Rural Healthcare Facing Existential Threats

Recent issues in Oklahoma, Nebraska portend a growing crisis.

The news coming out of Oklahoma was grim: Pauls Valley Regional Medical Center couldn’t keep its doors open, despite a GoFundMe campaign, as well as a reported solicitation from country music star Toby Keith. And in September, Latimer County General Hospital, a 33-bed facility in the small rural city of Wilburton, Okla., population 2,972, closed for business. Three of the five Oklahoma rural health centers closed for good in October, adding to the list of 90 other rural hospitals that have closed since 2010, according to the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.

The U.S. Government Accountability Office (GAO) recently reported that from 2013 to 2017, a total of 64 rural hospitals closed, more than twice as many as during the previous five-year period. In its report, released in September, the GAO attributed the closures to financial distress, “exacerbated in recent years by multiple factors, including the decrease in patients seeking inpatient care and across-the-board Medicare payment reductions.” On the other hand, the GAO reported that rural hospitals located in states that increased Medicaid eligibility and enrollment experienced fewer closures.

“There are a variety of reasons for this, but it is important to keep this critical issue in front of legislators and our communities,” Leslie Marsh, executive officer of Lexington Regional Health Center (LRHC) in Lexington, Neb., told Monitor Mondays listeners recently.

Of particular concern, according to Marsh, are what she described as obstetrics (OB) deserts in the rural health landscape: deserts created by closures, abetted by declining margins and other workforce issues.

Marsh said that in 1985, approximately 54 percent of rural hospitals provided OB services, but now, only 24 percent provide this type of care.

“Those of us living and working in rural areas are all too familiar with this alarming trend,” Marsh said. “ER has become the new OB department for some rural facilities.”

Marsh said one strategy in keeping rural healthcare vital involves sharing information on the economic impact that rural hospitals have on the local economy and on state tax revenues. She believes there is a business case to be made.

“Lexington Regional Health Center adds about 424 jobs, $55 million in revenue, and $1.5 million in local and state tax revenue,” Marsh said. “Job creation through any hospital – typically a major employer in rural communities – equates to real economic gains and or losses.”

Marsh used the metaphor of a three-legged stool to make her point about rural hospitals being an integral part of the community, noting that the other two legs are the municipal government and the schools.

“Without any one leg, the community becomes unstable and declines,” Marsh warned. “We need to share this important information with legislative bodies, community leaders, and other key stakeholders.”

“LRHC’s total economic impact of $55,762,552 helps foster revenue creation for hospitality industries, including lodging, transportation, and tourism, restaurants, and the construction industry,” a news release posted on the LRHC website reads. “The hospital’s economic impact includes induced effects, impacting real estate, insurance, electricity, and entertainment businesses through increased personal income and spending.”

Lexington, population 10,146, according to 2014, data, is one of four towns located under Dawson County’s expansive blue skies and among vast prairie lands. Food manufacturing is the largest job creator in Lexington. One plant alone provides jobs for 2,900 workers. At that plant, LHRC provides an onsite medical and therapy clinic, with physical and occupational therapy services offered through its occupational medical and rehabilitation clinic. In another manufacturing plant, LHRC provides what it describes as a “corporate wellness” menu of options.

“We are very interested in keeping care local, which has helped us achieve growth and finance targets,” Marsh said in a recent email. “Rural (healthcare) matters – together we make a meaningful difference in the lives of nearly 20 percent of the population.”

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