Since 2005, there have been 170 rural hospital closures, according to the University of North Carolina rural health research program. In 2019, a record 19 hospitals closed their doors—and nine hospitals have already closed in 2020. The rural hospitals that haven’t closed are operating on tight budgets and struggling to stay financially afloat. In fact, a recent Guidehouse analysis found that over 350 hospitals, or 25 percent, of rural hospitals are at high risk of closure.
How COVID-19 Is Affecting Rural Hospitals
While the Guidehouse research was conducted prior to the coronavirus pandemic, the researchers suggest that COVID-19 will only exacerbate the struggles facing rural hospitals. A recent HealthLeaders article shares common cash flow concerns that rural hospitals are dealing with amidst the pandemic—some include delaying non-urgent or elective medical services, paying more for personal protective equipment, and caring for underinsured patient populations.
What Leads to Rural Hospital Closures?
One of the primary reasons that rural hospitals struggle is simply because patient populations in rural areas tend to be more vulnerable and require more care. For example, the mortality rates, suicide rates, and opioid-related drug overdose deaths are all higher in rural communities. Rural areas also tend to have higher rates of individuals age 65 and older—patients who typically have more complex care needs.
Additionally, the Guidehouse analysis suggests the following factors as contributing to the struggles that rural hospitals face:
- Patient outmigration
- Higher rates of uninsured, Medicaid, and Medicare patients, leading to uncompensated or undercompensated care
- Declining inpatient care driving excess capacity
- Inability to invest in innovation and technology
- Clinician shortages
- Revenue cycle management
How a Hospital Closure Affects Rural Communities
The Guidehouse report found that 81 percent of the at-risk rural hospitals are considered highly essential to communities, based on things like vulnerable populations and geographic isolation. When rural hospitals close, community members have to travel further to get the care that they need. A University of Kentucky study found that patients spend an additional 11 minutes (a 76 percent increase) in an ambulance after a hospital closure in their area. For seniors, this number jumps to nearly 14 additional minutes (a 98 percent increase).
When every moment counts in emergency cases like heart attacks or strokes—those extra minutes could mean the difference between a patient living or dying. Unfortunately, one study found that rural hospital closures led to a nearly 6 percent increase in inpatient mortality rates in the year following the closure.
Additionally, rural hospitals are important economic centers as they can be a community’s largest employer. One study found that per capita income decreases by 4 percent and unemployment increases by 1.6 percent when a community loses its singular hospital.
Strategies Helping Rural Hospitals Keep Their Doors Open
So, amidst the struggles, how can rural hospitals work to keep their doors open? According to Guidehouse, rural hospitals can help mitigate the challenges by partnering and collaborating with regional and academic health systems, physician groups, accountable care organizations, payers, and other rural providers when possible. These types of partnerships or collaborations allow rural hospitals to take advantage of the resources and capabilities of larger facilities.
For Mon Health Preston Memorial Hospital, a critical access hospital in West Virginia, finding efficient ways to improve care delivery and keep rural patients healthy also started with care coordination. Using an ADT-based care collaboration platform, Preston Memorial has been able to merge inpatient, outpatient, and emergency care.
With technology, staff are able to identify at-risk patients in real time and support them in ways that deliver high-quality care while keeping costs low. This visibility functions as the game-changing element to programs designed to manage care for patients with chronic illnesses or patterns of high utilization—it’s these types of programs that have enabled Preston Memorial to decrease emergency department utilization and achieve a five-star rating from CMS.
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