How a rural Ohio health system is absorbing OBBBA’s impact

Linda Stevenson has a passion for advocacy, and it’s good thing, because rural healthcare organizations like Fisher-Titus Health, where she serves as CIO and COO, face mounting struggles. 

In addition to the “usual” challenge of having to do more with smaller margins than their larger and urban-based counterparts, rural facilities now must contend with decreased Medicare reimbursements and rising software costs. 

“We have to do the hard work, but we don’t have the same resources,” she said.  

Given the shifting landscape, it has become more critical than ever for CIOs to become their own advocates, said Stevenson, whether that means collaborating with other local organizations, adopting a new approach to vendor management, or taking a different approach to leadership. 

OBBBA’s impact

Like many organizations, Fisher-Titus has felt the effects of the One Big Beautiful Bill Act (OBBBA), which requires Medicaid recipients to re-attest every six months to keep receiving benefits. And although she supports the philosophy behind discouraging “perpetual use” of Medicaid, she also sees the potential for problems.  

“People who are on Medicaid are less likely to complete all the steps, and so, we anticipate an increase in self-pay patients,” she noted. In fact, they’re already seeing a boost, which means an increase in bad debt. “All of this is a big concern for our bottom line, as is the creep up in Medicare advantage programs, for which reimbursement is not as much as traditional Medicare. Every year that number creeps up, and every year, our reimbursement for Medicare goes down. The resource constraints are going in the wrong direction.” 

And while many believed the Rural Health Transformation (RHT) Program would provide much-needed relief, it hasn’t necessarily delivered — at least, not for hospitals.  The program, a $50 billion federal initiative, pledged to distribute funds across all 50 states from 2026 to 2030 to fix workforce shortages, upgrade technology, and improve care access, according to CMS. 

However, only a portion of the funds will go to hospitals, Stevenson noted, with others allocated to education programs and other care organizations.  

“Everyone thought the Rural Health Transformation funds were going to come to our rescue,” she noted. “It will help, but it certainly will not make up for the Medicaid losses over time.” 

Negotiate and walk away

So what can leaders do? There are a few steps, according to Stevenson. The first is to change the conversation with vendors — particularly as costs continue to spike. 

“I’m not signing anything that has an extraordinary increase attached to it,” she said, urging leaders to consider shorter-term agreements. “We don’t have those long implementations like we did in the past. I’m going to sign a one-year contract because I know at the end of that year, I can reassess.” 

It’s also critical to check over the terms of the agreement and ensure both sides benefit from the arrangement. If that’s not the case, “you need to be willing to walk away,” said Stevenson. 

Most importantly, leaders — especially those at small and rural organizations — can’t fall for “shiny object syndrome” when evaluating AI solutions. “When a vendor comes to me, the first thing I want to hear is, ‘what problems to do you have that we can help with?’ Or better yet, if a vendor comes in armed with knowledge about the problems we have and how a solution might help,” she noted.  

Those who come in simply pitching a solution won’t get much time from her team. “We can no longer afford to invest in fun or shiny objects,” Stevenson said. “We need to be solving real problems.” 

For instance, patient access, for which AI solutions can play a role — but it has to be the right partnership and the right contract. “It has to make sense for us.” 

Fortunately, Fisher-Titus has established and maintained strong partnerships with vendors, many of whom appreciate the myriad challenges her teams face. “They understand the play, and they’re willing to come to the table and do things for us that maybe they wouldn’t for other customers,” she said. The hurdles “have really opened peoples’ eyes.” 

Partnerships and advocacy

Another key pillar in her strategy involves collaboration with other organizations and stakeholders to share costs and contracts, exchange information, and provide support. Through the Ohio High Value Network, Fisher-Titus has teamed up with other rural facilities to pool resources, manage financial risks, and provide a higher level of care. 

“It’s been very valuable for us,” she said. 

In addition to serving on local boards, Stevenson is also a member of CHIME Board of Trustees, which has afforded her access to CIOs and other leaders across the country, along with the opportunity to participate in advocacy efforts. 

However, keeping pace with legislative changes is not for the faint of heart, she cautioned. “It’s probably one of the hardest things I do. But it has allowed me to stay close to the trends and have a pulse on what’s coming.” 

For Stevenson, who is involved with AHA’s Public Policy Group, along with several other local and wider-ranging initiatives, the opportunity to educate lawmakers and potentially affect change is well worth the effort. 

“There are people in Washington who have good intentions, but they’ve never worked in healthcare or may not have ever lived in rural areas,” she said. Hearing from those who walk the walk can have enormous benefits. 

Plus, “the more you get involved, the better you can do your own job,” she added. 

Her final piece of advice for all leaders — rural healthcare or not — is to keep learning, while continuing to share your experiences with others.  

“My goal is to do more training to help bring up the next generation of leaders,” said Stevenson, who is also a wellness coach, master yoga teacher, and mentor to many. “I want to make a difference.” 

Kate Gamble is an award-winning healthcare journalist and editor with more than 20 years of experience covering healthcare IT. She has interviewed hundreds of healthcare leaders, and has focused on numerous topics, including digital transformation, patient experience, rural healthcare, physician and nursing leadership, and more. She can be reached at [email protected].