Probe, map detail struggles of rural Midwest hospitals; Ky. hospital shows value of diversification, expanded Medicaid

At least 155 rural hospitals have closed since 2005, as shown on this map. Dots are sized by the number of beds in each hospital. (Map by The Conversation; click on the image to enlarge it, or click here for the interactive version.)

"Small rural Midwest community hospitals, squeezed by financial and regulatory pressures, are scaling back on services, merging with larger hospital systems and searching for other creative ways to survive in the short term," Jennifer Hemmingsen of IowaWatch reports, in part of an Institute for Nonprofit News investigation by 12 news organizations in seven states.

Nationwide, 113 rural hospitals have closed since 2010, including 16 so far this year. Most of the closures have been in Southern states, especially those that rejected Medicaid expansion under the Patient Protection and Affordable Care Act. "But even in the Midwest, 16 percent of rural hospitals rank high or mid-high on a financial stress index developed by University of North Carolina Cecil G. Sheps Center for Health Services Research," Hemmingsen reports. "Navigant, a consulting firm with clients that include hospitals and state hospital associations, crunched the numbers in a different way – looking just at operating margins, cash on hand and debt — and concluded that 18% of rural hospitals in 12 Midwestern states were at high risk of closing unless their finances improved."

The series looks at strategies some rural Midwestern hospitals are employing to stay open, including merging with larger health systems or bringing in specialists like obstetricians a few times a month. It also looks at the economic impact hospitals have in rural areas, where they're often the largest local employers. And, the series examines policy proposals that could help rural hospitals.

Meanwhile, Taylor Sisk reports for The Daily Yonder on the contrast between two Appalachian-foothills hospitals separated by 24 miles and the border of Kentucky (which expanded Medicaid) and Tennessee (which didn't). The Tennessee hospital recently closed, but the Kentucky hospital is doing well -- not just from Medicaid expansion, but diversification into a pharmacy and doctors' practices. And Parker Schorr of Wisconsin Watch reports that a critical-access hospital in Nellisville survived by becoming part of the huge Marshfield Clinic Health System.