USA Today: Rural hospitals in critical condition
USA Today, November 12, 2014 (excerpt)
...Since the beginning of 2010, 43 rural hospitals — with a total of more than 1,500 beds — have closed, according to data from the North Carolina Rural Health Research Program. The pace of closures has quickened: from 3 in 2010 to 13 in 2013, and 12 already this year. Georgia alone has lost five rural hospitals since 2012, and at least six more are teetering on the brink of collapse. Each of the state’s closed hospitals served about 10,000 people — a lot for remaining area hospitals to absorb....
...Critics say the ACA is also accelerating the demise of rural outposts that cater to many of society’s most vulnerable. These hospitals treat some of the sickest and poorest patients — those least aware of how to stay healthy. Hospital officials contend that the law’s penalties for having to re-admit patients soon after they’re released are impossible to avoid and create a crushing burden.
“The stand-alone, community hospital is going the way of the dinosaur,” says Angela Mattie, chairwoman of the health care management and organizational leadership department at Connecticut’s Quinnipiac University, known for its public opinion surveys on issues including public health....
The closings threaten to decimate a network of rural hospitals the federal government first established beginning in the late 1940s to ensure that no one would be without health care. It was a theme that resonated during the push for the new health law. But rural hospital officials and others say that federal regulators — along with state governments — are now starving the hospitals they created with policies and reimbursement rates that make it nearly impossible for them to stay afloat.
Low Medicare and Medicaid reimbursements hurt these hospitals more than others because it's how most of their patients are insured, if they are at all. Here in Stewart County, it's a problem that expanding Medicaid to all of the poorest patients -– which the ACA intended but 23 states including Georgia have not done, according to the federal government — would help, but wouldn't solve.
"They set the whole rural system up for failure," says Jimmy Lewis, CEO of Hometown Health, an association representing rural hospitals in Georgia and Alabama, believed to be the next state facing mass closures. "Through entitlements and a mandate to provide service without regard to condition, they got us to (the highest reimbursements), and now they're pulling the rug out from under us."
For many rural hospitals, partnering with big health systems is the only hope for survival. Some have resorted to begging large hospitals for mergers or at least money to help them pay their bills. But Douglas Leonard, president of the Indiana Hospital Association, said these days, "I'm not sure they can get anyone to answer the phone when they call." ...
(Meanwhile in Hawaii, HHSC has no shortage of potential partners but the HGEA/UPW owned Legislature has refused to allow any merger or partnership.)
...Change, including a move to costly electronic health records required under the ACA, can be difficult, and Department of Health and Human Services Secretary Sylvia Burwell says HHS will "work to incorporate feedback" from rural hospitals on how it's going.
"Transition takes time," she said.
But the $1 million or more it was going to cost to change over to electronic records was one of the last straws for Randy Stigleman, former owner of Stewart-Webster. Efforts to sell the hospital never panned out.
The anger residents feel toward Stigleman is palpable here in Richland. He appeared to shut the hospital down suddenly — giving them only a week's notice. But Stigleman says he just couldn't put any more money into the hospital.
While mergers and partnerships with large health systems are one way for hospitals to survive, "once they look at the demographics of Richland, nobody's going to give you money," he says....
read ... Rural hospitals in critical condition