and their investors.
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II
Duty of Care
Medical governance for organizations that send staff, students and volunteers into the field.
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Page III Partners · Nashville, Tennessee
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