A Sense of Alarm as Rural Hospitals Keep Closing

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Specializes in Geriatrics, Home Health.

Rural hospitals keep closing, particularly in states that rejected Medicaid expansion.

Hospitals are often thought of as the hubs of our health care system. But hospital closings are rising, particularly in some communities.

"Options are dwindling for many rural families, and remote communities are hardest hit," said Katy Kozhimannil, an associate professor and health researcher at the University of Minnesota.

Beyond the potential health consequences for the people living nearby, hospital closings can exact an economic toll, and are associated with some states' decisions not to expand Medicaid as part of the Affordable Care Act.

Since 2010, nearly 90 rural hospitals have shut their doors. By one estimate, hundreds of other rural hospitals are at risk of doing so.

In its June report to Congress, the Medicare Payment Advisory Commission found that of the 67 rural hospitals that closed since 2013, about one-third were more than 20 miles from the next closest hospital.

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I've lived and worked in a rural part of NC most of my career, and also traveled around the state visiting small hospitals in other rural communities as a hospital surveyor for the state and CMS. Not only are those hospitals the main source of healthcare in those communities, with the nearest "city" hospital sometimes two or three hours' drive away, but they are also often (usually) the biggest employer in those communities, as the article notes. The hospital closing is not only a loss of healthcare services, it is a huge economic blow to the area generally.

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Specializes in ICU/community health/school nursing.

When I was a public health nurse, the one rural hospital in four counties quit providing labor and delivery services. Because of EMTLA, a few deliveries occurred in the ER but the closure of that wing was really chilling for the community for years. People had to drive across counties for care. The hospital eventually merged with a big system, and they're delivering babies again. The downside is that the system created a monopoly and when a local insurer got into a beef with the reimbursement office about rates, a good portion of folks had to leave the county again for hospital services. There's no upside.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

As a medic, when I worked in some counties, it was COMMON to have EMERGENCY transports of 25-40 miles to the closest hospital. Imagine having to add another 30 miles to that - yeah, that's a recipe for bad things.

Think about that. Someone is trying to die and I've got some big real estate to cover to get them to the hospital alive.

An ambulance running, red lights sirens for miles - and someone you love in critical condition - and you are following that ambulance for 20, 30, 40, 50 miles. Excruciating.

Healthcare should be a right. Accessible. Affordable.

Small hospitals are ESSENTIAL.

I think Congress, Governors, State Lawmakers shouldn't have Cadillac on demand care. Do they get the best - you bet? Their health is valued, their pain is treated, they get treated in top rate facilities, by top docs. This is wrong.

They don't have to search for a MD that will see them in 3 weeks and participates in their "plan". Or drive through 3 counties to get to "care".

They (and their family) should have to spend a year on their state's public plan. Once that happens, healthcare will become funded, accessible.

And small hospitals will have a chance.

They don't know what they don't know. Once they know, by having lived it, the limitations of scant healthcare - all lawmakers will act.

Or something.

:angel:

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