The Community Health Center delivered newborns in Falls City, Nebraska, for more than a century until it closed its obstetrics department in November 2019.
The number of annual births has been steadily decreasing at the critical access hospital, making it difficult to attract and retain anesthesiologists and specialist nurses, said Ryan Larsen, executive director of the Center for Community Health. and the surgeon becomes difficult. That means administrators have to pay high prices for doctors and trainees on duty, who are already too skinny.
There are times, Larsen said, when the on-demand surgeon will drive 100 miles an hour from across the state to perform emergency cesarean sections. “When we finally stopped, there was a sense of relief. But there is also pain. Our employees have sacrificed a lot over the years,” he said. “It is also very difficult for the community. This is part of our identity.”
This scenario is playing out more frequently in rural communities. Maternity services are often the first service performed when finances are eroded. Quality suffers as patients are forced to travel further for care, and underserved and low-income communities often bear the brunt.
Pampa Regional Medical Center in Pampa, Texas, phased out obstetric care in April 2021. “While the community is eager to restart these services, hospitals are under pressure. Given the enormous amount of staffing and supply chain costs, we cannot afford the financial loss in this line of services,” CEO Jon Gill wrote in an email.
The number of rural hospitals that stopped providing obstetric services increased 9% from 2019 to 2020, leaving nearly 220 communities without maternity care, according to Chartis Rural Health Center data released today. Tuesday.
Eliminating maternity services can have a cascade financial impact. Surgeons and anesthesiologists often quit, reducing revenue. Medicaid patient numbers often decline and hospitals may lose their ability to qualify for 340B drug discounts and/or access additional payments.
“Service cuts are continuing unabated,” said Michael Topchik, country leader at Charti Rural Medical Center. “This is creating huge accessibility challenges. Rural communities are the bedrock of health care disparities.”
More and more rural hospitals are also cutting back on chemotherapy. Chartis found that more than 350 rural communities lacked access to cancer-related care as of 2021, up 13% from 2020.
Hospitals are cutting services as their profits dwindle. Nationwide, 43% of rural hospitals are operating at a loss as of the end of 2022, according to Chartis data, which does not include COVID-19 relief funds and is adjusted for cuts. 2% annually on Medicare reimbursements under the Budget Control Act of 2011. Operating margins for rural hospitals averaged 1.8% last year and facilities in states that expanded Medicaid under the Affordable Care Act performed better than facilities in states that didn’t.
Meanwhile, three rural hospitals have closed in the past two months, bringing the total to 143 since 2010, data from the University of North Carolina shows.
Brock Slabach, executive director of the National Rural Health Association, said patient numbers in rural hospitals have not returned to pre-pandemic levels and relief funds have dried up. “That could lead to an increase in the number of closures over the next two years,” he said.
Rural hospitals received some help from the year-end spending law, which extended the Medicare low-volume payment adjustment and Medicare-dependent hospital program through September 20, 2024. The law also delays the expiration of additional payments for ambulance service premises until 2025..
Some hospitals are pursuing new rural emergency hospital designations, which will boost payments and an estimated $3.3 million in annual facility fees, adjusted for inflation, for hospital eliminated inpatient service. Although Chartis has identified 77 hospitals that are likely to pursue the transition, many are reluctant because they will have to give up their 340B eligibility, among other factors.
However, rural hospitals need more aid, including an end to automatic Medicare cuts, Larsen said. “Just because someone lives in the countryside, it doesn’t mean they have to get second-rate healthcare or their life isn’t worth as much as a lover in an economically advantageous area.”
