AHA: Rural hospitals facing growing challenges to financial stability

While rural hospitals face unique challenges to delivering healthcare, a number of emerging issues—from the opioid epidemic and cybersecurity threats to high drug costs and workforce shortages—could exacerbate their financial instability, according to a new report.

That report from the American Hospital Association, released in conjunction with its Rural Health Care Leadership Conference this week, warns that these challenges to rural hospitals could threaten the economies of communities around them.

"Many rural hospitals, especially those with very limited resources, become overburdened as challenges intensify, accumulate, and compound each other," the report says. "Moreover, the issues of today may hinder rural providers’ preparedness for the challenges of tomorrow."

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In addition to larger shifts across healthcare, such as transitions from inpatient to outpatient care for many services, impacting rural hospitals, the AHA identified the following emerging challenges and threats:  

  • Opioid epidemic: There is an outsized impact on rural heatlhcare when it comes to the opioid crisis, the report says, citing a Centers for Disease Control and Prevention report that the rates of deaths from drug overdoses in rural areas were rising to surpass rates in urban areas in 2017.
  • Violence in communities. "To prepare for incidences of mass violence, many hospitals conduct preparedness drills with local law enforcement," the report says.  "Hospitals are also dealing with a wave of violence within their walls, sometimes directed at employees." It also cites human trafficking as an example of violence that is increasing in rural communities.
  • Medical surge capacity. While hospitals have always had disaster plans in place, there has been an uptick in incidences of hurricanes, wildfires, flooding, and threats of viruses like Ebola and Zika that have increased the need for improved emergency preparedness, the report says. "Although rural areas are not immune to natural disasters, terrorist attacks and epidemics, these communities may not be adequately prepared for large-scale events if they lack sufficient medical staff and resources to respond to such emergencies," the report says.

  • Cyberthreats. "Increasingly, bad actors are using phishing emails, malware, vendor access and other tactics to attempt to attack hospital computers, networks and connected devices," the report says. "Protecting information and appropriately responding to threats creates significant indirect costs for hospitals and can require individuals with specialized skills."

The AHA is calling for policies to improve Medicare and Medicaid reimbursement to cover the cost of care, as well as new models of care that improve financial predictability and include rural providers in the movement toward value-based care.

They're also calling for expanded access to telehealth services and ensuring health information technology costs and compliance requirements are addressed to ease the burden on rural hospitals, as well as workforce programs targeting rural areas hit hard by provider shortages.