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respondHealthcare Delivery System Nonprofit 130 Bed Community HospitalPayer MixPercentageMedicare50.2Medicaid/Managed Care10.5HMO0PPO34.4IPA0Self-pay/ Uninsured4.5Dr. Strong and Class,I work in a small community hospital in south-central Nebraska. We are in the Midwest farm belt. The breakdown of our payor source for our organization. I do believe this is an accurate reflection of the community. The city itself is an aging sleepy community that caters to the Medicare type clientele. There are very few fast food joints, and new and upcoming businesses do not happen in this city. The town is a large commuter town in which there are many that travel 20-30 mins away to work but “doctor” in their hometown. Many of the Medicaid/managed care people are here due to family support or the decreased cost of living that this community provides. The PPO is primarily the families of those that work in the city and or hospital.As a future nurse leader, one of the predications that I foresee with the aging population that the Medicare percentage will continue to grow, at least until Medicare itself is exhausted. The PPO percentage will decrease due to the aging of the people. Like many farm communities, the “kids” leave the area after graduating from high school. Without local businesses growing and investing in the future of the community as a whole, they will not come back.One of the recent concerns for our organization that within 20 miles, there is a brand new hospital that will be opening up to the community. They have the potential to entice staff to leave our facility. This adds additional burdens to the system. Our organization needs to be more competitive pay and staff benefits with neighboring community hospitals. These benefits would entice staff into staying. Early estimations from the hospital include expected loss if ten percent of the team to this new place. The employees that will leave initially are the ones that drive past it every day. That is a lot of people in an already struggling healthcare environment of the 1200 employees that our facility employees that would 120 people.