Share ThisOur vision is a world where everyone embraces health. In our Remarkable Leadership series, we talk with people who are making that vision a reality by leading the work to create a new system of health, empower our customers and communities, and better support every individual’s health journey.
Across the nation, rural hospitals have been taking on water — and that was before COVID-19 made landfall.
The clinical and operational difficulties that historically affect rural and critical-access hospitals — eroding volumes, aging facilities, workforce shortages, limited capital funds, hard-to-reach patients — were exacerbated by the novel coronavirus pandemic. COVID-19 forced hospitals large and small to temporarily close outpatient facilities and delay elective procedures, suppressing volumes and further destabilizing hospitals that were already at the breaking point.
The result was predictable: In 2020, close to half of the nation’s 2,100 rural hospitals operated in the red, and at least 450 of them are at risk of closing their doors.
AHN Grove City, a rural hospital in western Pennsylvania, was somewhat insulated from the worst effects of COVID-19. Having joined Allegheny Health Network (AHN) at the beginning of 2020, Grove City was now part of a growing hospital system and one of the nation’s largest, most stable health organizations. Resources and clinical programs that wouldn’t have been available to Grove City in 2019 were now a phone call away.
Still, the pandemic would create unprecedented challenges for the 67-bed acute care hospital. Those challenges have carried into 2021, as AHN Grove City — like all other hospitals — continues to adjust to its “new normal” even as it prepares for a post-COVID operating environment.
That was the precarious reality facing David Tupponce, MD, newly appointed president of AHN Grove City Hospital, from his first day on the job, in January 2021.
And that first day, as it turned out, didn’t go exactly as planned.
Dr. David Tupponce, president, AHN Grove City Hospital.
Bill Toland: So tell us about day one.
Dr. David Tupponce: Well, my wife had been feeling under the weather, but she had taken a rapid COVID test, which came back negative. So I decided to come to work on my start date.
I showed up for the very first morning huddle, and while I was in the huddle, I got a text from my wife saying that the follow-up confirmatory test was positive. So I called employee health right away, and they told me, “well, you have to go home now.”
It was a bit awkward — I had been at work for all of an hour when I had to email [AHN President and CEO] Cindy Hundorfean and other executives and tell them, “sorry, but I can’t come into the office for 10 days.” After my own confirmatory test came back, it was also positive. So I had to send Cindy another email, telling her I would be out for another 10 days.
I was completely asymptomatic the entire time, but it was almost three weeks between my start date and when I could actually get into the hospital and start meeting people.
Bill Toland: One of your first big jobs as hospital president was planning and executing the vaccination drives for your region. Did that present any special challenges for AHN Grove City?
Dr. David Tupponce: Like other hospitals, we were asked to absorb this additional mass-vaccination responsibility on top of everything else we were doing. At the time, we were a few weeks out from an electronic-medical-record go-live, so our hospital was crammed full of extra equipment and IT technicians. We just couldn’t do the vaccines at the scale we needed to, given our space limitations.
Obviously, we had to find space that wasn’t in the hospital. And it just so happens that our facilities manager is one of the fire captains in town. So he talked to the other fire captains about holding a drive-through vaccination clinic at the fire hall. One of the perks of being in a smaller town is that you have these built-in relationships with community stakeholders.
For us, the fire hall was a perfect setup. Because it was a drive-through clinic, we didn’t have to worry about seniors getting out of their cars and walking on snow or ice in the middle of February. We could do it at the scale we felt we needed. And pretty soon, AHN Grove City was doing 600 vaccinations a day, which was on par with the larger hospitals in our network.
Once we had our hospital operation in place, we were able to push further into our surrounding community — senior high rises, stand-up clinics, and so on. To date, Grove City has distributed about 20,000 vaccines, which accounts for 60% of the vaccine doses distributed in Mercer County.
Bill Toland: Have your vaccine clinics have been well received in Mercer County?
Dr. David Tupponce: Absolutely. And it feels like we’re doing something big and different. Historically, we’ve been a hospital that has acted locally and focused on Grove City. But the vaccination campaign has really allowed us to stretch.
