Navigating the evolving healthcare landscape
The healthcare industry is engaged in massive innovation while also having to respond to demanding regulations. That leaves organizations like yours challenged with finding solutions that allow you to provide a revolutionary patient experience and still meet evolving legislative demands.
Rising denials, reimbursement pressure and staffing shortages are making it harder to protect margins and maintain financial stability. Healthcare organizations need greater visibility into revenue cycle performance and support for navigating complex Medicare, Medicaid and commercial payer requirements. Wipfli helps you identify revenue leakage, optimize reimbursement processes and strengthen revenue cycle management so you can improve cash flow and support long-term financial health.
Increasing labor expenses, inflationary pressures and limited reimbursement growth continue to strain healthcare organizations. Leaders are being asked to do more with fewer resources while maintaining quality care and patient outcomes. We take a comprehensive approach to financial and operational performance, helping you improve efficiency and build strategies that support sustainable growth.
Many healthcare organizations struggle with disconnected systems, cybersecurity risks and uncertainty around how to prioritize technology investments. Wipfli combines healthcare industry experience with comprehensive technology services to help you modernize confidently and maximize the value of your technology investments.
Evolving regulations, changing reimbursement models, shifting patient demographics and growing patient expectations are reshaping healthcare at an unprecedented pace. Wipfli provides specialized healthcare advisory services that connect strategy, finance, operations and technology, helping you respond proactively to disruption and position your organization for what’s next.
Explore our healthcare services
Our specialized team of healthcare professionals thoroughly understands the pressures placed on your leadership team. We provide tailored solutions to help you increase market share through partner alignment, embrace new payment structures and leverage technological advancements to gain real-time insights.
Insights for healthcare leaders
ARTICLE
Rural hospital strategy: Maximizing value for your entire network
Rural hospitals are often essential access points, major employers and important parts of a regional delivery network. Yet within a large health system, their financial contribution can be easy to overlook because their total revenue may be smaller than that of a single service line at a tertiary hospital. That is the wrong comparison. The better question is whether the rural hospital is being used strategically. Is the system preserving local access, directing the right care to the right setting and taking advantage of the reimbursement structures available to qualifying rural providers? The answer is not to move services to a rural location simply because reimbursement may be different. It is to evaluate patient need, clinical appropriateness, capacity, compliance and system economics together. Why rural hospitals require a different strategy Rural healthcare operates with lower volume, a higher proportion of patients covered by government programs in many markets, longer travel distances and persistent workforce constraints. Rural communities also vary widely. A frontier hospital, a regional rural referral center and a hospital located near a metropolitan area do not face the same market conditions. Specialist access is one of the clearest differences. When patients must travel long distances for routine specialty care, they may delay treatment or rely on the emergency department. A coordinated outreach, rotating-specialist, or telehealth model can keep appropriate care local while connecting the rural hospital to the broader health system. For the health system, that rural location is more than a small hospital. It is existing infrastructure, a trusted community presence and a platform for primary care, diagnostics, outpatient services, emergency care and referrals. The strategic value comes from using that platform well. Three reimbursement structures that matter for rural hospitals Rural status by itself does not create a single reimbursement model. The relevant payment methodology depends on the provider type, program eligibility, ownership structure, services furnished, payer and state rules. Three programs deserve particular attention. 1. Critical Access Hospital reimbursement A CAH is a specific Medicare provider type, not a general term for every rural hospital. Qualifying hospitals must meet federal requirements that include rural location, distance or necessary-provider criteria, a limit of 25 inpatient beds, 24/7 emergency services and an annual average length-of-stay requirement for acute inpatient care. Medicare generally reimburses CAHs for allowable costs under a cost-based methodology. That can be advantageous in a low-volume environment, but it does not automatically make every service profitable. Leaders still need disciplined cost reporting, service-line analysis, charge capture and an understanding of how shared costs are allocated across the system. 2. Rural Health Clinic payment An RHC is a federally certified outpatient clinic located in a rural, underserved area. RHCs may be independent or provider-based, and Medicare generally pays qualifying visits under an all-inclusive-rate methodology, subject to applicable rules and limits. The key point is not that an RHC receives the full amount charged. Payment depends on the clinic’s status, the service, the payer and current payment rules. Health systems should evaluate where RHC certification is available, whether the provider-based structure is appropriate and whether operations, staffing, billing and documentation support compliance. 