R. Kyle Kramer, CEO of Day Kimball Health

In this episode, R. Kyle Kramer, CEO of Day Kimball Health, shares how his rural Connecticut hospital is tackling workforce shortages, financial pressures, and care access disparities through population-specific strategies, legislative advocacy, and community-driven leadership.

Episode Transcript

(00:00):
This is Madeline Ashley with the Becker's Healthcare

(00:02):
podcast, and I'm excited to be joined today
by Kyle Kramer, CEO at Day Kimball Health.
Hey, Kyle. Thanks for joining me. It's my
pleasure to be here, and thanks for having
me. So,
Kyle, before we dive into our conversation today,
do you mind sharing with our listeners just
a little bit about your background and your
organization?
Absolutely. I have,

(00:22):
been a health care executive
in various,
organizations
for thirty four years. Started in Houston
in the Texas Medical Center, was at Penn
State Hershey,
at Yale New Haven Health and Main Line
Health, and have also done quite a bit
of consulting work. But I'm presently the CEO
at Day Kimball Health, which is a 104

(00:44):
bed community
hospital in a rural part of Northeast Connecticut.
We also have four outpatient ambulatory sites.
So we really represent,
small and rural community health care organizations, and
it's a
a very different type of health care delivery
model than what you typically see in your
more urban and academic setting. So I'm excited

(01:06):
to share a little bit more about that.
Well, I so appreciate you breaking down a
little bit more about your background there.
I wanted to start things off. You know,
you mentioned you're in more of a rural
setting, and Becker's so far in 2025.
This could literally change by the end of
today or even in the next week.
But so far this year, we've reported on
12 hospital closures.

(01:28):
And I also just checked. We've also reported
on 12 maternity service closures
at hospitals, unfortunately, often in in rural areas,
across The US. So when you hear that,
can you maybe just give me your initial
reaction to hearing, you know, that number of
closures, such a high number in in so
early in the year?
And what do you think can be done
to combat this?

(01:49):
I think one of the biggest challenges facing
small and rural health care organizations is the
ability to drive scale.
As
as small and independent organizations,
there's,
limited ability to affect
the the reimbursement
that is received from commercial payers.
And certainly, there's a comparable

(02:11):
concern around supply acquisitions.
Larger organizations
have a better opportunity
for negotiating power
with, with payers and with suppliers of services.
And then, you know, the other piece that
goes into
small and rural organizations
is the cost of labor. It's a smaller
market, less of a

(02:31):
pool of individuals for employment, and as a
result, it typically has a higher cost to
get individuals
to come into that type of an environment.
And, you know, when you think about, you
know, small and rural facilities
and the challenges that they face, there's
really three fundamental challenges that are of paramount
concern. Number one is general losses on patient

(02:53):
services contributed to by,
you know, the reimbursement side as well as
the cost side. And in small markets, it's
not infrequent that you see a large portion
of
of reimbursement
being on the Medicaid side of things. And,
you know, typically,
there is a level of under reimbursement to
cost

(03:14):
within that proposition.
And in addition,
another big concern is, you know, the the
lack of revenue from other commercial sources. When
you have limited ability to negotiate those higher
rates comparable to
what you might see in larger academic environments
that, certainly has its own
set of challenges. And then finally, when because

(03:34):
you're in a smaller market, there's also
less of an opportunity to generate philanthropic funds
or other sources of revenue.
And, as a consequence, you have lower reserves
within your your pool of available funds to
support sustaining operations.
Could you dive a little bit deeper into,
you know, the workforce aspect of things too?

(03:56):
How how are you at Day Kimbell Health
recruiting and retaining
workers, you know, in in more rural areas?
Is it more difficult? And and if you
could just share some strategies there, I'd be
so curious.
Yeah. So I would say that it is
a a chronic and perpetual challenge for us,
in in a small urban
in a small rural area like ours.

