The U.S. is a very large country. There are vast expanses of countryside – farm, prairie, mountain, coast – with low population density and small towns. The people depend on rural hospitals because they may be many hours away from large city hospitals.
Rural hospitals are part of the Macro economy. When rural hospitals close, it is medically and economically devastating for communities. They have supported one in every 12 rural jobs and contributed to about $220 billion in economic activity per year, according to the American Hospital Association. A community’s population typically shrinks soon thereafter.
Over 600 rural hospitals — 30 percent of the total — are at risk of shuttering. In 10 states, at least 40 percent of rural hospitals are in danger of closing.
A new federal program offers hefty payments to small hospitals at risk of closing. But it comes with a bewildering requirement.
By Emily Baumgaertner, The New York Times, Dec. 9, 2022
For 46 million Americans, rural hospitals are a lifeline, yet an increasing number of them are closing. The federal government is trying to resuscitate them with a new program that offers a huge infusion of cash to ease their financial strain. But it comes with a bewildering condition: They must end all inpatient care.
The program, which invites more than 1,700 small institutions to become federally designated “rural emergency hospitals,” would inject monthly payments amounting to more than $3 million a year into each of their budgets, a game-changing total for many that would not only keep them open but allow them to expand services and staff. In return, they must commit to discharging or transferring their patients to bigger hospitals within 24 hours.
The government’s reasoning is simple: Many rural hospitals can no longer afford to offer inpatient care. A rural closure is often preceded by a decline in volume, according to a congressional report, and empty beds can drain the hospital’s ability to provide outpatient services that the community needs…But bigger hospitals — bogged down with Covid surges, pediatric R.S.V. patients and their own financial woes — are increasingly unwilling to accept transferred patients, particularly from small field hospitals unaffiliated with their own systems…[end quote]
This is an issue on the remote north Olympic Peninsula where I live in a small town about 45 minutes away from a rural hospital that has inpatient beds. People I know have had less than stellar experiences at this hospital so I traveled to Seattle (2.5 hours each way) for my cancer care. (Thanks to DH who drove many times.) But I would not want to see the local rural hospital give up inpatient care for the many patients who can’t travel.
When a rural hospital is losing money, especially from inpatient care, what is the answer?