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ruralamerica

Apr 07

Rural Emergency Hospital Program Could Resuscitate Hospitals on Life Support

By Make Health IT Easier

Rural Emergency Hospital Program Could Resuscitate Hospitals on Life Support 

Rural healthcare has been on life support for some time now and may have just received a lifeline that is too good to refuse. To no one’s surprise, rural hospitals struggled during the pandemic, but federal aid did manage to keep many afloat. According to a recent analysis, more than 180 rural hospitals have closed in the United States since 2005, with 19 closing in 2020 alone. Now while other industries are feeling like they are finally out of the woods from COVID-19, the aid rural healthcare once had is drying up, and more financial support is essential. The American Hospital Association (AHA) projected in September of 2022 that some hospitals may not make it.  

A large contributor to rural hospital closures is the cost of maintaining inpatient units, otherwise known as beds for patients who need to stay more than a few days. In most cases, patients requiring longer stays or complex surgeries will be transported to larger, higher acuity hospitals, leaving rural hospitals with only a few inpatient beds full. In comes CMS’ new Medicare provider designation for rural hospitals, the Rural Emergency Hospital (REH) program, which was implemented in January. The program requires rural hospitals to only provide emergency, observation, and potentially outpatient care, and transfer all inpatients (patients requiring lengths of stay longer than 24 hours), to a network of hospitals that provide higher levels of care.  

This will allow rural hospitals to adjust their healthcare infrastructure to fit their needs, while still providing the medical and emergency services their communities need. Rural and critical access hospitals that meet the conditions of participation will receive huge financial relief through a 5% payment increase for their services, a monthly facility payment, amounting to more than $3 million a year, a 3.8% pay increase for 2023 outpatient providers, and restored rates for medicines acquired by the 340B drug payment program.  

REH Program

Although the REH program will provide a much-needed lifeline to rural healthcare, nearly 1600 hospitals aren’t sold due to the requirement to cease inpatient services. These facilities argue that inpatient care is not only key income for the hospital but also an essential need for their patients. Under this program, patients that require inpatient care would be transferred to a large hospital in the closest city, which could be at capacity itself or difficult to travel depending on weather, roadblocks, and more; leaving the patients with only a few options – wait or travel out of state.  

The question many rural hospitals are now trying to answer is whether a hospital without inpatient services is better than no hospital at all. While it is unknown how many hospitals will eventually get on board with the REH program and how many will continue to provide for the needs of their community, even if that means financially suffering, a few other steps were taken in the last few months by policymakers to mitigate the closures.  

Spending Bill

In December 2022, Congress passed an omnibus spending bill that included a two-year extension of Medicare payment adjustments targeted toward rural hospitals. Additionally, the Center for Medicare & Medicaid Innovation (CMMI) is testing the Pennsylvania Rural Health Model which provides rural hospitals with an all-payer global budget and is intended to reduce costs, increase quality, and improve the sustainability of rural hospital finances. 

Mar 31

The Cost of Rural Hospitals Closures

By Make Health IT Easier

The Cost of Rural Hospitals Closures

As much as we’d all like to put the COVID-19 pandemic behind us, the world is still feeling the aftershocks of the havoc it wreaked and will for many years to come. Communities in rural America were hurting long before COVID, with 150 rural hospitals closing between 2005 – 2019. This tragedy was amplified by the pandemic. As patients sought care during the pandemic, they soon learned how limited their hospital options were, and the available hospitals were overrun with sick patients.

Financial Loss
Rural hospitals have been experiencing persistent financial loss and low financial reserves for years now, and COVID has only exasperated the issue. Although some steps have been taken by the government to help soften the blow, including financial assistance during COVID, which is soon to expire, now more than ever, we need solutions across the board. Out of 600 rural hospitals, 200 are in danger of closing in the next two to three years, according to the CHQPR survey, while 30% of those 600 facilities are at risk of closing in the future.

Some wonder what this means for our rural communities, but we should ask what this means for our Nation. When we really dive into the issues, we discover a vicious cycle. Operating at a loss is one thing, but that loss causes ripple effects for the rural community. Doctors and clinical staff are feeling burned out. With many “jumping ship” during the pandemic, hospitals are short-staffed and struggling financially, leaving doctors carrying a load of even more patients for what might be inadequate compensation. Unfortunately, it seems like there is little to no help on the way, as new doctors don’t want to work and live in rural America because of this.

Eventually, these hospitals can’t stay afloat any longer and must close their doors. Even in urban and suburban communities, hospitals are at risk of closure. These aren’t considered so bad, assuming that if one hospital closes, it is easy enough to go to another. But think about how many patients will now knock on the next door. This may mean more dollar signs to some, but this doesn’t mean more efficient patient care. To accommodate everyone, the facility will have to speed up care, which is when mistakes occur. Sadly, this proves to increase patient mortality.

Hospital Locations
In rural America, a hospital closure can be far direr. The average travel time to the nearest hospital is about 17 minutes compared to 12 minutes in the suburbs and 10 minutes in urban areas. Some in the farthest percentile average a 34-minute drive, with others over an hour. These 5 -10 minutes can make a huge difference in the outlook of a patient’s health. If the nearest hospital closes, it leaves many almost stranded, with the next closest hospital double or triple the distance. Another significant problem with hospital closures is that in rural America, hospitals are often the largest employers in the area, leaving many without jobs if their doors were to close.

Vicious Cycle
To close the loop on this vicious cycle, we must recognize the severity of this issue on our Country as a whole. Urban and suburban America relies on rural America for food, energy, and recreation. If this area of our Country’s health is declining, so will their ability to produce these essentials for the rest of the Nation. Some might think that rural hospital closings will not affect them, but here we see that we are all connected and that the opportunity to survive and thrive must be given to ALL American hospitals. Various lifelines are being extended by legislators that could save some of the rural healthcare, but there is no one size fits all approach.

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