(04:18):
You know, we we we like to promote
ourselves as being super suburban, which is kind
of a catchy term.
We're about an hour east of Hartford,
An Hour West of Providence, and about thirty
minutes south of Worcester. So for individuals who
want to have access to more of an
urban area,
you have that within reasonable proximity. But the

(04:41):
other thing that you learn in smaller markets
is that distances become relative.
In our market, driving
twenty, thirty minutes becomes
far.
And for a lot of your population, and
if it's an elderly population, those distances become
even greater.
For individuals
that we are attempting to recruit, number one,

(05:03):
if somebody has grown up in a market
like ours, there's a more likely scenario where
they might come back or or be willing
to entertain employment and engagement in a market
like ours.
But for a lot of your your folks
who have trained in urban environments and they're
used to that type of an atmosphere,

(05:23):
convincing them that they want to
come into a more rural environment becomes a
little bit more of a challenge. So we
have to be a little bit more, deft
with strategies to attract people. Number one,
being more aggressive with sign on bonuses. Number
two, making sure that we are offering
competitive opportunities
around
tuition,

(05:44):
reimbursement for individuals who wish to advance their
careers,
loan forgiveness for individuals who are coming out
of training programs,
as well as offering flexible shifts or or
flexible schedules
that, that attract people.
So it's a, it's a chronic challenge. I
don't know that there's an easy answer.

(06:05):
And I think part of the other piece,
at least within the state of Connecticut, has
been,
especially within nursing, the fact that at any
given time, there are probably some 4,000 open
positions across the state. And each year,
the schools that produce nursing graduates are only
graduating close to 2,000.
So the supply and demand

(06:27):
is is definitely off. There's a lot of
work being done with the state legislator to
create additional incentives
for individuals to enter the field, but that's
more of a long term play, not a
short term play. So Yeah. Forced into using
temporary labor, which has a higher cost.
Yeah. Exactly. And, you know, I've also talked
to a lot of health care leaders that
have said, you know, go back to the

(06:48):
school. Start even as young as middle school,
you know, bringing these the attention and the
excitement around health care and working in in
the field,
and then maybe kinda like you said, almost
like a homegrown situation
with some of these employees.
And and in fact, I'm glad you mentioned
that because we have started several programs with
our local high schools for,

(07:09):
certified nursing assistant certification.
And the
the plus on doing that is that we're
introducing individuals
to the broader spectrum of health care opportunities
because what we find often
is if you survey middle school and high
school students and ask them about career paths
within healthcare, they'll often tell you doctor or

(07:29):
nurse.
What they don't recognize is that within the
field, there's a vast array of other opportunities.
So through creating
this type of training opportunity, we're giving young
people exposure to the vastness of the health
care field. And, you know, in a lot
of settings, I've joked with some of my
colleagues that we are making offers to middle

(07:50):
school students,
in the hopes that at some point they
will, join us in the workforce. And we
say that tongue in cheek, but I think
earlier exposure creates opportunity for people to gain
interest.
And if we can stimulate that interest by
giving them
on-site opportunities to observe what we do, obviously
respecting patient privacy

(08:10):
and confidentiality
concerns,
but if we can expose people to opportunities,
the likelihood that we inspire
that spark of interest
increases.
Yeah. No. Definitely. Thank you for kinda diving
deeper there with that. You know, and you
mentioned before we got into the workforce,
you know, aspect of it, you mentioned a
few other challenges that rural hospitals are facing.

(08:33):
Could you share some strategies that have been
successful for Day Kimbell Health, maybe for our
listeners that might be in, you know, dealing
with challenges at their hospitals or or systems?
For sure. We've, taken a very population centric
approach to the services that we're really emphasizing
and pushing.
Obviously, all of what we do is rooted

(08:54):
in a strong foundation of primary care access
across the market. But within the population we
serve, we know that we're dealing with a
population that's aging and aging largely in place.
With that, we know that there are certain
conditions that are going to routinely and commonly
present themselves, not the least of which are

(09:14):
heart disease,
digestive diseases, pulmonary and respiratory diseases,
various forms of cancer, as well
as orthopedic services.
We've taken a very strong approach to advancing
our orthopedic efforts as well as our cardiac
efforts and our digestive health efforts.

