Access to Care: A Small-Town Example

Sometimes we neglect the importance of our hospitals in our communities.

EDITOR’S NOTE: Sharon Easterling, the newest member of the ICD10monitor editorial board, will be reporting on health equity while also sharing thoughts about her personal experiences as a Black woman working in the healthcare industry. 

We all think small towns are a great place to go when you are ready to hang up that coding, clinical documentation improvement (CDI), or physician advisor hat, right? Ahhh … if only to kick back on that front porch or fire up that grill in the backyard with the birds singing and the grandkids playing in the yard. Sounds like the life, right?

Well, maybe, but…maybe not. You see, I’ve lived in a few beautiful small towns. Sometimes I do think I would love to move back and take in nature again. But then I reflect on what has happened over the past few years. Could it be the limited access to care causing me to pause and rethink that?

You may say wait…why would you say that? Well, let me give you some insight into healthcare in small-town America.

In 2015, it was decided to close a small-town local hospital in Marlboro County, South Carolina. With the closure, patients were routed to two hospitals in neighboring towns, 15 and 20 miles away from the closing hospital. You may think that does not sound like so big an issue, but we are talking about a very rural county with high population density. That equals more miles to cover between people and hospital.

Hospitals began to consolidate and close around the U.S. around this same time due to the impact of insurance changes, recovery audits, and economic challenges. Fast forward to 2021, and this disruption in healthcare has continued, and we continue to see the fallout even though there have been some success stories. Some hospitals still struggle to stay open due to revenue challenges, and have difficulty maintaining adequate staff and resources.

We all know that if there are no hospitals, there are fewer physicians. As you can see below (Table A), something changed within the county. There is drastic impact to access for primary care. In Marlboro County, starting around 2019, there were well over 5,000 patients for one primary care physician. This, of course, causes delays in care, no care, late referrals, decreased trust, and impact on chronic conditions: in other words, poor outcomes. This is a problem all over the United States, but it is in my thoughts because of the personal connection. I worked at the hospital and saw the needs of the community challenged by the closure of major industries. I also wonder how this is affecting the Black community, as the demographic most impacted by economic disadvantage nationwide.

Table A

The chart above immediately made me think about how residents are faring with chronic conditions and mortality. Of course, this was in my mind from the moment the doors closed for the last time, but it may be playing out on paper. If you look at tables B and C below, you too will find that the county has higher rates in more disease areas and death. This makes me wonder about the true impact of access, coupled with socioeconomic disadvantages. This data is only three years out from 2015, but should be monitored. You may want to look at your towns as well that may have concerns with access due to closures.

Table B

Table C

It is important to remember that this is only one example, and sometimes we neglect the importance of our hospitals in our communities. Closures are many times addressed with alternatives such as diverse medical groups or standalone emergency departments/urgent care centers, if the money or sponsorship is there. Ultimately, revenue and quality are needed for facilities to survive. Either one could be an endgame if subpar and detrimental to our minority populations.

As for me, I won’t be moving away anytime soon, but hope to one day. As a patient, we must be our own advocates, and stay abreast of what may impact our livelihood. Are you watching?


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