1. … Rural hospital closures are creating a growing healthcare challenge …
RURAL HOSPITALS NEED A CURE
FAST
A national healthcare issue that cannot heal on its own
Bare Sky Marketing — Healthcare Content Writing
Apr 10 · 9 min read
John G. Baresky
Closing rural hospitals are reducing access to care in
multiple states
Between January 2010 and January 2020, 114 rural hospitals closed. More
than 30 of these were critical access facilities. Data from the University of
North Carolina Cecil G. Sheps Center for Research provides further insights
showing that from 2005 to 2020 a total of 170 rural hospitals shut down.

2. There seems to be no indication this trend is subsiding and a sizable portion
of it has occurred during a time of record economic expansion. There is no
telling how many more would have closed their doors had a weakened
economy continued.
Key drivers of rural hospital closures
There are many reasons behind the closures of so many rural hospitals and
it’s a far more complicated environment than most persons realize. These are
some of the leading triggers that contribute to the ongoing contraction of
quality healthcare in the rural U.S.A.:
• Hospital and health system consolidation has absorbed more profitable
rural hospitals leaving the less profitable ones to fend for themselves
• Commercial and government healthcare reimbursement (Medicare,
Medicaid, etc.) falls short of the minimum rural hospitals require to
operate effectively
• The number of people living in rural areas across the nation has dropped
so caseloads and cash flow into rural hospitals is reduced
• With fewer patients and income rural hospitals struggle to stay afloat,
attract new staff members or upgrade equipment and facilities
• Procedures that once required overnight or 2 to 3 days of hospital stays
are performed on an outpatient basis further reducing income

3. Key benefits of rural hospitals
Frequently overlooked, rural hospitals are a pivotal component of our
national healthcare system. They do not have the size and scope of services
provided by mid-sized hospitals or hospitals aligned with healthcare systems
or academic/university hospitals. Regardless of size, their place in the U.S.
healthcare system is essential for many reasons:
• Rural hospitals provide routine and emergency access to care for farmers
and their families, the core source of our national food supply, plus the
communities they live near
• When patient loads peak, as seen in the COVID-19 pandemic, rural
hospitals can absorb some of the patient load so larger facilities are less
overwhelmed
• Rural hospitals serve as business catalysts in the communities they serve
that attract new residents and add vitality to the local economy
• Besides conventional hospital care, rural hospitals are the champions
behind the local business, school, church and other community health
and wellness initiatives such as screenings, smoking cessation groups,
drug and alcohol addiction awareness, pre and postnatal wellness for
mothers and infants plus other programs
Misconceptions about rural hospital closings
There is a wide misunderstanding of the importance of rural hospitals. This
includes:
• Rural hospitals should close so resources allocated to them are channeled
into mid-sized and larger hospitals and health systems; by centralizing

4. healthcare services it makes it more convenient for more patients to
access multiple tiers of care in one location
• A large number of rural hospital closings is a natural progression of
market forces that fairly redistributes access to care although disruption
occurs as these changes take place
• Access to quality healthcare in the United States, including rural areas, is
the best in the world; farmers and the residents of rural communities can
easily travel to the next closest rural hospital for care in an emergency
The reality of rural hospitals in the United States
The average rural hospital employs about 300 staff members and is located
in a community of approximately 60,000 people. When a rural hospital
closes, the loss of work is significant in terms of the total jobs available in a
community of that size. It also means 60,000 citizens are without an
advanced care provider capable of saving patient lives at the rural hospital
point-of-care setting or stabilizing more critical patients so they can survive
the journey to reach a larger facility with more resources.

5. The disparity of care in rural communities data from the Robert S. Woods Foundation and the National Center
of Health Statistics
In emerging markets and 3rd world nations, the trend is to increase access to
care outside of major metropolitan areas and port cities. A top priority in
these countries is to bring viable healthcare services to their rural areas to
reduce disease and improve overall health and domestic economics.
Conversely, as a medical and economic world leader, the closure of rural
hospitals indicates the U.S. is going in the opposite direction of this trend.
The mortality rate in the U.S. is greater among populations that reside in
rural areas compared to those who live in urban areas and this trend is
climbing. Over the last 15 years, the difference in mortality between rural
and urban areas has tripled — from a 6 percent difference to an 18 percent
difference in 2015.

6. Injury deaths data from the Centers for Disease Control (CDC) and the Robert S. Woods Foundation
Minutes and miles count in rural America when a rural hospital closes and
the patient is required to travel to the next closest facility which on average is
20 miles away or further. In these circumstances and others, healthcare
professionals will agree that time is an essential element in successful patient
outcomes:
• Asthma and other respiratory emergencies
• Burns
• Cardiac care
• Childbirth
• Trauma stemming from accidents involving farm equipment, auto,
motorcycle, construction or business and household mishaps
Women’s Healthcare
A substantial portion, almost half, of rural hospitals are not able to support
obstetric and gynecologic services. This translates to less than half of rural
women having access to perinatal care within a 30-minute drive of their
homes. Over 10% of rural women have to drive 100 miles or more to access
OBGYN care.

