Sam Greenberg (Host): Welcome to the Healthcare Executive Podcast, providing you with insightful commentary and developments in the world of healthcare leadership. To learn more, visit ache.org. Intuitive is one of ACHE's premier corporate partners. Our premier corporate partners support ACHE's vision and mission to advance healthcare leadership excellence. For more information on Intuitive, please visit the corporate partners page at ache.org.

I'm your host today, Sam Greenberg. And in this episode, we are joined by Dr. Jaime Wong, senior Vice President and Chief Medical Officer at Intuitive and a fellow of the American College of Healthcare Executives, as we talk about addressing the rural healthcare gap, leveraging robotic-assisted surgery, and the Rural Health Transformation Program. Dr. Wong, thank you so much for your time. And of course, thank you for being an ACHE fellow.

Jaime Wong, MD: Thank you very much, Sam. It's great to be here with you today.

Host: Dr. Wong, we continue to hear from rural hospital executives about how challenging today's healthcare environment has really become. From your perspective, what are some of the biggest challenges out there facing rural hospitals and the patients they serve?

Jaime Wong, MD: We hear that current healthcare environment's challenging too. When we speak with rural hospital leaders, three challenges come up again and again, and they really feed into each other. The first is workforce. Rural hospitals have always done more with less. But, you know, look at surgery. The surgeon workforce is getting older and recruiting and keeping people in rural communities keeps getting harder.

There was a recent study in the Annals of Surgery that projected about 60% of general surgeons in non-metro areas will reach traditional retirement age in the next decade. And even scarier is that there aren't enough younger surgeons coming up to replace them. So, you think in a small hospital, one surgeon might be the entire surgery program. So if that person retires or they leave and you can't replace them, the community just doesn't lose one doctor, it actually loses an entire service.

So, the second challenge is distance and access. When local services go away, patients have to travel further for the same care they used to get just down the road, because that means time off work, travel costs, and a real burden on families and caregivers. And so, from a hospital's perspective, every patient who leaves for care elsewhere takes that revenue with them, which then, of course, puts more strain on that local hospital.

And then, the third challenge is financial sustainability. The 2026 Chartis analysis found that more than 40% of rural hospitals are operating at a loss. And over 400 are vulnerable to closure. And so with this, rural hospitals have also continued to lose services such as obstetrics and general surgery and chemotherapy. But access isn't only whether the hospital's doors are open or not. It's also about what kind of care you get once you're inside the hospital.

So, we've looked at this through collaborative research. Minimally invasive surgery, or what some people refer to as MIS has shown some real benefits compared with open surgery. So, we ask the question: Is everyone getting equal access to MIS? And in a national study published in JACS, the Journal of the American College of Surgeons, we looked at more than 3,400 geographic areas. And when we compared similar communities, areas without access to robotic surgery had a 66% chance of having open surgery than areas with access to MIS.

Now, I know there's many scientists online today as well, so just to call it, that's an association. That's not proof of causation, but it points to a real gap. And so, these three challenges all connect. Workforce shortages lead to lost services. Lost services mean patients need to travel for care. That means less revenue for local hospitals, which puts financial pressures on those hospitals, and it makes it harder for them to invest in people, facilities, and technology that could really keep that care close to home.

Host: Those challenges obviously extend well beyond any single technology or company. How do things like technology, evidence, education, implementation, and even innovation support rural hospitals?

Jaime Wong, MD: I think the right place to start is this: technology alone doesn't solve rural healthcare challenges. The first question should always be: What problem are we trying to solve for the patient, the workforce, and the health system? From there, we ask whether a solution moves us towards the quintuple aim. So, that means a better patient experience, better patient outcomes, lower total cost to treat, improve workforce wellbeing, and more access to care.

So, technology can absolutely be part of the answer. That could be robotic-assisted surgery, robotic bronchoscopy, telehealth, or advanced diagnostics. But it only works when it's backed by evidence, education, good implementation, and the right resources.

So starting with evidence, robotic-assisted surgery now has a very mature evidence base. And in fact, there's been over 50,000 peer-reviewed studies across da Vinci. And I just want to call out two of them so two large reviews that can help put that in perspective.

So, the first called the Compare Study, it pulled together 230 studies and nearly four million patients treated for different cancers. And then, the second study, which was looking at benign conditions, so aptly named the Benign Compare Study looked at 366 studies and about 14 million patients in 32 countries across 13 common benign procedures. And what stands out is how consistent the findings were.

Compared with laparoscopic surgery, da Vinci surgery was associated with fewer conversions to open surgery. That means having to go from what you plan to be a minimally invasive surgery and having to do the big cut with open surgery. Associated with fewer transfusions and shorter hospital stays, but the operating times were longer. And if you compare da Vinci surgery to open surgery, results were favorable across a number of outcomes. But evidence is only part of it.

