Emily Baumgaertner reported yesterday for the New York Times under the headline, "A Rural Hospital's Excruciating Choice: $3.2 Million a Year or Inpatient Care?" Here are some excerpts from an important feature:
For 46 million Americans, rural hospitals are a lifeline, yet an increasing number of them are closing. The federal government is trying to resuscitate them with a new program that offers a huge infusion of cash to ease their financial strain. But it comes with a bewildering condition: They must end all inpatient care.
The program, which invites more than 1,700 small institutions to become federally designated “rural emergency hospitals,” would inject monthly payments amounting to more than $3 million a year into each of their budgets, a game-changing total for many that would not only keep them open but allow them to expand services and staff. In return, they must commit to discharging or transferring their patients to bigger hospitals within 24 hours.
The government’s reasoning is simple: Many rural hospitals can no longer afford to offer inpatient care. A rural closure is often preceded by a decline in volume, according to a congressional report, and empty beds can drain the hospital’s ability to provide outpatient services that the community needs.
But the new opportunity is presenting many institutions with an excruciating choice.
“On one hand, you have a massive incentive, a ‘Wow!’ kind of deal that feels impossible to turn down,” said Harold Miller, the president of the nonprofit Center for Healthcare Quality and Payment Reform. “But it’s based on this longstanding myth that they’ve been forced to deliver inpatient services — not that their communities need those services to survive.”Some rural health care providers and health policy analysts say the officials behind the rule are out of touch with the difficulties of transferring rural patients. Bigger hospitals — bogged down with Covid surges, pediatric R.S.V. patients and their own financial woes — are increasingly unwilling to accept transferred patients, particularly from small field hospitals unaffiliated with their own systems.
There are also blizzards, downed cattle fences and mountain pass roads that close for months at a time.
“I really want to give this policy a chance to work well,” said Katy Kozhimannil, director of the University of Minnesota Rural Health Research Center. But gambling with transfers could mean that “some of the most extremely remote and marginalized communities could end up with no care at all — and that’s what we were trying to avoid in the first place.”
More than 180 rural hospitals have closed since 2005.
There's lots more recent reporting on rural healthcare worthy of note. Here are just a few:
This one, from the Texas Tribune, is about rural hospital closures in the Lone Star State, with Jayme Lozano reporting:
Texas hasn’t had a hospital close since 2020, a much-needed relief following the previous decade of closures that were predominantly seen in rural communities.
That could change soon: A new report from Kaufman Hall, a health care consulting agency, that was made public Wednesday shows that nearly 1 out of every 10 Texas hospitals are now at risk of closure, twice as many as before the coronavirus pandemic began in 2020.
“Ultimately, our concern is this will impact patient care,” said John Hawkins, president of the Texas Hospital Association.
The report highlights the pandemic’s striking toll on hospitals in the state as they face growing strain from surges in respiratory illness, workforce shortages and rising costs of medication, medical supplies and labor. This has caused hospital expenses to increase greatly — the total expenses for Texas hospitals this year have cost $33.2 billion more than before the pandemic.
While the risk is greater for all Texas hospitals, it’s higher for rural hospitals than for urban facilities — a 26% risk of closing compared with a 5% risk. Hawkins said there is concern about the challenges rural hospitals could face in the near future.
Health experts have long credited support from the federal spending spurred by the COVID-19 pandemic for lessening the closure risk in 2020 and 2021. Those funds are expiring soon, leaving hospitals without that financial safety net. Nearly half of all Texas hospitals are in negative operating margins because revenue is not covering the cost of patient care.
“We know, as that federal funding runs out, we’ve created a fiscal cliff,” Hawkins said. “These operating challenges are going to continue to be real for rural hospitals.”
And two recent stories about rural health care in Colorado are here and here, both from the Colorado Sun.
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