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NRHA CEO: Back to normal 'is not sustainable' for rural health

The financial vulnerability of rural hospitals has been well-documented over the past decade. As of 2018, about 41% of an estimated 2,454 rural hospitals were unprofitable according to an analysis of rural hospital profitability from the Cecil G. Sheps Center for Health Research in North Carolina.

The number of rural hospital closures hit a historic high in 2019 with 18 closures, followed by 19 closures in the first year of the pandemic, according to researchers.

Experts initially feared the strain on already depleted health care resources would be exacerbated by COVID-19, prompting more closures. But over the last year, those numbers have dwindled.

Two facilities closed last year and one hospital has closed so far this year.

The drop-off has been largely attributed to an influx of federal emergency funding.

In 2020, hospitals in rural and urban areas reported receiving over $32 billion in federal support from the Provider Relief Fund, in addition to $8.5 billion from the American Rescue Plan and distributions from the Payment Protection Program.

"I don’t know that we would have been able to do what we were able to do without that funding," said Ruby Kirby, CEO of Camden General Hospital and NRHA member Bolivar General Hospital in West Tennessee.

Notably, the Medicare sequestration was halted, providing additional relief for rural hospitals.

But these measures were only a stopgap, said Alan Morgan, the CEO of the National Rural Health Association. Federal funding is expected to dry up this year, and the moratorium on the Medicare sequestration is scheduled to end in June.

“It is not an understatement to say the federal response saved rural health. But we are back to a pre-pandemic environment, which is not sustainable for the future,” Morgan said.

Solving the workforce shortage is crucial for rural hospitals’ survival, Morgan said.

By 2026 there will be a shortage of 3.2 million health care workers in the U.S., according to the American Hospital Association.

“We had challenges in the past, but now you have incredible workforce shortages combined with an unsustainable salary structure and no federal support directed at that,” Morgan said. “The numbers don’t work for the long term.”

Michael Topchik, director of the Chartis Center for Rural Health, said the rural hospital crisis will continue in states that refuse to expand Medicaid.

“That really has disproportionately hamstrung the rural hospitals in the South,” Topchik said.

Other potential solutions include expanding telehealth, forming affiliations with larger health care systems, and expanding the workforce of nurse practitioners, community health care workers and physician assistants in rural areas.

Kirby said her hospitals have worked to educate communities on the importance of preventative care as a way to lower patient costs.

"I wish there was a silver bullet," Kirby said. "We want people to remember rural hospitals and what we do and the services we provide in our community that nobody else is out here to do."

NRHA adapted the above piece from a May 26 article in The- Tennessean entitled "Rural hospitals in the South face uncertain post-pandemic future"

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