How some rural hospitals thrive

Under myriad pressures, an increasing number of rural hospitals are either shutting their doors or joining up with large systems. Some, though, continue to do quite well as independents.  Scores of rural hospitals around the country have closed in the last six years, but Southeastern Health’s 452-bed main facility and 30 primary care and specialty clinics remain open. That gives Langley the ability to focus on local care. The challenges to viability are many. According to the University of North Carolina’s Cecil G. Sheps Center for Health Services Research, 78 rural hospitals have shut down since January 2010. Fifty-one of those were in the South. Many rural communities have declining, aging populations, and rural hospitals receive a higher percentage of patients with no health coverage than their urban counterparts. They also tend to operate on tighter margins– tighter still in the aftermath of the March 2013 federal sequestration. Further cuts came when the federal government reduced the bad-debt reimbursement Medicare pays to hospitals for shouldering much of the cost of care for those who can’t afford it. This was done with the assumption that Medicaid expansion would help offset the lost revenue – which might at least partially explain so many closures in the South. Nineteen states have chosen not to expand Medicaid, 10 of them in the South. Mark Holmes, director of UNC’s Sheps Center, said there’s a lot of overlap in the map of where hospitals have closed and of states that haven’t expanded Medicaid. But, he cautioned, “I think it’ll be awhile before we can know for sure” the extent to which the closures can be directly attributed to decisions not to expand Medicaid.