Rural hospitals may hold key to success or failure of Patient Protection and Affordable Care Act

"The Affordable Care Act’s success or failure will depend in large part on the efforts of rural hospitals" such as $173 million state-of-the-art Poplar Bluff Regional Medical Center in the 17,000-population town of Poplar Bluff, Mo., Jim Doyle reports for the St. Louis Post-Dispatch. The hospital also operates seven family clinics in four counties in southeast Missouri. (Post-Dispatch photo by Erik Lunsford: The $173 million hospital that opened in January)

"It may be in a shiny new building, but it has a long way to go to provide efficient, low-cost medical care in its market. And like other rural hospitals, Poplar Bluff has special challenges," Doyle writes. Missouri has some of the country's highest rates of obesity, diabetes, heart failure and smoking, with many residents having multiple chronic conditions. "About 70 percent of Poplar Bluff’s patients are Medicare or Medicaid patients, and the number of uninsured and under-insured patients is growing. The health reform law promised hospitals a windfall of expanded Medicaid coverage," but Missouri lawmakers have said they will not expand Medicaid.

The hospital is already struggling financially, with an annual revenue exceeding $720 million and a net income of about $24 million, Doyle reports. "But the hospital’s charity care and bad debt also have climbed significantly in recent years." The hospital is struggling to win over new patients, and without expanded Medicaid, drawing new patients could be even more difficult, because the hospital "will need to find new ways to triage their services for the poor and uninsured. To bridge that gap, hospital charges would surely increase for self-pay patients, and individuals covered by an employer’s health plan would need to chip in higher insurance premiums." (Read more)