How does the closure of a rural hospital affect the community?
Heading into the COVID-19 pandemic, the U.S. was already experiencing a drop in the number of hospitals, according to American Hospital Association data. Compared with fiscal year 2018, fiscal year 2019 saw a 9% decline in rural and other hospitals. The number of hospitals in fiscal year 2018 was 6,146, compared to 6,090 in 2019.
How can we improve patient care access in rural areas?
Sep 09, 2019 · The number of rural hospital closures in the United States has increased over the past decade. 1 Since 2010, 113 rural hospitals, 2 predominantly in …
Can provider networks help address the challenges faced by rural hospitals?
Aug 18, 2021 · A North Carolina Rural Health Research Program 2018 findings brief, Access to Care: Populations in Counties with No FQHC, RHC, or Acute Care Hospital, describes the scope of limited primary care access in rural areas in the U.S. and covers three facility types that provide primary care services to rural communities, including Federally Qualified Health Centers …
How do patients get to medical appointments in rural areas?
This overview discusses articles published in this issue of the Health Care Financing Review, entitled “Access to Health Care Services in Rural Areas: Delivery and Financing Issues.”. These articles focus on the following topics: rural hospitals (including closures, the impact of Federal grants, network development, and costs), managed care ...
Hospital Closures Across the U.S. from COVID-19
Hospital numbers were already declining as the U.S. approached the heart of the COVID-19 pandemic in 2020. In 2019, the U.S. had 6,090 hospitals, 56 fewer than the previous year, according to the AHA. Similarly, 2018 saw 64 fewer hospitals than the year before.
What Is a Rural Hospital?
As hospitals in general grapple with the financial implications of COVID-19 and other challenges, rural hospitals are feeling the effects even more acutely. Rural hospital closures are affecting an increasing number of communities.
Why Are Rural Hospitals Closing?
Today’s healthcare environment provides challenges that are leading to rural hospital closures. In 2020, the Center for Healthcare Quality and Payment Reform (CHQPR) reported that 800 rural hospitals nationwide were at risk of closure. Why are rural hospitals closing?
U.S. Hospitals: Closing Statistics
Hospitals’ closing statistics paint a troubling picture: The AHA reports 9% annual declines in the number of rural and other hospitals.
What Rural Small Town Hospitals Can Do to Survive
Faced with multiple obstacles and a challenging outlook, what can rural small town hospitals do to survive? From implementing debt management measures to building customer loyalty, rural hospitals are taking steps to stave off closure and continue providing valuable services.
Rural Hospitals: A Vital Healthcare Provider Working to Overcome COVID-19 Challenges
Rural hospitals are valuable assets to the health of their economies, but years of challenges to U.S. hospitals, worsened by the COVID-19 pandemic, have left the nation with a decreasing number of hospitals and a growing number of rural hospital closures.
Introduction and summary
The number of rural hospital closures in the United States has increased over the past decade. 1 Since 2010, 113 rural hospitals, 2 predominantly in Southern states, have closed. This is a concerning trend, since hospital closures reduce rural communities’ access to inpatient services and emergency care.
Rural hospitals have been closing at an unprecedented rate
From 2013 to 2017, rural hospitals closed at a rate nearly double that of the previous five years. 6 (See Figure 1) According to the Government Accountability Office (GAO), recent rural hospital closures have disproportionately occurred among for-profit and Southern hospitals.
Financial data shows that rural hospitals are more likely to struggle
To compare the financial situations of rural and urban hospitals and examine how future rural hospital closures could affect the availability of emergency care, CAP analyzed data from the CMS Healthcare Cost Report Information System (HCRIS). The CMS requires all Medicare-certified hospitals to report their financial information annually.
Policies to improve rural emergency and nonemergency care
As rural hospitals continue to close, it is crucial to preserve access to emergency care for rural Americans. The following section details a series of policy recommendations to support adequate emergency care and address care shortages in rural communities.
Conclusion
Mounting closures of rural hospitals across the country are exacerbating the disparity in health care access between rural and urban areas. The financial vulnerability of the remaining rural hospitals suggests that the trend may continue, leaving shortages in emergency care and other hospital services.