3. The 340B Drug Pricing Program The 340B program allows eligible covered entities to purchase outpatient drugs at discounted prices. For qualifying rural hospitals, it can support access and financial sustainability, but participation brings significant eligibility, registration, recordkeeping and program-integrity responsibilities. Health systems should treat 340B as a compliance-intensive program, not simply a margin opportunity. The right approach is to confirm eligibility, maintain strong oversight and monitor federal and manufacturer developments that may affect the program. Where the opportunity is for rural hospitals The most durable opportunity is to match local demand with services that can be delivered safely and efficiently in the rural community. That may include primary care, infusion, imaging, rehabilitation, selected outpatient procedures, behavioral health, specialty clinics or other services supported by the market. This requires a system-level view. Moving every patient to the tertiary center can create travel burdens, increase leakage and underuse rural capacity. Moving a service to a rural site solely for reimbursement can create compliance and operational risk. The goal is a clinically sound network in which each location has a clear role. Bring specialty care closer to the patient A rotating-specialist model can expand access without requiring a full-time specialist at every rural location. It also strengthens the connection between local primary care providers and the health system’s specialty network. In many cases, consultation, diagnostics and follow-up can occur locally, while more complex interventions remain at the tertiary center. Done well, this model can reduce avoidable travel, improve continuity and create a more predictable outpatient pathway. It also helps the system reserve higher-acuity capacity for patients who truly need it. Use telehealth as care infrastructure, not a future windfall Telehealth can extend specialty, behavioral health and follow-up care into rural communities, but reimbursement rules remain service- and site-specific and continue to change. Current Medicare rules for RHC and FQHC distant-site medical telehealth do not simply mirror the RHC all-inclusive rate, while mental health telehealth follows different requirements. For that reason, telehealth should be evaluated first as an access and workforce strategy. The business case should reflect the current billing rules, technology costs, clinical workflow, patient connectivity and the value of keeping care within the system. Any future payment improvement should be treated as upside, not the foundation of the investment. What health systems should do now? Start with a practical, location-by-location review: Define the role of each rural hospital and clinic within the regional continuum of care. Analyze service-line demand, contribution margin, capacity, referral patterns and patient out-migration. Validate CAH, RHC, provider-based and 340B eligibility, operations and compliance. Review cost-reporting practices, cost allocation, charge capture, coding, denials and payer performance. Identify services that can be delivered locally based on community need, clinical appropriateness, staffing and infrastructure. Build specialist outreach and telehealth models around access and continuity, using current reimbursement rules in the financial model. Evaluate rural facilities with measures that reflect their mission and strategic role, including access, network retention, quality, workforce and financial sustainability. A rural hospital should not be dismissed because it will never produce the same total revenue as a large urban medical center. Its value is different. It can preserve access, anchor the local care network, support primary and outpatient care and connect patients to the broader health system. The opportunity is not to chase reimbursement. It is to build a disciplined rural strategy that aligns community need, clinical delivery, reimbursement, infrastructure and long-term sustainability. Health systems that do that well can strengthen both their rural facilities and the system as a whole. Read more Rural healthcare RCM: Let data analytics improve your financial performance 5 reimbursement strategies for rural health clinics The tech infrastructure that can drive your rural health transformation
ARTICLE
How innovation in senior living can be a catalyst for growth and transformation
The senior living sector is at an inflection point, facing numerous challenges that require immediate attention and action. As the landscape evolves, so must the strategies employed by providers. The dissatisfaction with the status quo is palpable, and the need for modernization is more pressing than ever. Senior living providers must embrace change and invest proactively in innovation to thrive in an increasingly competitive environment. Why innovation is critical to senior living businesses The senior living industry is facing constant changes and challenges, including emerging competitors, changing customer demands, a volatile regulatory landscape and a difficult labor market. To remain competitive and meet evolving resident demands, your senior living business must be committed to innovation. Market disruption The senior living industry is undergoing significant transformation driven by various factors, including demographic shifts, evolving consumer expectations and regulatory changes. Providers that remain stagnant risk becoming obsolete as new entrants and innovative models disrupt traditional care paradigms. Demographic trends: The aging population is increasing, leading to a surge in demand for senior living services. Providers must adapt to meet the diverse needs of this growing demographic. Competitive landscape: New players are entering the market, often with fresh ideas and innovative service models that challenge the status quo. Consumer expectations are shifting Today’s seniors are more informed and discerning than previous generations. They expect high-quality services, personalized care and engaging environments. To remain relevant, providers must understand and respond to these evolving expectations. Modern residents seek tailored experiences that cater to their unique preferences and lifestyles. They want facilities that allow for freedom, with modern amenities and comforts. Nobody wants to get stuck in the stereotypical “old person’s home” — they’re looking for a bistro. Technology can play a critical role in modernizing the senior living experience for these discerning residents. With the rise of digital solutions, seniors now expect technology to enhance their living experience, from health monitoring to social engagement. Workforce challenges The senior living sector is grappling with a labor shortage that impacts service delivery. Providers must address workforce challenges by investing in employee training and development, as well as implementing strategies to attract and retain talent. Staffing shortages: High turnover rates and a lack of qualified candidates can hinder service quality. Training and development: Investing in workforce development can improve employee satisfaction and retention, ultimately benefiting residents. Regulatory and reimbursement pressures Navigating the complex regulatory environment is a significant challenge for senior living providers. Changes in policies, particularly around Medicaid and Medicare, can have profound implications for service delivery and financial viability. Organizations must stay abreast of