For her newspaper and its chain, a rural editor investigates health reform's effect on rural hospitals

In an example of good enterprise reporting, Cristina Janney, managing editor of the daily McPherson Sentinel in the town of 13,000 in central Kansas, spent four weeks researching and writing about federal health reform's effect on rural hospitals as part of a project with the paper's owner, GateHouse Media.  (Janney photo: Marcy Hospital in Moundridge has kept obstetrics although it makes no money from it. Many other rural hospitals have eliminated the department.)

Cristina Janney

In an extensive story, Janney explains how the law works, and how it affects rural hospitals, many of whom are already struggling financially, and could be hurt even further through the act, especially in a state like Kansas, which chose not to expand Medicaid. "Rural hospitals rely on Medicare payments – which primarily cover older people – for almost 45 percent of their annual income," she writes. " "Hospital administrators say they will have to change services and staffing to become more efficient and put more resources into primary care to reduce unnecessary hospital admissions. Administrators also say the changes will be difficult at a time when rural hospitals already face tough economics. Rural hospitals work on a much smaller scale than their urban counterparts and so have a history of operating on small margins." (Read more)

Janney did a Q-and-A story with basic facts about the Patient Protection and Affordable Care Act, and wrote rural stories on a national level, about the struggles of Perry Memorial Hospital in Illinois and Barton Memorial Hospital in South Lake Tahoe, Calif., and how the hospitals are trying to cope with changes. Both states expanded Medicaid.

"Perry Memorial Hospital will close its obstetrics unit at the end of the year after 93 years of delivering babies," Janney writes. "The small Princeton, Ill., hospital lost $500,000 on its obstetrics program last year. Under the Affordable Care Act’s new payment rules for Medicare, which primarily covers people over 65, and previous federal budget cuts under sequestration, the hospital is also facing $1 million in federal cuts." The hospital averaged 380 deliveries a year 15 years ago, but now averages 100 per year. The nearest hospital with an obstetrics department is 25 miles away. (Read more)

The California hospital is concerned about re-admissions, "one of the measures that will be tracked and tied to payments" with hospitals facing fines "as high as 3 percent of hospitals’ billings by fiscal year 2015," Janney writes. The hospital has trained four registered nurses as health coaches to make home visits to "review the patient’s case and care, including background on the illness and medications, and to answer any questions. The health coach also helps to arrange any follow-up visits with a primary care provider or specialists, and checks back by telephone on day 2, 4, 7, 14 and 30 after discharge." (Read more)