When AHN Grove City showed up in Sharon — about 30 miles away from our hospital — to do our own 1,000-dose clinic, everyone asked, “Wait, what’s Grove City doing here?”
We are really developing a reputation as a hospital that goes out into the community, and into the county. We’re not constrained by the walls of our hospital or by our traditional geographic boundaries.
Bill Toland: Rural hospitals, especially independent ones, have had a hard time navigating the COVID-19 pandemic. How has being part of AHN helped AHN Grove City to weather the storm?
Dr. David Tupponce: It’s not hard to find stories across the nation about how rural hospitals and critical-access hospitals are really struggling, financially or otherwise. There are a lot of obvious ways that we benefit, of course, from our affiliation with AHN and its parent organization — sharing HR services, sharing supply chain, shared electronic medical records, and so much more. Like any hospital, we are in the midst of this ongoing transition away from a fee-for-service reimbursement model, and toward a population health, outcomes-based model. The goal is to make that transition without financially devastating your organization. And one way to do that is to find partners who can help you cross that chasm from one payment model to another, as painlessly as possible.
Once we get to that other side, we can be very much contributors to the financial and clinical success of AHN. This can’t be a purely one-way relationship, where we have to rely on AHN for our continued survival. We have to also bring value to AHN and the larger enterprise.
Bill Toland: In what ways?
Dr. David Tupponce: For one, just by giving them a presence here between Pittsburgh and Erie. That’s important for all of us.
Within the larger enterprise, there are also some unique opportunities for us to tackle big legacy problems in a small way, on a scale that’s appropriate for Grove City. We can be a kind of living lab for innovations that are being developed elsewhere in the organization. We can scale quickly. We can implement quickly. And for those reasons, Grove City can be a very important part of the Living Health strategy.
One of the things we’re now talking about is how we take some of these ambitious population health programs that we’re developing as an organization and deploy them early on at Grove City. Sometimes it’s easier in a smaller town without a lot of competing programs — you can see the outcomes more clearly and there aren’t as many confounding factors.
You can also get a clearer sightline into some of the social determinants affecting someone’s overall health picture. We’re able to examine problems like mental well-being, food insecurity, education, that might be harder to isolate in a larger, busier hospital.
That doesn’t mean they are necessarily easier to solve — but at least we see the issues more clearly.
Bill Toland: That’s a much bigger role than hospitals are accustomed to, and it may require resources that a lot of rural hospitals may not have. How do we get there?
Dr. David Tupponce: Over time, we may have to restructure the services we provide in our brick-and-mortar building. Care might look much different five years from now than it does today. But as long as we’re fully aligned with the organization, and benefiting the communities we serve, I’m more than good with that.
This can’t be a subsistence model, though. It has to be baked into the care equation, so that hospitals can get by financially — or are rewarded financially — if they are able to keep people out of the emergency room, or keep them out of an inpatient setting.
But at the end of the day, if I don’t have as many people in my hospital, I’m OK with that, because I know that I’m contributing in a bigger way to the health and well-being of this region.
Bill Toland: Aside from size, how do rural hospitals differ from their urban counterparts?
Dr. David Tupponce: In Maine, I helped to lead a larger acute care trauma center that was attached to two critical-care satellite hospitals, about 45 minutes away. And what I learned is that when it comes to a smaller community hospital — and especially at rural or critical-access hospitals — patients rely on their hospitals in totally different ways.
It’s a personal, more intimate type of care. The trick for places like AHN Grove City is tying that personal, intimate feel into the capabilities of a larger health system, in a way that advances care in the communities we serve.
Bill Toland: Has behavioral health access been historically under-addressed in rural areas?
Dr. David Tupponce: Certainly, providing better mental health care and behavioral health care services is one of the many access issues we face. We have the same rates as you might find in an urban area, but access to care can be a challenge in a rural geography.
Bill Toland: Does telemedicine help to address that challenge?
Dr. David Tupponce: A critical part of improving access to care is robust telemedicine capabilities. Not just inpatient, telestroke, or eICU capabilities, but all sorts of outpatient and specialty care.
