To them, conversion is better than closing: First rural hospitals begin converting to emergency-services-only

Administrator Christina Campos, center right, speaks to emergency-
department staff at Guadalupe County Hospital. (Adria Malcolm, KHN)

To avoid closure, some rural hospitals are choosing to adapt by transitioning into a Rural Emergency Hospital. "The designation was created as part of the first new federal payment program launched by the Centers for Medicare & Medicaid Services for rural providers in 25 years," reports Sarah Jane Tribble of Kaiser Health News. "And though it is not expected to be a permanent solution to pressures facing rural America, policymakers and hospital operators alike hope it will slow the financial hemorrhage that continues to shutter those communities’ hospitals."

CMS wouldn't tell Tribble which hospitals have applied, but she reports that one in Crosbyton, Texas, has been approved, that two in Perry and Blackwell, Okla., will apply; and that Guadalupe County Hospital in Santa Rosa, New Mexico, which has been named one of the nation's best rural hospitals, has applied. She uses it as her object example. 

Guadalupe County (Wikipedia)

"It’s the only hospital for the more than 4,500 people living on a swath of 3,000 square miles of high plains and lakes east of Albuquerque [and] has for decades provided emergency care for a steady flow of people injured in car crashes and ranching accidents," Tribble reports. Hospital Administrator Christina Campos told her, “For years, we’ve been anticipating kind of our own demise, praying that a program would come along and make us sustainable.”

Tribble reports, "Facilities that convert will get a 5% increase in Medicare payments as well as an average annual facility fee payment of about $3.2 million in exchange for giving up their expensive inpatient beds. Dr. Paula Chatterjee, a med-school professor at the University of Pennsylvania, said outpatient and emergency visits already make up about 66% of Medicare payments for rural hospitals that are eligible to convert. . . . Still, she found that many would likely need to scale up some outpatient services . . . Even then the payment model might not be able to shift the 'foundational pressures' of declining, aging, and sicker populations that are making it hard to deliver care in rural America she said." Chatterjee told Tribble, "This feels like rearranging deck chairs on the Titanic."

Hospital administrators worry that there will not be enough ambulances to transport more critical cases, and patients that need inpatient care will have to travel long distances, Tribble reports. Brock Slabach, chief operations officer for the National Rural Health Association, told Tribble, “It’s enough for now. But is it going to be enough for the long term? I don’t think so." Tribble adds, "The federal law will need to be amended to help larger rural hospitals with more overnight stays . . . .Top priorities for the group include adding the ability for hospitals to participate in a federal drug discount program and allowing for longer patient stays."