About the authors
Tarun Ramesh was an intern for Health Policy at the Center for American Progress. He is an undergraduate at the University of Georgia studying economics and genetics.
Methodological appendix
CAP analyzed data from the CMS HCRIS data using Stata 15 statistical software. Data were from FY 2017, the most recent year for which the CMS has a complete set of hospital cost filings.
Why do rural hospitals join networks?
Local rural healthcare facilities may choose to join healthcare networks or affiliate themselves with larger healthcare systems as a strategic move to maintain or improve healthcare access in their communities. These affiliations or joining of healthcare networks may improve the financial viability of the rural facility; provide additional resources and infrastructure for the facility; and allow the rural healthcare facility to offer new or expanded healthcare services they could not otherwise provide. However, the benefits of an affiliation with a larger healthcare network may come at the expense of local control.
What are the barriers to access to mental health care in rural areas?
In rural areas, there is little anonymity; social stigma and privacy concerns are more likely to act as barriers to healthcare access. Rural residents can have concerns about seeking care for mental health, substance abuse, sexual health, pregnancy, or even common chronic illnesses due to unease or privacy concerns. Patients' feelings may be caused by personal relationships with their healthcare provider or others working in the healthcare facility. Additionally, patients can feel fear or concerns about other residents, who are often friends, family members, or co-workers, who may notice them utilizing services for health conditions that are typically not openly discussed, such as counseling or HIV testing services. Co-location or the integration of behavioral health services with primary care healthcare services in the same building can help ease patient concerns. Understanding Rural Communities, a 2018 podcast from the Hogg Foundation for Mental Health, features an interview with Dennis Mohatt, the Vice President for Behavioral Health at the Western Interstate Commission for Higher Education (WICHE), discussing rural health and the stigma surrounding mental healthcare in rural communities.
How does health literacy affect rural communities?
Health literacy impacts a patient's ability to understand health information and instructions from their healthcare providers. This can be especially concerning in rural communities, where lower educational levels and higher incidence of poverty often impact residents . Low health literacy can make residents reluctant to seek healthcare due to fear of or frustration related to communicating with a healthcare professional. Additionally, navigating the healthcare systems can be difficult without health literacy skills. To learn more about low health literacy in rural America, see What are the roles of literacy, health literacy, and educational attainment in the health of rural residents? on RHIhub's Social Determinants of Health for Rural People topic guide. The Rural Monitor 's two-part series on rural health literacy, Understanding Skills and Demands is Key to Improvement and Who's Delivering Health Information?, provides insights, connections between health and health literacy, and discusses how health information is being delivered to rural populations.
Can rural Medicare beneficiaries have hospice?
A 2013 National Advisory Committee on Rural Health and Human Services' policy brief, Rural Implications of Changes to the Medicare Hospice Benefit, states that rural Medicare beneficiaries can have limited access to hospice care.
What is the mental health shortage in rural areas?
Access to mental health providers and services is a challenge in rural areas. As a result, primary care physicians often fill the gap and provide mental health services while facing their own barriers, such as lack of time with patients or adequate financial reimbursement. As of December 2019, 60.98% of Mental Health Professional Shortage Areas were located in rural areas. For the most current figures, see HRSA's Designated Health Professional Shortage Areas Statistics .
What is the Federal Office of Rural Health Policy?
The Federal Office of Rural Health Policy (FORHP) focuses on rural healthcare issues and is part of HRSA. Rural Health Research Centers are funded by the Federal Office of Rural Health Policy to produce policy-relevant research and analysis on healthcare and issues impacting healthcare in rural areas.
Is access to healthcare good?
While access to medical care does not guarantee good health, access to healthcare is critical for a population's well-being and optimal health. The challenges that rural residents face in accessing healthcare services contribute to health disparities.
How can rural healthcare professionals support their patients?
Outside of clinical initiatives, healthcare professionals in rural areas can also support their patients by addressing social determinants of health. Geographic barriers and treatment accessibility are two key social determinants of health capable of being addressed through community outreach.
What are the health problems that patients living in rural areas are more likely to have?
What’s more, patients living in rural areas are also usually higher risk with a propensity to have complex health issues. Rural health specialists at Stanford Medicine state that patients living in remote regions are more likely to manage one of many health conditions: Obesity. Inactivity.
