Hospital Impact: How rural hospital closings weaken the nation's health

Editor’s Note: On Thursday, residents, schools, hospitals, community leaders and healthcare providers will celebrate National Rural Health Day. The nationwide observance was formed in 2011 by the National Organization of State Offices of Rural Health to increase awareness of rural health-related issues and bring national recognition to the important work of rural healthcare providers, State Offices of Rural Health and other rural stakeholders.

Approximately 1 in 5 Americans—62 million in total—live in rural areas and receive healthcare from rural providers. The closing of a rural healthcare facility is a community crisis, affecting residents, caregivers, employers and the community at large. The consequences for patients in decreased access to timely, quality care are obvious. Individuals living in or near the poverty line who receive crucial services from rural hospitals lose a vital safety net.

A troubling trend

The North Carolina Rural Health Research Program (NCRHRP) at the Cecil G. Sheps Center for Health Services Research, which tracks rural hospital closures, reported that 72 rural hospitals closed between January 2010 and April 2016, compared to 42 closures between 2005 and 2009. Since the 2008-2009 recession, the annual number of closures has increased each year. Many more are vulnerable to closure.

“When I came to this hospital 11 months ago, it was on the brink of closure and employees worried about their paychecks clearing."

The NCRHRP interviewed stakeholders about the impact hospital closures are having on their communities. According to an April 2015 brief (PDF) from NCRHRP, many rural residents are not receiving needed tests or care due to lack of transportation to get the services. Diagnostics tests and scans were the most commonly identified services that now required travel after the rural hospital closed.

Additional findings included:

  • Average travel distance to alternative locations was 25 miles from the closed hospital’s address. Some alternative locations were in neighboring states
  • Major and complex treatments like dialysis, cancer therapies and treatment for catastrophic injuries were also a concern
  • Overall, an increased distance to healthcare is perceived to be an issue for members of these communities

Less-obvious effects of hospital closings are the potentially devastating effects on the broader community when a hospital closes. Often, the local health facility is the largest employer. The National Center for Rural Health Works reported (PDF) the total economic impact of a typical Critical Access Hospital is 195 employees and $8.4 million in payroll. A study by the National Institutes of Health found that the closure of a rural hospital reduces per-capita income by an average of $703 and increases the local unemployment rate by 1.6 percent.

In survival mode

To fight back, rural hospitals are learning how to survive in a shrunken economy. Many now need to reset the expectations of their communities about what services they can provide and remain viable.

“When I came to this hospital 11 months ago, it was on the brink of closure and employees worried about their paychecks clearing,” said Charles Lovell, CEO of Barbourville ARH Hospital in Knox County, Kentucky.

First, the hospital's leaders conducted a comprehensive needs assessment and met with members of the community to determine what was needed to meet the community’s needs. Following strategic planning sessions, they decided to expand the hospital's services. So they worked with sister hospitals to bring in specialists, added speech-language therapy, occupational and physical therapies and created an outpatient psychiatric day program for older patients.

"I’m proud to say I believe we’ve turned the corner. You can’t put a price on being there for a patient having a seizure or a heart attack. It’s important for rural hospitals to remember their scope of practice--to provide good quality primary care,” Lovell said.

In many parts of the country, especially the South, numerous rural hospitals have closed. In the town of Edgefield, South Carolina, however, Edgefield County Hospital is among those still providing care to the local community thanks in part to an affiliation agreement with Self Regional Healthcare, a large nonprofit hospital in Greenwood.

“Many hospitals in rural areas don’t survive because they don’t replace family practice doctors who leave the community or retire, and when they leave that’s typically when the hospital fails,” said Edgefield County Hospital CEO Carlos Milanes. ”We were looking for ways to enhance services we provide locally, and we partnered with another provider to accomplish our goal and stabilize family practice doctors in our community.”

The affiliation enables Edgefield to participate in a group-purchasing plan that provides considerable savings on medical supplies and pharmaceuticals. The hospital also works closely with the South Carolina State Office of Rural Health, which regularly shares information about best practices and updates on legislative initiatives. Recently, the hospital was able to recruit a family physician from Self Regional’s Family Practice program, thereby eliminating costly recruitment fees.

“Valuable collaborations like this help save dollars and keep us viable,” Milanes said. 

Collaboration is a key role of each of the 50 State Offices of Rural Health, many of which are celebrating more than 25 years of service this year. With proactive leadership and targeted technical assistance, vulnerable hospitals and communities may be able to avoid closure by adopting innovative approaches to caring for their citizens.

National Rural Health Day is a time for all of us to learn from the innovative work of those hospitals and providers that are thriving in rural America. Learn more about rural health by listening in to webinars Thursday.

Teryl Eisinger is executive director of the National Organization of State Offices of Rural Health, a national nonprofit membership organization that represents the 50 State Offices of Rural Health around the nation. A longtime healthcare professional, Eisinger has worked in rural health and health promotion for underserved populations for the past 20 years.