Case Study: Rural Hospital Seeks Operational and Strategic Outpatient Services Improvements

Case Study: Rural Hospital Seeks Operational and Strategic Outpatient Services Improvements

Avanza capabilities at work: Strategic Planning, Feasibility Assessment, Operations, Evaluation

“We had the pleasure of working with Avanza for an assessment of our outpatient services and patient throughput. The experience was extremely positive both during the time members of the Avanza Team were onsite, and follow-up conversations. The report they generated was comprehensive, easy to read, and was an excellent roadmap for us to follow in enhancing our services."


A rural hospital in the Southwest is the sole acute care provider in its area. This has allowed the organization to operate its programs without competition. The organization, unlike many rural hospitals, is not under significant financial stress. It has been able to invest in a number of facility-owned physician practices and on-site centers of excellence.

Despite these positive attributes, the hospital faces many of the same challenges posed to other rural providers. These include how to effectively provide high-quality healthcare to a small community in a medical center that must offer a basic level of services. Further complicating matters is the dynamism of reimbursement rates and programs, and the shift to value-based care.

The hospital's leadership recognized it needed to begin to address inefficiencies that could magnify the negative effects of the challenging healthcare environment facing rural hospitals. Rather than focus on the organization's entire operations, leadership identified the outpatient service lines as the ones bringing in more than 70% of the revenue and also the most in need of attention.


Avanza Healthcare Strategies was brought in by the hospital's leadership to identify operational and strategic improvements to current imaging and lab practices through interviews, process evaluation, data analysis, and best practice benchmarking.


  • Conducted on-site interviews with executive leaders, physicians, operational leaders and staff.
  • Evaluated operational data of imaging and lab services.
  • Documented current activities of outpatient lab and imaging functions as detailed and easy-to-understand flowcharts.
  • Performed utilization analysis by modality for imaging services
  • Interviewed operations leadership of comparable rural hospitals to identify the most current best practices for lab.
  • Detailed opportunities to improve efficiencies in administrative support areas to improve scheduling, appointment reminders, insurance verification, patient payment notification, and patient flow.
  • Shared steps to take to effectively cross-train staff members as a means to maximize utility, support professional development, and help address the tight labor market.
  • Analyzed the operations of the facility-owned physician practices, and made technology, process, and leadership suggestions to address how providers accessed lab and imaging services at the hospital, curb duplication of services, and better ensure timely, cost-effective care.
  • Educated leadership on different definitions of "outpatient," and the importance of using a definition consistent with like-organizations for accurate benchmarking.
  • Recommended review of emergency services to identify non-emergency cases that could be handled in a lower-cost outpatient environment.
  • Evaluated the medical campus and presented options for restructuring the location of outpatient care delivery with the intention of raising community awareness, optimizing patient access, and increasing volume in a cost-effective environment.


Avanza generated a detailed and comprehensive report that shared findings and 10 categories of recommendations with varying levels of ease of implementation and value-add to the organization. Recommendations were broken down by suggested implementation time period: immediate term for big-impact projects, short term for medium-impact projects and projects already underway or mostly in the hospital's purview.

This report was provided to the hospital's leadership, which accepted the recommendations and has begun their implementation.