So, turning technology into consistent high-quality care takes education and teamwork across clinical, operational, and administrative leaders. And then, there's implementation, which is what turns an investment into a sustainable program. It means understanding the specific barriers in that hospital and putting the right people, processes, training, and support around the solution. And looking ahead, we're very interested in digital connectivity. Tools like telepresence, telementoring, and peer-to-peer collaboration can connect a rural surgeon with larger clinical networks and specialized expertise so that the distance matters less.

So, the goal isn't just to put a new piece of equipment in a rural hospital. The goal is to help build lasting clinical capability that improves access and outcomes, supports the workforce, and lets more patients get appropriate care closer to home.

Host: Absolutely. And Dr. Wong, one of the most significant developments in rural healthcare has been the Rural Health Transformation Program, or RHTP. So for healthcare leaders who, say, may not be deeply familiar with it, what does RHTP intended to accomplish? Where can technologies such as robotic-assisted surgery and advanced diagnostics align with those objectives?

Jaime Wong, MD: So, it's interesting. RHTP is unprecedented, you know, both in size and really what it's trying to do. For those of the people online who might not be as familiar, it's a $50 billion federal investment over five years with funding going to all 50 states. And right now, the states are moving from planning into implementation.

But I think what's important is that it isn't a program built to plug short-term budget holes. The goal, as the name implies, is transformation. So, CMS has made sustainable access, workforce development, new care models, and technology innovation as core priorities. And then, it gives the states a lot of flexibility to decide how to meet those goals based on what their rural communities need.

And so, we're already seeing technology show up in those state plans. CMS has highlighted RHTP investments involving surgical robotics in states like Alaska and Georgia, you know, along with other technology-enabled approaches. But I'd encourage leaders to start with the right question. It's not how do we fund a robot? It's what rural healthcare problems are we really trying to solve. Are patients regularly leaving the community for procedures that could be done locally? Is the hospital struggling to recruit or keep surgeons and other specialists? Could new surgical or diagnostic capability support a sustainable service line so patients get care closer to home? Could technology strengthen the connection between a rural hospital and a larger clinical network? That's where, you know, robotics and advanced diagnostics can be especially relevant. So in the right setting, they can be part of a broader strategy to expand access to minimally invasive care that help with recruiting and keeping clinicians and build stronger ties between rural hospitals and regional clinical networks.

So, technology can align very well with RHTP's goals, but the strongest case starts with a clear patient access or workforce problem backed by evidence and then a realistic plan for implementation and long-term sustainability.

Host: As the RHTP program moves into its second year, states and rural hospitals have really had their first opportunity to translate plans into actual investments and programs. What are some early learnings from year one that rural healthcare leaders should be thinking about right now?

Jaime Wong, MD: So, we're already hearing a few lessons from organizations taking part in the program. The first is that the program is state-driven. So, there's a federal framework, but the priorities, eligibility, funding mechanisms, and timelines vary a lot from state to state. So, there's not a single national RHTP playbook. Hospital leaders need to understand what their state is trying to accomplish and then where their community's needs fit.

The second is that the strongest strategies connect multiple challenges rather than treating them independently. For example, technology investment can also help with recruiting. Telepresence can strengthen a hub-and-spoke network. A new diagnostic capability can create referral pathways, so more patients get specialty care locally.

I just want to take a moment and pass on a story that stuck with me. So, there was a critical access hospital in Iowa that had been trying for years to recruit a general surgeon. They'd bring candidates in, interviews would go well, and the candidates really liked the hospital and the community. But one question kept coming up and that's, "Will I have access to robotic surgery?" And for a long time, the answer was no. And I get it. For a small rural hospital, the capital investment was just simply out of reach.

Then, the hospital received an RHTP support that included access to robotic-assisted surgery. And so, the next time a candidate came by and asked that question, they actually had a different answer. And that surgeon accepted the job and is actually expected to start next summer after finishing training. And so for a community that size, landing a surgeon's huge. Now, one piece of technology doesn't decide where a surgeon goes, but it shows how technology, workforce, and access are all connected.

And then, the third lesson is to plan for implementation and sustainability from day one. This is time-limited funding, so the investment has to last after the program ends. That means asking some hard questions early. Who will lead the program? Where will the patients come from? Will the team be trained? What partnerships do you need? And what happens financially when the grant money runs out? The organizations asking those questions up front are the ones most likely to turn a one-time investment into a lasting capability for their community.

