As you can imagine, the future is top of mind for the rural hospital CEOs and trustees gathered here in Phoenix. To be more specific, the future in an accountable, value-based, bundled, integrated and coordinated world.

Clinton MacKinney, M.D., talked this morning about how rurals can find their way. MacKinney, an assistant professor at the University of Iowa, told attendees that they need to realize that the payment equation is changing. "Value" is becoming the driver. He spent a fair amount of time talking about how rurals may participate in accountable care organizations once the Medicare regulations are issued later this year. He cautioned the ACO concept seems to be built around an urban model of integration and hospitals owning physician practices. That's not necessarily how rural hospitals are set up. Also, rurals need to think about how referral patterns may change as ACOs are formed, or if new affiliations will be needed.

Ultimately, MacKinney said, rurals need to think about the new world order in terms of improving patient care. Providers need to be more proactive in managing patient health. He wondered why it is that his vet sends him notes a couple of times a year that it is time for his dogs to get their shots, but primary care physicians very rarely notify patients that it is time for their immunizations.

Oh, and a word of warning from Ronnie Musgrove, former governor of Mississippi and current chair of the National Advisory Committee on Rural Health and Human Services: don't get sidetracked by the political chatter going on in Washington or your statehouse. Changes are upon us and providers need to work toward system reform.