Rural Hospitals Discover How to Stay Afloat Amid Threats of Closure
Nearly three decades after rural hospital closures became widespread, the trend seems to be intensifying. The closure of rural hospitals began to pique interest in the late 1980s, as changing demographics and economic conditions led many independent medical centers to shut their doors. The Office of Inspector General of the U.S. Department of Health and Human Services began conducting an annual report of closures at that time, but interest in the phenomenon declined in the late 1990s, when the closure rate declined. Recently, however, rural hospital closures are on the uptick, and medical administration leaders are paying attention.
According to the N.C. Rural Health Research Program, many rural hospitals never recovered from the recession that began around 2008. Others have been affected by population declines, hospital mergers, and changing health care legislation. The N.C. Rural Health Research Program also reported that more than 80 rural hospitals have closed since 2010. In addition, as many as 700 additional hospitals could close in the coming decade, according to Alan Morgan, the CEO of the National Rural Health Association (NHRA), in an article in The Huffington Post.
Numerous media outlets have recently reported on the devastating effects that the closure of a rural hospital can have on its community. Here are some the consequences.
· Further from a hospital
People in rural communities can live as many as a few hours’ drive from a hospital. A short drive to a medical center can mean the difference between life and death during emergencies such as a stroke or heart attack.
· Less availability of care for health issues
Certain health issues are more prominent among rural residents, especially those who live in the Southeast, where more rural hospitals are closing. For example, the residents of rural areas in the Southeast require more immediate or regular visits to a medical facility due to increased cases of diabetes, hypertension, and obesity-related conditions. The NHRA reports that residents of rural areas have a 22 percent higher risk of death related to injuries and that more than 50 percent of deaths related to vehicle crashes occur in rural areas. As more rural hospitals close, the residents of rural areas have less access to the health care they need.
· Economic spiral
When a rural hospital closes, it can severely affect the economy of the surrounding community. This can mean business closures, lost jobs, and fewer health care providers, as other medical professionals tend to leave the area when a hospital closes. Small communities also often find it difficult to attract new businesses — especially large employers — if there is not quality health care nearby.
Ways to stay afloat
Other rural hospitals are finding ways to stay afloat. In rural Cook County, Georgia, for example, where the hospital was in danger of closing, county commissioners approved a $35 million plan for a new hospital. The plan offers a fresh approach to hospital design and its service offered, eliminating the need for an expensive emergency room and building a new facility with a focus on primary care clinics, a geriatric psychiatric center, outpatient and inpatient services, and a surgical center.
More than 200 people attended the commissioners meeting in the spring, when the hospital plan was on the table. Mayor Buddy Duke of Adel, Georgia, was among those who spoke on the issue. “We felt like as leaders we had to band together to save 250 jobs and the industry in the area,” the Huffington Post reported Duke as saying.
County leaders in Pemiscot, Missouri, also saved their rural hospital by scraping up more funding. In 2013, the hospital was short by just more than $1 million to make payroll and debt payments, and its chief executive officer asked a local bank for an emergency loan. The loan was granted, and it kept the hospital afloat for another year. The CEO got a larger loan for the hospital in 2014 that has bought the hospital additional time to make some changes in order to save money. The changes have included outsourcing ambulance services and finding new sources of revenue, such as a prescription drug program for people from economically disadvantaged communities.
Freestanding emergency rooms
Another strategy that rural communities are exploring is the creation of freestanding emergency rooms. Many patients go to the ER for non-emergency care, and unpaid ER bills can run into the millions of dollars for hospitals, which are required to provide emergency care to all people regardless of whether or not they can pay. Freestanding emergency rooms, separated from typical hospital facilities that provide follow-up care, could encourage more people with non-emergencies to visit less expensive care clinics instead.
Some hospitals are also considering telemedicine, in which physicians use telecommunications technology to provide advice and care to patients remotely. While hospitals are not sure if these strategies will be sufficient to stop further rural hospital closures, they know that if they do not try, then rural communities will face even more serious health care shortages.