Host: Doctor, you answered it a little bit there, especially in that story or that case study, but we've already seen some rural hospitals use funding from the program to expand access to technologies such as robotic-assisted surgery and robotic bronchoscopy. For those hospitals that have made the investments, what are some key signs of what success looks like, and how can they ensure the technologies translate into sustainable programs and meaningful improvements for patient access and patient care?

Jaime Wong, MD: You know, for hospitals that have already made those investments, installing a robotic system isn't the finish line. It's actually the starting line. So, you know, what does success look like? It means defining success before you begin. And success at a rural hospital can look very different from success at a large academic medical center.

For a rural hospital, I look at a few things. So, patients, are people who used to leave the community now getting appropriate care locally? Is travel going down? Are more patients getting minimally invasive surgery or lung nodules diagnosed closer to home? For workforce, are you recruiting and keeping clinicians? In terms of outcomes, are length of stay, complications, and transfers moving in the right direction? And then, sustainability, are you meeting your state's required performance measures? And is the program financially sustainable? Those are the measures that tell you whether real transformation is happening.

So, how do you get there? After more than 30 years and thousands of program launches around the world, including many in rural America, we've learned that technology is only one part of the solution. Whether it's robotic surgery or robotic bronchoscopy, you need engaged clinical and executive leaders, the right training, a committed care team, thoughtful case selection strong referral pathways, and enough volume to keep the program going.

Host: For leaders in rural hospitals listening today who may be considering pursuing the Rural Health Transformation Program funding, what sort of resources, evidence, tools, and support do they need as they continue to evaluate opportunities and develop their strategies?

Jaime Wong, MD: My first piece of advice is to start with your community's needs, not the grant. So, ask yourself, what healthcare problem are you trying to solve? And are there proven approaches that have worked similar in similar communities? And so once you're clear on that, you can figure out the right mix of workforce, technology, partnerships, and new care models to address it.

So, evidence and data, solid clinical evidence, plus your own data on utilization and where patients are going for care today. A real plan, a realistic implementation, a workforce strategy, and outcomes you can actually measure, and sustainability—a credible plan for what happens after the funding ends. And partnerships matter too. That could be another rural hospital, a larger health system, an academic medical center or your state rural health association. You have to realize you don't have to do this alone. And because these are public funds, you should know your state's specific rules on eligibility, procurement, and compliance.

Now, those obligations don't go away once you receive an award. But in the end, the strongest strategy isn't built around a product. It's built around a clearly defined problem and a sustainable plan to solve it. And where it makes sense, that's where we at Intuitive can help. If da Vinci or Ion fits a hospital strategy, we can help bring evidence, data insights, education, and implementation experience to the conversation. And of course, we'd welcome hearing from any of the leaders listening today. Please reach out to us at executive.education@intusurg, I-N-T-U-S-U-R-G.com

Host: Finally, Dr. Wong, switching gears, we ask this question of all of our guests who are fellows of ACHE: How has your FACHE credential helped you advance in your career?

Jaime Wong, MD: It's a great question. As a physician, I spent years training to earn my own clinical board certification and, you know, it tells patients and my colleagues that I've met the high standard in my field. And as I moved into a management and administrative role, I realized leadership and healthcare management deserve that same standard.

So, it's a different discipline with its own body of knowledge, and I felt that earning my FACHE was board certification for that side of my career. And it validated that knowledge, that experience, and it helped me to the high standards of the profession. And I'd say it helped me in a few different ways.

First, it gave me a more holistic view of healthcare. As a clinician, you see the patient in front of you. And through ACHE, I gained a much broader perspective on operations, finance, workforce, and strategy, and then really how all those connect back to patient care.

And second, it expanded my network. I met with other leaders I would have never crossed paths with otherwise, and those relationships shape how I think about problems like the one that we talked about today.

And then third, it's given me a chance to mentor others. You know, for me, that's one of the most rewarding aspects. So, you know, I feel it's not just a credential, it's more of a commitment to keep learning and keep growing as a leader.

Host: Dr. Wong, your diverse and really impressive background and your commitment really provides a unique perspective on rural healthcare and rural health transformation. This has all been incredible information. Thank you again for your time. And again, as always, thank you for being an ACHE fellow.

Jaime Wong, MD: Thank you very much, Sam. I really appreciate you inviting me to the podcast and enabling us to talk about this important topic, and I look forward to seeing you in person at the conference.

Host: Yes, sir. It's my pleasure. Intuitive is one of ACHE's premier corporate partners. Our premier corporate partners support ACHE's vision and mission to advance healthcare leadership excellence. For more information on Intuitive, please visit the corporate partners page at ache.org. If you enjoyed this podcast, please share it on your social channels and check out the entire Healthcare Executive Podcast library for topics of interest to you. I'm your host, Sam Greenberg, and this is the Healthcare Executive Podcast.