evolving regulations to avoid penalties and ensure quality care and will also need to adapt to changing reimbursement structures to maintain financial stability. Financial vulnerability In an environment of rising costs and increasing competition, financial vulnerability is a pressing concern for many senior living organizations. Providers must adopt strategic financial planning to help ensure sustainability. Cost management: Identifying areas for operational efficiency can help mitigate financial pressures. Investment in innovation: Proactively investing in innovative solutions can drive long-term growth and profitability. Technology’s role in senior living Investing in innovative solutions can enhance operational efficiency, allowing providers to deliver higher-quality care while reducing costs. Implementing a tech stack that fits your operations can free staff to focus on resident care, improve decision-making and optimize operational performance. The right technology for the senior living industry Embracing technology is no longer optional; it is essential for success in the senior living sector. Providers must integrate advanced technologies to enhance service delivery and resident experiences. Artificial intelligence: AI can optimize staffing, improve care coordination and enhance resident engagement. Telehealth solutions: Offering telehealth services can improve access to healthcare for residents, particularly in rural areas. Enterprise resource planning (ERP): Modern ERP systems can facilitate interoperability with your accounting, billing, payroll and planning systems to help your team make informed, strategic decisions. Automation: Automated tools can play a pivotal role in enhancing service delivery within senior living communities. Automating administrative tasks can reduce the burden on staff and improve efficiency. Implementing automated communication tools can also enhance engagement between staff and residents. Data analytics: Leveraging data analytics can empower organizations to make informed decisions that enhance service delivery and operational performance. Data-driven decision-making can help your organization assess effectiveness and identify areas for improvement, as well as gather data on resident preferences and needs that can inform program development and service delivery. Workforce innovation strategies for senior living organizations To navigate the challenges of the modern senior living landscape, organizations must prioritize workforce development and leadership innovation. Some key areas to focus on include: Training programs: Investing in continuous training can equip staff with the skills needed to provide exceptional care. Leadership development: Fostering a culture of innovation and collaboration among leadership can drive organizational success. Middle market opportunities in senior living The middle market represents a significant opportunity for senior living providers. Many older adults do not qualify for subsidized housing but cannot afford luxury options. Technology can go a long way toward bringing down operating expenses, allowing providers to build for an underserved middle market in the senior living space, but more investment needs to be made to fill the gap. Tailored services for middle-income seniors Providers must develop tailored services that address the unique needs of middle-income seniors. Value-based care: Integrating value-based care models can help ensure that seniors receive the support they need while managing costs. Community engagement : Creating community-focused programs can enhance the living experience for middle-income residents. Public-private partnerships: Collaborating with government entities may be a cost-effective way to create affordable housing options without sacrificing quality. How senior living organizations can build a culture of innovation Most senior living organizations would probably say they are committed to innovation. But to actually embed a culture of innovation, your business needs to take the following actions: Embrace change management To successfully implement change, senior living providers must adopt effective change management strategies. Leadership buy-in: Securing buy-in from leadership is crucial for driving organizational change. Stakeholder engagement: Involving staff, residents and families in the change process can foster a sense of ownership and commitment. Develop a long-term vision A clear long-term vision can guide organizations in navigating the complexities of the senior living landscape. Strategic goals: Establishing measurable goals can help track progress and help ensure alignment with organizational objectives. Adaptability: Organizations must remain flexible and open to adjusting their strategies in response to changing market conditions. Fostering creativity and collaboration To thrive in a competitive landscape, senior living providers must cultivate a culture of innovation. Encouraging ideas: Creating an environment where staff feel empowered to share ideas can lead to creative solutions. Cross-department collaboration: Encouraging collaboration across departments can foster a holistic approach to service delivery. Incentive programs: Implementing programs that reward innovative ideas and solutions can encourage staff to think creatively. Celebrating successes: Highlighting successful initiatives can inspire others to pursue innovative approaches. The path forward for senior living providers The senior living sector must embrace change and proactively invest in innovation to navigate the challenges ahead. By understanding the risks of complacency, prioritizing operational efficiency and fostering a culture of innovation, providers can position themselves for success in an increasingly competitive landscape. The future of senior living depends on the willingness to adapt, innovate and prioritize the needs of residents. By implementing these strategies, senior living providers can not only enhance their service delivery but also create a sustainable business model that meets the needs of today’s seniors. The time for change is now, and those who embrace it will lead the way in shaping the future of senior living. Read more 6 strategic planning imperatives for senior living organizations Tax strategies for senior living providers: New ways to maximize savings 5 benefits of data and analytics for senior living facilities
Reach out to our team
Connect with our healthcare specialists to discuss practical strategies for improving operations, managing risk and delivering better outcomes.
LET'S CONNECT
Discover how our experienced healthcare advisors can help you strengthen financial performance and prepare for the future of care delivery.
