Hospitals in rural America face a dire monetary forecast. The federal government has an incentive plan to assist them hold their emergency departments open, whereas shutting their inpatient providers.
Daniel Acker/Bloomberg by way of Getty Photographs
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Daniel Acker/Bloomberg by way of Getty Photographs
Hospitals in rural America face a dire monetary forecast. The federal government has an incentive plan to assist them hold their emergency departments open, whereas shutting their inpatient providers.
Daniel Acker/Bloomberg by way of Getty Photographs
KEOKUK, Iowa — People on this Mississippi River city hope a brand new federal program can revive the optimism engraved way back in a plaque on the aspect of their hospital.
“Devoted to the Way forward for Well being Care within the Tri-State Space,” the signal declares. “Might 11, 1981.”
Newer placards posted on the facility’s entryways are ominous, nevertheless. “Closed,” they are saying. “No Trespassing.”
An engraved signal put in on the hospital’s latest addition in Keokuk, Iowa, expressed the hopes organizers had for the ability, which is now closed.
Tony Leys/KFF Well being Information
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Tony Leys/KFF Well being Information
An engraved signal put in on the hospital’s latest addition in Keokuk, Iowa, expressed the hopes organizers had for the ability, which is now closed.
Tony Leys/KFF Well being Information
The Keokuk hospital, which served rural areas of Iowa, Illinois, and Missouri, closed in October 2022. However new homeowners plan to reopen the hospital with the assistance of a brand new federal cost system. The Rural Emergency Hospital program ensures hospitals additional money if they supply emergency and outpatient providers however finish inpatient care.
“We have been with out a hospital for over a yr — and I do not suppose anyone in Keokuk or the encompassing areas can be choosy in any approach, form, or kind,” says Kathie Mahoney, mayor of the city of about 9,800 folks. She says residents would like to have a full-service hospital with inpatient beds, regardless that these kinds of beds had been used sparingly in recent times.
The revival of the Keokuk hospital would mark a small victory within the nationwide wrestle to avoid wasting rural hospitals, which proceed to shut as a consequence of staffing shortages, low reimbursement charges, and declining affected person numbers. The brand new federal program, which went into impact in January 2023, is supposed to stem the closures. However there have been rising pains, says George Pink, deputy director of the North Carolina Rural Well being Analysis Program, which tracks hospital closures and conversions.
The ambulance entrance on the hospital in Keokuk, Iowa, has been unused because the facility closed in 2022.
Tony Leys/KFF Well being Information
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Tony Leys/KFF Well being Information
The ambulance entrance on the hospital in Keokuk, Iowa, has been unused because the facility closed in 2022.
Tony Leys/KFF Well being Information
Simply 18 of the greater than 1,700 eligible rural hospitals nationwide have utilized for and received the brand new designation. Many hospitals are reluctant to surrender inpatient providers totally, and a few are involved about how different cost streams may very well be affected, rural well being leaders say. The brand new designation’s unclear definition of “rural” has additionally precipitated confusion.
“We’re nonetheless in an period of rural hospital closures,” Pink says. 9 hospitals closed in 2023, and that quantity might rise in 2024, he says. An inflow of federal aid funds through the pandemic saved struggling hospitals afloat, however now that cash is essentially gone.
The Rural Emergency Hospital program is the primary new federal cost mannequin for hospitals since 1997. Dr. Dora Hughes, performing chief medical officer of the Facilities for Medicare & Medicaid Providers, says the brand new mannequin’s standards are outlined by statute and “hospitals ought to contemplate particular circumstances earlier than making the choice to use.”
The federal company is offering outreach to rural communities and welcomes suggestions, Hughes wrote in an electronic mail to KFF Well being Information.
Now, rural well being leaders and federal lawmakers are working shortly to tweak the brand new program to draw extra candidates, says Carrie Cochran-McClain, chief coverage officer of the Nationwide Rural Well being Affiliation.
At the moment, services that convert to rural emergency hospitals obtain a 5% enhance in Medicare funds, plus a median annual cost of about $3.2 million, in alternate for giving up their costly inpatient beds and focusing solely on emergency and outpatient care. Rural hospitals with not more than 50 beds, like Keokuk’s, that closed after the legislation was signed on Dec. 27, 2020, are eligible to use for this system and reopen with emergency and outpatient providers.
