New rural hospital model could save communities and jobs
When the Pickens County Medical Center closed weeks before the first wave of the COVID-19 pandemic, the local pharmacy felt it immediately.
It was one of several businesses in Carrollton, which has about 1,000 residents in western Alabama, that had to lay off employees and cut spending after the 56-bed hospital closed. Carrollton Drugs had a contract with the hospital to fill prescriptions for the facility’s approximately 200 employees.
Every business from agco-op to coffee has been affected by the shutdown, said David Handley, owner of Carrollton Drugs and another pharmacy in Reform, Alabama.
“It was a huge financial and economic blow to this community,” said Handley, who served as director of pharmacy at Pickens County Medical Center for about 20 years. “The emotional toll was huge too. People were worried because they didn’t know what to do when mum falls and breaks her hip, when someone has a stroke or when there’s a bad car accident. “
Pickens County is one of more than 100 rural communities that saw their annual income, population and workforce decline after their hospitals closed, new research shows.
According to a To analyse comparing 109 rural counties that experienced hospital closures between 2001 and 2018 and 1,650 rural counties that retained their hospitals. Hospitals that converted to stand-alone emergency departments or outpatient centers had limited economic fallout, according to the study published Monday in Health Services Research.
“My co-authors and I believe that converting hospitals should be considered an alternative to complete closure,” said study lead author Tyler Malone, a doctoral student in health policy and management at the University of North Carolina.
Ninety-eight rural hospitals across the country have closed since 2005, according to UNC Data. Another 83 hospitals transitioned from inpatient care to outpatient and emergency services during this period.
Pickens County Medical Center was one of the most recent hospitals to close. It had an unsustainable mix of too few patients, reduced federal funding and a growing number of uninsured patients, the Pickens County Health Care Authority said in a news release when the hospital closed in March 2020. hospitals tend to do worse financially in states like Alabama. , which decided not to expand Medicaid.
“(Rural) hospitals are often the biggest employer in the community – it’s scary when you shut down,” said Jeff Goldsmith, president of consultancy Health Futures.
Short of closing, rural hospitals have had to carve out some services to stay afloat. Nearly 200 rural hospitals stopped providing obstetric care from 2011 to 2019, while nearly 300 rural hospitals discontinued chemotherapy treatment from 2014 to 2020, according to data from the Chartis Center for Rural Health show.
As a result, residents had to travel further afield for treatment, which adversely affected their health.
“I know of two recent cases — one where a child and another where a teenager were trying to get to the DCH Regional Medical Center in Tuscaloosa about 35 minutes away — and they were unsuccessful,” Handley said. “We now have an ambulance in this county, and whether it’s on call or sitting in DCH, families have to pile into their cars to get to the nearest health facility.”
Rural hospital closures worsen health inequities, studies show. Rural counties that lost their hospital between 1990 and 2020 had higher proportions of black and Hispanic residents compared to the median of all rural counties, linked research published in March by the NC Rural Health Research Program found. According to the working paper, these same counties were also more likely to have above-median levels of income inequality, lower per capita income, and higher unemployment.
This trend explains, in part, why black and Latino people living in rural areas are more likely to die prematurely or experience poverty, especially among children, according to Chartis.
“If you lose a rural hospital, you’re talking about downtown tumbleweeds. That means Main Street is drying up and blowing away because the affiliated health services can’t survive for very long without a safety net for acute care,” said Michael Topchik, national leader for Chartis. “Lack of access means delayed care, poorer outcomes and more expensive acute care down the road when things could have been taken care of more locally.”
Rural hospitals are trying to keep patients in their communities and avoid service cuts. They have partnered with nearby academic medical centers to try to maintain services through video consultations. Alternatively, more facilities should convert to stand-alone emergency departments or outpatient centers, which could provide a buffer for local economies, policy experts said.
Operating costs, often subsidized by taxpayers, decline when hospitals end inpatient care. Their quality may also improve as they focus on a more limited range of services, said Ge Bai, an accounting professor at Johns Hopkins University who has studied rural hospital closures.
“This transformation makes hospitals financially healthier and better able to serve the local community and reduce the burden on taxpayers, without harming local economies,” she said.
Critical access hospitals and rural hospitals with fewer than 50 beds can upgrade to the new rural emergency hospital status. It aims to support rural hospitals with very low inpatient volumes, which averaged around 38% in 2016, according to research from Modern Healthcare.
They would stop offering all of their inpatient care and instead offer outpatient services, including 24-hour emergency care, observation services, nursing services and ambulances. Beginning in 2023, these hospitals would receive a 5% higher Medicare outpatient reimbursement rate than full-service hospitals receive, in addition to monthly facility payments.
The annual income and unemployment rate of counties where rural hospitals converted their inpatient operations to emergency, rehabilitation or outpatient care improved after the conversion, according to the study. Effects on population and labor were negligible. But it remains to be seen if these models are viable in the long term, Topchik said.
Meanwhile, Carrollton residents like Debra Sudduth have faced health emergencies without a local safety net.
Sudduth’s father suffers from atrial fibrillation. Her pulse dropped significantly Monday night, but the nearest hospitals in Tuscaloosa or Columbus, Mississippi, were overwhelmed, she said. Luckily, they were able to stabilize him at home and track his pulse with an oximeter, Sudduth said.
But last month, a complication arose from its removal. Her heart filled with blood and caused an infection. An ambulance was not available and they had to drive about 45 minutes to Tuscaloosa Hospital, Sudduth said.
“He ended up being fine, but what if he hadn’t? You have a lot of old people here driving 45 minutes when an ambulance isn’t available, it’s just dangerous.”
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