(09:35):
We've had a long standing and stable cancer
program. We know that we're not going to
be
the the equivalent of an MD Anderson or
a Sloan Kettering or a Dana Farber, but
what we do, we do well.
And we do it in a manner that
allows individuals who may have gone to one
of those larger

(09:55):
in organizations
and received a diagnosis to receive care
at a local setting that, is far more
accessible
and more comfortable for them to to travel
to.
But by taking that population specific approach, what
we're doing is driving opportunity that gives us
the ability
to generate a return that allows us to

(10:16):
reinvest in those programs.
We've also taken
a very strong approach
to lobbying
our legislators
from our region as well as across the
state and working with our federal,
elected officials on developing an understanding
of what's unique about rural healthcare,

(10:36):
why our mix of patients and why our
payer mix in particular is more challenging than
in urban environments,
and working to develop
a level of appreciation and respect at the
legislative level that we can't paint all hospitals
with the same brush.
And that rural entities do have a different

(10:56):
level of access concern.
And there's also a different challenge when you
put people in rural areas in a position
where they have to travel great distances. And
often that puts them in a position of
hardship, especially with elderly individuals. So we've kind
of taken a multi pronged approach to addressing
the concerns of of limitation,

(11:17):
but also elevating
opportunities through collaborating with the legislature.
No. Some very,
insightful responses there. I'm sure our listeners will
find, you know, some great some great strategies
from that, so thank you for sharing.
You know, also, leadership is a key piece
here as well, for some of these strategies
just to tackle these role health care challenges

(11:38):
we're seeing right now. Could you share with
me maybe the best piece of lead leadership
advice you've received over your career in health
care and maybe how it's influenced you in
your current role?
So I will
tell you the same thing that I have
told so many individuals that have worked with
me or worked, as
a part of my direct structure.

(12:01):
The, the advice that I received from my
very first boss in health care back in
June of nineteen ninety one at the University
of Texas in Houston. Ali Myers
was the vice president for the department of
medicine within the medical school. And on day
one, he told me, Kyle,
your job as a leader is to do

(12:21):
three simple things, and you'll probably wanna write
this down because it's going to evolve and
change
for the entirety of your career.
Oversee all,
act on some,
and overlook a lot.
And what that has evolved to mean is
that as a leader, it's important that you
have the full and broad perspective of everything

(12:41):
that's going on within your organization,
within the environment that you're working with.
There's things that you're going to need to
step into and really engage your team in
advancing,
and there's some things that you're gonna have
to step back from. So the ability to
prioritize
your approach, your focus, and to be able
to shift,

(13:02):
sometimes on a dime,
is an important part of leading through change,
leading through challenge, leading through
hardship,
but also leading
in times of of winning. And I've I've
carried that with me for my entire career.
I think it still holds true today. You
know, I think there are many people that
we could look to as leaders,

(13:24):
but, you know, what mister Meyer shared me
with me that one day,
upon starting in health care has has stuck
with me. And then I've always carried with
me
the things that I learned from my father
who was a high school football coach in
Texas,
that if you believe in yourself, you believe
in your team, and you put your faith
in a higher power, good things will ultimately

(13:46):
happen.
That is some great advice, I mean, on
both accounts there and that you've taken, you
know, those those pieces of leadership advice into
your roles. It's been really great to hear,
and it's also been so wonderful connecting with
you, Kyle.
I truly appreciate you taking the time to
speak with me today, and I look forward
to connecting with you again down the line.

(14:07):
Same here. I'm honored, and I appreciate the
opportunity.
Thanks so much.