Tuesday, December 13, 2022

Feds offer rural hospitals 'excruciating choice' of a lot more money in exchange for becoming a glorified first-aid station

Rural hospitals are a lifeline for 46 million Americans, yet an increasing number of them are closing, a situation that has prompted the federal government to initiate a new program that will offer a huge infusion of cash to more than 1,700 of them, but comes with the condition that they must end all inpatient care, "an excruciating choice," Emily Baumgaertner reports for The New York Times.

Any hospital that accepts this deal would become a "rural emergency hospital," allowing it to get monthly payments totaling more than $3 million a year and get higher Medicare reimbursements.  For many, that would be a game-changer "that would not only keep them open but allow them to expand services and staff," Baumgaertner writes, but "In return, they must commit to discharging or transferring their patients to bigger hospitals within 24 hours." 

The rationale: "Many rural hospitals can no longer afford to offer inpatient care," she writes. "A rural closure is often preceded by a decline in volume, according to a congressional report, and empty beds can drain the hospital’s ability to provide outpatient services that the community needs."

Harold Miller, president of the nonprofit Center for Healthcare Quality and Payment Reform, told the Times: “On one hand, you have a massive incentive, a ‘Wow!’ kind of deal that feels impossible to turn down. But it’s based on this longstanding myth that they’ve been forced to deliver inpatient services — not that their communities need those services to survive.”

Critics of the plan told the Times that officials behind the new program are out of touch with the difficulties of transferring patients, noting that bigger hospitals are increasingly unwilling to accept transferred patients, particularly from small field hospitals that are unaffiliated with their own systems. Add to that, they pointed to other challenges, including blizzards, downed cattle fences and mountain pass roads that are closed for months at a time. 

She also tells stories of how rural hospitals have saved patients when the hospital couldn't find another one to take the transfer and how rural hospitals routinely care for patients with chronic conditions like congestive heart failure or when they need rehabilitations. In essence, keeping these patients closer to home for their extended care. 

“I really want to give this policy a chance to work well,” Katy Kozhimannil, director of the University of Minnesota Rural Health Research Center, told the Times. But gambling with transfers could mean that “some of the most extremely remote and marginalized communities could end up with no care at all — and that’s what we were trying to avoid in the first place.”

More than 180 rural hospitals have closed in the United States since 2005, according to a recent analysis, with a record 19 closings in 2020 alone. In 2021, the number plummeted to just two, but the more than $15 billion in pandemic-era federal aid was injected into rural hospitals to keep them open will mostly expire Dec. 31.

"Over 600 rural hospitals — 30 percent of the total — are at risk of shuttering," Baumgaertner writes. "More than 200 could close within three years, according to a study by the Center for Healthcare Quality and Payment Reform. In 10 states, at least 40 percent of rural hospitals are in danger: In Kansas, 16 could close within three years; in Mississippi, 24."

The office of Senator Charles E. Grassley, Republican of Iowa, who is one of the lawmakers behind the program, said in a November statement, “The goal is to preserve patient access to emergency medical care in rural areas that can no longer support a fully operational inpatient hospital.” There are no exceptions for maternity hospitals. The new option becomes available Jan. 1.

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