Baldy wrote:Rural hospitals in critical condition
RICHLAND, Ga. — Stewart-Webster Hospital had only 25 beds when it still treated patients. The rural hospital served this small town of 1,400 residents and those in the surrounding farms and crossroads for more than six decades.
But since the hospital closed in the spring of last year, many of those in need have to travel up to 40 miles to other hospitals. That's roughly the same distance it takes to get from Times Square to Greenwich, Conn., or from the White House to Baltimore, or from downtown San Francisco to San Jose.
Those trips would be unthinkable for city residents, but it's becoming a common way of life for many rural residents in this state, and across the nation.
Since the beginning of 2010, 43 rural hospitals — with a total of more than 1,500 beds — have closed, according to data from the North Carolina Rural Health Research Program. The pace of closures has quickened: from 3 in 2010 to 13 in 2013, and 12 already this year. Georgia alone has lost five rural hospitals since 2012, and at least six more are teetering on the brink of collapse. Each of the state's closed hospitals served about 10,000 people — a lot for remaining area hospitals to absorb.
The Affordable Care Act was designed to improve access to health care for all Americans and will give them another chance at getting health insurance during open enrollment starting this Saturday. But critics say the ACA is also accelerating the demise of rural outposts that cater to many of society's most vulnerable. These hospitals treat some of the sickest and poorest patients — those least aware of how to stay healthy. Hospital officials contend that the law's penalties for having to re-admit patients soon after they're released are impossible to avoid and create a crushing burden.
"The stand-alone, community hospital is going the way of the dinosaur," says Angela Mattie, chairwoman of the health care management and organizational leadership department at Connecticut's Quinnipiac University, known for its public opinion surveys on issues including public health.
Rural hospitals closing, health professionals losing jobs, the poor and elderly losing access to health care, doctors closing private practices, consolidating auxiliary providers. All this is jon's definition of a resounding success.
Meh…rural hospitals and communities have been in decline for decades. There are many factors outside of the ACA and some programs within it that could actually assist.
The ACA Provisions Directly Affecting Rural Hospitals
Although the health care reform law was not tailored to suit the specific needs of rural and critical access hospitals, such providers are poised to benefit from the law. Here are a few examples of provisions covering rural hospitals.
340B program expansion: Critical access hospitals now can participate in the federal government's 340B drug discount program, meaning they can receive certain outpatient prescription drugs at a lower price.
Accountable care organizations: Just like other hospitals, rural facilities can create ACOs, which are designed to help coordinate services and improve efficiency and offer the possibility of shared savings.
Health insurance exchanges: The ACA's health insurance exchanges were touted as a way to help achieve universal coverage and reduce the amount of uncompensated care provided. Rural areas generally have higher numbers of uninsured residents, meaning providers in those areas could benefit from an increase in health coverage.
Pilot projects to test new care models: The ACA established several demonstration projects, including the frontier community health integration project demonstration, which aims to develop and test new care models in rural areas to improve health outcomes and reduce Medicare costs.
Value-based purchasing program: Critical access hospitals must be included in the program's quality reporting requirements and measurements by 2012, which would increase transparency of hospital practices.
The ACA Provisions That Missed Expectations
Not all of the ACA's promised improvements for rural hospitals have become reality.
According to Kaiser Health News, fewer than one in 20 critical access hospitals are part of an ACO. Leah Binder of the Leapfrog Group said that many rural hospitals do not have a large enough patient base to form ACOs and, therefore, struggle to take part.
Meanwhile, the frontier community health integration pilot has been limited to five states -- Alaska, Montana, Nevada, North Dakota and Wyoming -- and no critical access hospital participants have been announced yet.
Further, Congress has yet to provide funding for critical access hospitals to receive bonuses or penalties based on quality.
Priya Bathija, senior associate director of policy at the American Hospital Association, told California Healthline that "there is a sentiment from critical access hospitals that they want to participate in those programs, and some are publicly reporting their quality data." She noted that critical access hospitals could benefit from such a program that takes into account the hospitals' lower patient volume.
Another challenge for rural hospitals is that the Supreme Court's ruling to allow states to opt out of the law's Medicaid expansion has created a greater financial burden on hospitals in non-expansion states, Bathija said. A findings brief from the NC Rural Health Research Program notes that of the 11 states not expanding Medicaid at the time of its research, six -- Arkansas, Maine, Mississippi, Montana, South Dakota and Wyoming -- had more than 20% of their populations residing in rural areas.
Holmes, also an associate professor of health policy and management at the University of North Carolina-Chapel Hill, said, "Rural areas were generally more uninsured and although a lot of [ACA] provisions were designed to mitigate that gap in some states," it has gotten worse because some states with large rural populations declined to expand their Medicaid programs. According to Holmes, it's "not a design or implementation issue, that is just how things transpired."
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