Greater than 100 rural hospitals nationwide have inquired about changing, says Janice Walters, interim government director for the Rural Well being Redesign Middle, which has a federal grant to supply technical help to hospitals that wish to apply.
However solely a few quarter of these inquiries are more likely to turn into a rural emergency hospital, and persuading extra troubled hospitals to make the leap would require regulators to make modifications, Walters says.
Her recommendation? “Give them 10 beds to only care for their group.”
In a journal article printed final yr, Dr. Sara Schaefer, a surgeon, worries concerning the unintended penalties of eliminating rural inpatient beds. Schaefer, who spent six months of medical faculty at a small rural Idaho hospital, says she noticed firsthand how tough it was for the hospital to switch sufferers to larger services, which had been typically too full to take them.
“There must be a greater approach,” says Schaefer, who can be a analysis fellow on the Middle for Healthcare Outcomes & Coverage on the College of Michigan.
The agricultural well being affiliation’s Cochran-McClain says lawmakers are contemplating modifications that might permit the hospitals to:
- Preserve in a single day beds for sufferers who want average ranges of care, resembling these with pneumonia or in want of bodily remedy after surgical procedure.
- Permit participation in a federal drug low cost program known as 340B, which supplies hospitals with additional income.
- Preserve inpatient
- Make clear eligibility, together with which services qualify below the definition of “rural” and whether or not the hospitals that closed earlier than the 2020 date within the legislation can apply.
Updates to the legislation might have an effect on communities nationwide. In Fort Scott, Kansas, the place the hospital closed in late 2018, Mayor Matthew Wells says the group needs the eligibility date pushed again. U.S. Sen. Jerry Moran (R-Kan.) launched a invoice in Decemsber that, if handed, would push eligibility again to 2015.
“It is a matter of life and loss of life to my group,” Wells says. “I see a transparent path, however the federal laws specifically make that path practically unimaginable.”
In Holly Springs, Mississippi, hospital chief government Dr. Kenneth Williams says he does not perceive the federal definition of “rural.” His hospital, Alliance Healthcare Hospital, was one of many first to win the brand new Rural Emergency Hospital designation in early 2023. He laid off workers and shut down his inpatient beds. Then, CMS officers known as to inform him they’d made a mistake.
Bruce Mackie, the Keokuk hospital’s sole remaining staffer, appears to be like at a CT scanner ready for use once more. He hopes to see the hospital reopen in 2024.
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Bruce Mackie, the Keokuk hospital’s sole remaining staffer, appears to be like at a CT scanner ready for use once more. He hopes to see the hospital reopen in 2024.
Tony Leys/KFF Well being Information
“And I mentioned, ‘Wait a minute,'” Williams says. The hospital, which is about an hour south of Memphis, Tennessee, does not meet the present standards of rural, they informed him. Williams, an inside medication physician, purchased the hospital in 1999 and has been attempting to maintain it working since.
Federal regulators are actually asking Williams to transform the ability into one other kind of Medicare cost mannequin, resembling the only real group hospital with inpatient beds that it was earlier than. Williams says that will be tough: “What sort of transition can I make, particularly with lowered providers?”
In Keokuk, the hospital matches the present necessities. Perception Well being Group, the Michigan firm that purchased the shuttered facility final March, plans to use for the brand new federal designation as quickly because it obtains state permits below new Iowa laws tailor-made to rural emergency hospitals. It will be the primary such hospital within the state.
Like many different rural hospitals struggling to outlive, Keokuk’s shuttered a number of key departments years in the past, together with its maternity and inpatient psychiatric models. In 2021, the final full yr it was open, the hospital averaged fewer than three inpatients per night time, in response to information posted by the Iowa Hospital Affiliation.
Greater than half of the three-story constructing would stay mothballed if the ability reopened below the brand new designation, however the emergency division might serve sufferers once more as quickly as late summer season, says Atif Bawahab, Perception’s chief technique officer.
Bruce Mackie has labored 32 years on the hospital, together with 10 years as director of plant operations. The brand new homeowners saved him on to observe over the constructing. Beds, high-tech scanners, and lab tools stay, however a lot of the clocks have stopped. “It is spooky,” he says.
Even when the providers are extra restricted than earlier than, Mackie says, “everyone needs the hospital to reopen. This metropolis wants an ER.”
KFF Well being Information, previously referred to as Kaiser Well being Information (KHN), is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF — the impartial supply for well being coverage analysis, polling, and journalism.
