Rural hospitals face tough choices, and no option is 'a slam dunk'

Only 15 out of 600 hospitals have converted to the Rural
Emergency designation. (Photo by Adhy Savala, Unsplash)

With many rural hospitals facing financial crises, some have opted to end inpatient stays and convert to emergency services care. In another case, a hospital has gotten creative -- turning to crowdfunding -- to keep its doors open.

In January, The Centers for Medicare and Medicaid Services offered a new payment model where federal payments to qualified hospitals would increase if centers gave up inpatient care. As of October, "Just 15 facilities have taken the federal government up on its offer, reports McKenzie Beard of The Washington Post. "That's a fraction of the more than 600 rural hospitals that the nonprofit Center for Healthcare Quality and Payment Reform estimates are at risk of closing in the near future."

The Rural Emergency Hospital designation seeks to stem hospital closures by offering different payment incentives; however, "for a rural hospital to switch to the new payment model, its state legislature must first pass legislation regulating the program," Beard writes. "Of the 15 hospitals that converted this year, all but two are located in the South. Texas and Mississippi lead the pack with five and two rural hospital conversions, respectively. At the same time, Sturgis Hospital in Michigan and South Central Kansas Medical Center in Kansas are the only facilities in the Midwest to make the switch."

Hospitals that opted to convert are already seeking legislative program changes, and the switch is not a "a slam dunk," Beard reports. Carrie Cochran-McClain, chief policy officer at the National Rural Health Association, told Beard, "It's definitely not the panacea."

Clinton County, pop. 38,000
(Wikipedia map)

Hospitals can face unexpected financial setbacks and lack additional funds to buffer losses. Bucktail Medical Center, in western Clinton County, Pennsylvania, is one of those hospitals. "First, one of its employee retention credit applications, worth up to $400,000, was delayed. That filing became mired in a bureaucratic chain of events that meant a delay of up to 14 months," reports Liz Carey of The Daily Yonder. "Next, the Pennsylvania Department of Human Services sent a notice that it had overpaid the hospital in 2018, and they needed to pay back $255,000."

In total, the hospital faces a $1.5 million shortfall. "Without some short-term funding, Tim Reeves, the hospital's administrator, said, the hospital may be forced to close," Carey writes. "The idea to put a fundraising call out on GoFundMe came from one of the hospital's board members, he said. So far, the campaign has raised just over $15,500. . . . Still, the hospital is working with its state legislators and Congressmembers to get some help."

"At 85 employees, it is the largest employer in western Clinton County. The impact of the hospital closing would be devastating for the county, Reeves said. As he works on a short-term solution, there are long-term decisions America has to make about healthcare in rural areas, he said." Reeves told Carey: "I think as a society we need to make a choice – do all Americans deserve the same level of health care? Are we okay with the disparity where you may receive a lesser quality of health care because of where you decide to live?"