If your diabetes isn’t well controlled, for example, and your PCP wants you to see a certain endocrinologist — well, it’s really hard to have people drive from here to downtown Pittsburgh to see an endocrinologist. There are so many barriers to that.
So what we want to do is have the patient come to one of our offices, sign in, we take their vitals — just like a normal office visit — and then we set you up in front of a camera and put you in touch with the endocrinologist in Pittsburgh, and have a full video consult with the specialist. And if the patient needs any labs or imaging, it’s right down the hall.
It’s all about breaking down barriers, to ensure that anyone in our community can have regular access to the great specialists that are a part of this network. Capabilities like this will really separate a rural hospital that is part of a larger hospital network from an independent hospital.
Even an independent hospital that is much larger than Grove City won’t have the same access to specialists and educational opportunities as we are going to have.
These capabilities will change how we perceive health care in communities like Grove City, and over time I think it will change the perception that you have to live in the middle of a big city in order to have access to great doctors and great clinical programs.
Bill Toland: Changing the perception for patients is one thing. But how do you attract a high-quality clinical workforce to Grove City Hospital? How do you sell the hospital and the town?
Dr. David Tupponce: Those are two separate questions, but they may have the same answer.
Obviously, hospitals will always have a larger share of on-site workers. Doctors and nurses still have to be on-site. And we recruit them by being an outstanding hospital that’s part of an innovative, mission-driven, people-first health care organization.
I think that will always be attractive to prospective employees.
As for selling the town, as the pandemic has shown, for a lot of us it is possible to decouple the need for people to be close to where they work. So for a place like Grove City, maybe you can now attract people who might otherwise have to live closer to an urban center for their work. It has great health care, great education, it’s a vibrant college town. If I no longer have to live so close to my job, maybe I can telecommute, and wouldn’t it be great to live in an environment like this one?
Either way, whether we’re trying to attract new employees or new people in general, we have to hold up our end of the bargain by providing outstanding health care. We have to be the care hub that Mercer County and surrounding communities have been hungry for.
AHN will help us get there. We’re all pulling together toward a common goal, in partnership with the communities that we care for. We’re growing into something great.
David Tupponce, MD, MMM, FACHE, is the senior vice president of Allegheny Health Network’s Institute Operations.
Dr. Tupponce previously served as AHN Grove City Hospital president, a 67-bed facility in Grove City, Pa. A family practice physician, he was the hospital’s first physician president when he joined in January 2021.
Upon becoming AHN Grove City’s top leader, Dr. Tupponce assumed responsibility for resourcefully and effectively guiding the hospital through the height of the pandemic, balancing the needs of the community with those of the hospital staff and physicians. He expanded the hospital’s physician team, attracted talented specialists and created new programs in fulfillment of a promise made to the community when AHN acquired the hospital in January 2020.
Before returning to Pittsburgh, Dr. Tupponce served as executive vice president of Central Maine Healthcare and president of Central Maine Medical Center in Lewiston, Maine, a 234-bed acute care hospital.
Dr. Tupponce earned his medical degree from George Washington University and a Master of Medical Management from Carnegie Mellon University. He was a family medicine chief resident at UPMC, and his clinical background includes service as a hospitalist and family practice physician.
Before joining Central Maine, Dr. Tupponce was CEO of Tenet Healthcare’s Abrazo Scottsdale Campus, a 120-bed acute-care hospital in central Arizona. Prior to Tenet, Dr. Tupponce was chief medical officer and then chief executive officer of Paradise Valley Hospital, part of Vanguard Health in Phoenix, Arizona.
Dr. Tupponce and his wife, Jaye, have two children.
Highmark Health and its subsidiaries and affiliates comprise a national blended health organization that employs more than 42,000 people and serves millions of Americans across the country.
Entire contents © Highmark Health. All Rights Reserved.
Highmark Health is an independent licensee of the Blue Cross Blue Shield Association.
Need to find info about providers, prescriptions, coverage, claims, ID cards, or health spending or savings accounts? If so, your Highmark member site is the place to go. (It’s separate from this blog.)