What are the health conditions that people living in remote areas are more likely to manage?
Rural health specialists at Stanford Medicine state that patients living in remote regions are more likely to manage one of many health conditions: Obesity. Inactivity. Being kept from working/daily activities because of physical or mental health. Smoking and drug and alcohol use. Chronic illness.
What percentage of rural populations are poor?
According to Stanford Medicine research, rural populations also report poorer healthcare quality, with 4.5 percent of individuals rating their health as poor compared to 3.6 percent of their urban counterparts. Improving rural patient healthcare access proves to be a multi-pronged effort.
Is telehealth a cost-related challenge?
Telehealth also comes with some cost-related hurdles. While interested healthcare organizations will need to prioritize telehealth costs, grant funding options are available to certain entities. Telehealth in rural areas also comes with a very specific challenge — access to adequate WiFi and broadband connectivity.
Is broadband more efficient in rural areas?
Although arguably more efficient, broadband connections also have their limits in rural towns. AMIA President and CEO Douglas B. Fridsma, MD, PhD, asserted that strong broadband access is a social determinant of health that must be addressed to create health equity in rural areas.
What are rural areas affected by?
Patients living in rural areas are disproportionately affected by regulatory and reimbursement changes to Medicare and Medicaid, the organization contends. Patients in these areas rely heavily on community health centers to access their healthcare conveniently and inexpensively.
What are rural hospitals?
Rural hospitals are the cornerstones of their communities, serving as key access points of care for nearly 20% of Americans. Beyond their direct impact on health and well-being, they also offer broader community benefits. They are often the largest local employer and help attract other businesses to the area, which can improve economic stability.
Why are hospitals important in rural areas?
Rural hospitals are the cornerstones of their communities, serving as key access points of care for nearly 20% of Americans. Beyond their direct impact on health and well-being, they also offer broader community benefits. They are often the largest local employer and help attract other businesses to the area, which can improve economic stability. Having a hospital nearby is a sign of community vitality.
Why are rural hospitals stretched thin?
As rural hospitals are already stretched thin by caring for chronically ill patients with fewer clinicians and fewer dollars, they have to tackle changes in health care practice, payment and compliance requirements — all of this occurs at the same time as patient needs evolve.
What are the consequences of hospital closures?
The consequences of closure are significant. A recent study by researchers at the University of Washington found that rural hospital closures are associated with higher mortality rates, and previous research has suggested such closures negatively affect economic measures, including per capita income and unemployment.
Is there a balance between short term and long term health care?
As long as resources are finite, there will always be a delicate balance between short-term and long-term approaches to improving health and health care. However, they need not be mutually exclusive; investments to address short-term needs can be made to align with long-term goals.
Rural Hospitals Address Limited Staffing Issues
Leveraging Telehealth to Overcome Geographic Barriers
- Telehealth offers a technological bridge to connect patients and their clinicians, no matter the distance between the two parties. “Traveling to receive services places burden on patients including cost and time,” says the Rural Health Information Hub. “For people with low incomes, no paid time off of their jobs, physical limitations, or acute conditions, these burdens can significan…
Supporting Alternative Care Sites to Fill Geography Gaps
- In addition to technology options, rural healthcare professionals should look to alternative care sites to fill geographic disparities. As noted by AHA, rural communities see more outpatient needs than inpatient care needs. Ambulatory facilities tend to be less expensive to operate, have a smaller footprint, and are easier to maintain throughout rural areas. “In some instances, a vulner…
Addressing Social Determinants of Health
- Outside of clinical initiatives, healthcare professionals in rural areas can also support their patients by addressing social determinants of health. Geographic barriers and treatment accessibility are two key social determinants of healthcapable of being addressed through community outreach. “We determined that addressing these challenges through enhanced clinic…
How Is The Industry at Large Dealing with This Issue?
- The industry’s leading stakeholders also have an immense responsibility to create opportunities for rural communities to improve patient healthcare access. Industry leaders and policymakers must use nationwide programs and legislation to support individual interventions. The American Medical Association has lent its support to the efforts by helping clinicians make decisions abo…