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Rural hospitals face an uncertain autumn

Autumn is here. The nights are cooler and football is back. Enough to brighten the mood of anyone worn down by a hot, muggy summer, unless your favorite football team lost, that is. But the season isn’t looking bright for 26 rural hospitals that shuttered operations across the United States since 2013. That’s more closures in just the last 19 months than the total between 2003 and 2012. These communities are struggling to overcome the absence of vital health services and the economic loss of local jobs. American Public Media’s Marketplace featured a look at this epidemic earlier this year. This poignant story, “When rural hospitals close, towns struggle to stay open,” tracks what happened to Sparta, Ga., when its rural hospital closed 14 years ago. When Sparta attempts to recruit industry, the first question asked by a company executive is “do you have a hospital?” A Georgia state senator wept describing the dire situation: “[It] ends up with rural communities, such as Hancock County, Ga., where 39 percent of the folks who have a stroke or have a heart attack die. That’s a lot higher than in counties with hospitals close by.” It is believed that many more rural hospitals are teetering on the edge of closure. Evidence reveals that 66 percent of the nation’s 2,323 rural hospitals are operating at a financial loss, according to iVantage Health Analytics. A rural hospital in Washington State is seeking a special tax levy to keep its doors open. Another rural hospital in Tennessee is in danger of closing unless it finds another operator. Imagining a future for these 26 rural communities whose hospitals have closed is difficult. Sparta may offer a glimpse for what awaits. However, legislators and policymakers at the state and federal levels have the tools to alter the forces that have collided to create this reality. NRHA suggests a two-pronged approach to reversing these dismal trends. The first prescription is to do no harm. Congress should not make any further cuts to rural hospital and practitioner reimbursements. The uncertainty around rural provider reimbursement programs causes rural providers to focus on the short term at the expense of their long-range planning. This means settling the Sustainable Growth Rate formula permanently, extending the Medicare-dependent hospital and low-volume hospital programs, making no changes to the critical access hospital program as well as other payment structures that help keep rural hospitals solvent. Once providers are assured of several years of constancy with reimbursement programs, we can then focus on NRHA’s second objective, transforming rural delivery systems based on community need. This requires a creative and dynamic process that focuses on population health and alters the trajectory of current trends in rural communities. NRHA is actively engaged in this important two-pronged approach to solving the seemingly intractable problems of hospital closures. It is our hope and expectation that legislators and policymakers will work with us toward achieving these important goals. Join us Sept. 1-Oct. 3 for NRHA’s 13th annual Critical Access Hospital Conference to learn more about the closure crisis and how you can help prevent more rural hospitals from closing their doors.

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