Rural Healthcare Endangered

By Christine Kern, contributing writer

Close to one-third of all U.S. rural hospitals are “vulnerable to closure” in 2016.

According to an iVantage Health Analytics report, the concept of rural healthcare is endangered. The report, What’s the State of Rural Healthcare in America in 2016, found 673 rural hospitals — more than 33 percent of all rural hospitals — in 42 statesare “vulnerable to closure.” Among them, 210 are classified as “most vulnerable” and 463 are “at risk.” Sixty-eight percent of the hospitals vulnerable to closure are critical access hospitals.

Between 2010 and 2014, 43 rural hospitals with a total of more than 1,500 beds closed according to data from the North Carolina Rural Health Research Program, USA Today reported. The closures have also accelerated, jumping from three in 2010 to 13 in 2013 to 12 in 2014. Georgia alone has lost five rural hospitals between 2010 and 2012, and each of the state’s closed hospitals served about 10,000 people — a lot for remaining area hospitals to absorb.

According to the iVantage Health report, more than 60 rural hospitals have closed since 2010, representing a troubling trend for healthcare access in remote areas.“The stand-alone, community hospital is going the way of the dinosaur,” said Angela Mattie, chairwoman of the healthcare management and organizational leadership department at Connecticut’s Quinnipiac University.

“2016 survey results show the rural health safety net continues to operate in a complex socioeconomic, demographic, regulatory, and reimbursement environment with numerous challenges. Since 2010, more than 60 rural communities have experienced a hospital closure. iVantage research has identified another 673 facilities that are now vulnerable or at risk for closure in 2016,”said iVantage senior vice president Michael Topchik in a press release.

“When you consider that a rural hospital is often a community’s largest employer, the loss of an immediate — or local — point of care can have a significant impact on a community. We estimate that if this group of 673 hospitals were to close, 11.7 million patient encounters would be at risk, and lead to a potential loss of 99,000 healthcare jobs, 137,000 community jobs, and $277 billion to the GDP,” Topchik added.

Drivers of these hospital closures, according to iVantage, include loss of market share; lower patient volumes; declines in quality and outcomes; and decreases in reimbursements, among others.The report also found southern states exhibit higher rates of vulnerability, as do states that have opted not to expand Medicaid. For example, Mississippi’s vulnerability rate is 79 percent while Louisiana has a rate of 58 percent.

As the study states, “The unintended consequences of policy — specifically sequestration, hospital bad debt and the decision by states not to expand Medicaid under the Affordable Care Act — have had a lasting, negative impact on rural hospital revenue. Add to this list the proposed reimbursement cuts associated with swing-beds and the downward revenue pressure may grow larger still.”

To help save these endangered healthcare facilities, U.S. Representatives Sam Graves (R-MO) and Dave Loebsack (D-IA), introduced the bipartisan Save Rural Hospitals Act, (H.R. 3225) in July, 2015 to provide rural hospitals financial and regulatory relief to enable them to stay open. The bill also includes additional funding for rural providers and EMS, grants for population health initiatives, and to assist with changing to value-based payment models.