Equipping the new hospital is another challenge in terms of return on investment.
"The problem in the rural environment is not how long the equipment will last; the real issue with technology turnover is how long the equipment will be there before it is considered obsolete and no longer serviceable," Tyler noted. "For example, if you spend $2 million on a CT scanner it is supposed to last 10 years and will. The equipment is good. However, the technology turns over so quickly that the machine becomes obsolete in four years. And you can't get parts for it. So you have not received the ROI, but you have to go out and buy a replacement. That is one of the biggest challenges with regard to equipment and capital.... In the rural environment, it's not so much trying to keep with the 'Joneses'-the big tertiary care facilities and larger hospitals-it's more just trying to keep your equipment up to date enough so that you can provide a viable service."

The new facility will feature a 64-slice GE CT scanner; it has a dual slice CT now. "Here, the economic downturn has helped us in those negotiations. We are trying to get in on the upper end of the curve where we can have that longest period of time for return on investment. We are adding nuclear medicine which we don't have now and will be used primarily in diagnosis of heart disease. We will add digital mammography, a digital chest X-ray room and a digital fluoroscopy room, making us fully digital." (The hospital already has a full-time radiologist and also uses teleradiology in the emergency department.)
Perhaps just as important as the hospital's role as guardian of community health, it also plays an indispensable role in the area's economic health. Typical of rural hospitals, Carilion Giles is one of the community's largest employers, with about 200 full- and part-time workers, contributing $35 to $45 million to the local economy just in terms of spending power.

"In my role as a hospital administrator, I wish I could just look within the four walls, but I really have to look outside the four walls and understand the hospital's role in this community and what it means to this community, not just in providing health care but in the bigger economic picture. We are a vital part of that," says Tyler.

Some Sobering Facts About Rural Health
-Rural communities encompass nearly one quarter of the U.S. population; however, less than one in ten physicians practice in those communities.
-Heart disease, strokes, and diabetes more frequently lead to hospitalization because of lack of timely and effective preventive care and primary services.

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