7. Understandably, geography and the inherent elements of rural living mean
that quality healthcare will simply not be available within a 10-minute drive
of every household. It does urgently convey that OBGYN care should be
available at the closest provider of advanced treatment services which is a
rural hospital. Access to quality OBGYN care issues impacts women’s and
infant’s health before, during and after pregnancy with further social and
cost consequences moving forward.
Telehealth or telemedicine is a growing resource but not a
solution to help rural hospitals stay open
The Office for the Advancement of Telehealth (OAT) supports telehealth
technologies for health care delivery, education and health information
services as applied to rural healthcare. They are well aware of the critical
needs in farm communities and other remote areas that lack sufficient access
to healthcare.
Telehealth is a useful resource for limited diagnosis, patient monitoring and
follow up. In rural healthcare it provides supportive care but has two
primary shortcomings:
• Telehealth is not able to put hands on a patient to perform an internal
examination or perform a medical procedure (examples of this are the
specific care requirements involved in delivering a baby or performing
emergency surgery to halt hemorrhaging)
• Reliable and far-reaching broadband access in rural areas is still a
challenge; while the Internet has been with us for roughly 30 years, there
are still wide swaths of the nation without reliable Internet access and
mobile devices are not enough of a difference-maker to fill this gap

8. Options that can help prevent rural hospital closings
There are various ways to help alleviate the care and cost imbalance in rural
hospitals. As a market segment, there is not a one size fits all solution. A
luxury outcome would be to restore the operations of the 30 critical access
hospitals that have closed. The immediate primary goal is to prevent more
closures and provide sound operational footing for those that are still open:
• Stabilization of reimbursement and the ability to pay employees a
competitive wage in rural hospitals will go a long way in empowering
them to provide quality care and manage operations without having to
constantly juggle finances while cutting and reintroducing care as funding
changes allow. Increasing reimbursement for rural hospitals’ care is one
minimal requirement so they can support themselves and continue to
deliver care to uninsured, underinsured and other disadvantaged
patients. This includes a long term (versus year-to-year) stabilization of
Medicare reimbursement plus a firm solution to minimize wage disparity
issues that erode rural hospitals’ ability to operate and attract new talent.
• Apply pressure to states not participating in Medicaid expansion. These
states (at least 18) are holding out on the beneficial provisions of the
Medicaid expansion opportunities which results in more citizens
(especially the elderly, children or other economically disadvantaged
individuals) not having the ability to pay nor is there a provision in place
for Medicaid to pay for them on their behalf.

9. • Develop strategies to establish closer relationships between
academic/university hospitals and health systems with rural hospitals to
not only train future generations of nurses, doctors and other clinicians
but also share purchasing power resources that a commercial for-profit
hospital or health system will not. An example of this is the Vanderbilt
Health Purchasing Collaborative (VHPC).
• Make provisions for rural hospitals to allow the skills of nurse
practitioners and physician assistants to be more widely utilized. This is
not meant to supplant the role of medical doctors in rural hospitals. It is
intended to augment the level of care they provide. The shortage of
medical doctors and for that matter, nurses, in the United States is an
ongoing challenge. By enabling rural hospitals to retain medical doctors
and nurse practitioners by providing them with additional clinician
support, they can focus on the most difficult cases and the rural hospital
is better able to manage through peaks and troughs in patient loads.
• Invite disruption to compete against the traditional healthcare supply
chain business models by working with Amazon (NASDAQ: AMZN) and
perhaps a partnership with rural health and agricultural associations or
other enterprising stakeholders. By collectively aligning programs,
processes and systems with the needs and budgets of rural hospitals, it
can help them lower the cost of procurement and improve their finances
while breaking apart a decades-old supply chain business model that has
ensnared larger hospitals and health systems as well.

10. Maintaining rural hospitals is preventative medicine for
larger healthcare issues
Rural hospital closures lead to other issues. Those that remain open in
adjacent communities are not automatically equipped to absorb the patients
from one or more surrounding towns. Reopening a closed rural hospital is a
monumental task to bring a shuttered facility back to fully operational status
plus find new staff as the number of nurses, doctors and other clinicians is
already in short supply across the nation.
Communities with closed rural hospitals become disadvantaged to the extent
that when new residents and businesses are seeking to locate in a new
location, access to care is important. It can be a tipping point for them to opt
for the town that has better access to healthcare through its rural hospital.
Although separated by distance, rural hospitals are an integral part of the
U.S. national healthcare network. Each one is a vital resource. The options
above represent opportunities to maintain and revitalize this mainstay
segment that provides healthcare and economic benefits to the rural
communities they serve.
Thank you for reading this story
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