Study: More than half of rural Kansas hospitals at risk of closing

[bnew]

https://www.ksn.com/news/health/these-are-the-rural-kansas-hospitals-at-risk-of-closure/

Study: More than half of rural Kansas hospitals at risk of closing​

by: Colter Robinson
Posted: Aug 9, 2023 / 12:00 PM CDT
Updated: Aug 10, 2023 / 08:51 AM CDT


Editor’s Note: This article has been changed to more accurately portray the data provided by the CHQPR. We regret this error.

TOPEKA (KSNT) – Earlier this week, Governor Laura Kelly announced she would be pushing for Medicaid expansion after a study released in July, 2023 by the Center for Healthcare Quality and Payment Reform (CHQPR) found 58% of rural hospitals were at risk of closure.

“Already, too many rural hospitals have shut their doors,” Governor Laura Kelly said in response to the report. “When that happens, the communities have been devastated. These Kansans have to drive hours now to receive their basic care. There is an obvious way to stop the bleeding: Expand Medicaid.”

Since 2005 there have been nine rural hospital closures in Kansas. Currently, Kansas has 104 rural hospitals, of which 29 are at immediate risk of closure due to severe financial problems. CHQPR attributed the financial issues to patient service margin loss over a multi-year period and to low financial reserves.

Many rural hospitals have a positive total margin despite losses from patient services because they receive local tax revenue or grants to offset the losses. If the other sources of revenue continue to decrease or are terminated, the hospital would no longer have enough revenue to remain open, according to a CHQPR Saving Rural Hospitals report.

The largest factor CHQPR attributed to financial issues was private insurance plans paying less than the cost to deliver services to patients.

Rural hospital closings threaten the nation’s food supply and energy production because farms, ranches, mines, drilling sites, wind farms and solar energy facilities are mostly in rural areas. Attracting and retaining workers may be difficult if workers can’t get adequate healthcare services in these rural areas, according to the CHQPR study.

The CHQPR compiled data from Medicare Cost Reports available as of July 2023. The following rural Kansas hospitals have the largest negative patient service margins:

Number	Hospital	City	Total Expenses	Patient Services Margin	Total Margin
1	Mercy Hospital, Inc	Moundridge	5,222,563.00$	-32.70%	1.50%
2	Hillsboro Community Hospital	Hillsboro	9,269,917.00$	-32.30%	-17.70%
3	Patterson Health Center	Anthony	26,342,268.00$	-29.90%	-7.60%
4	Bob Wilson Memorial Hospital	Ulysses	14,373,454.00$	-29.80%	-19.80%
5	Kiowa County Memorial Hospital	Greensburg	10,683,575.00$	-27.80%	-10.50%
6	Rush County Memorial Hospital	La Crosse	7,595,457.00$	-27.40%	-18.10%
7	Stanton County Hospital	Johnson	11,127,033.00$	-27.30%	-8.60%
8	Jewell County Hospital	Mankato	8,011,394.00$	-27.20%	5.50%
9	Morton County Hospital	Elkhart	8,162,331.00$	-25.80%	4.80%
10	Hamilton County Hospital	Syracuse	15,304,125.00$	-24.70%	-7.30%
11	Grisell Memorial Hospital	Ransom	7,251,543.00$	-24.10%	7.10%
12	Stormont Vail Health Flint Hills, LLC	Junction City	45,166,234.00$	-23.20%	-2.40%
13	Ashland Health Center	Ashland	10,108,097.00$	-22.80%	14.80%
14	Stafford County Hospital	Stafford	12,945,545.00$	-22.60%	0.10%
15	Minneola District Hospital Nbr 2	Minneola	16,261,523.00$	-22.40%	-2.20%
16	Kiowa District Hospital	Kiowa	9,419,882.00$	-20.10%	-1.80%
17	Fredonia Regional Hospital	Fredonia	14,567,673.00$	-19.40%	6.40%
18	Comanche County Hospital	Coldwater	6,650,524.00$	-19.20%	1.20%
19	Anderson County Hospital	Garnett	32,998,080.00$	-18.40%	-2.30%
20	Wichita County Health Center	Leoti	11,263,772.00$	-18.10%	6.10%
21	Smith County Memorial Hospital	Smith Center	23,257,586.00$	-17.90%	-4.70%
22	Meade District Hospital	Meade	16,842,582.00$	-16.90%	-6.60%
23	Greeley County Health Services	Tribune	15,101,309.00$	-16.90%	15.90%
24	Decatur Health	Oberlin	11,403,737.00$	-16.80%	5.50%
25	Russell Regional Hospital	Russell	21,149,221.00$	-16.40%	4.80%
26	Gove County Medical Center	Quinter	20,794,345.00$	-15.60%	-2.80%
27	Trego County Lemke Memorial Hospital	Wa Keeney	19,951,810.00$	-15.60%	4.90%
28	Sedan City Hospital	Sedan	5,593,941.00$	-15.50%	3.60%
29	Ellinwood District Hospital	Ellinwood	9,986,530.00$	-15.50%	4.60%
30	Ness County Hospital District #2	Ness City	12,663,445.00$	-15.10%	13.50%
31	Lincoln County Hospital	Lincoln	8,104,437.00$	-14.80%	3.00%
32	Mercy Hospital Columbus	Columbus	5,505,270.00$	-14.70%	-7.60%
33	Graham County Hospital	Hill City	10,499,098.00$	-14.30%	14.70%
34	Satanta District Hospital	Satanta	16,399,524.00$	-14.10%	3.20%
35	University of KS Health System Great Bend Campus	Great Bend	63,887,560.00$	-13.10%	-8.10%
36	Osborne County Memorial Hospital	Osborne	9,161,655.00$	-12.90%	12.30%
37	Greenwood County Hospital	Eureka	14,249,587.00$	-12.70%	15.20%
38	Ellsworth County Medical Center	Ellsworth	21,876,596.00$	-12.30%	0.00%
39	Edwards County Medical Center	Kinsley	11,156,184.00$	-12.30%	9.90%
40	Medicine Lodge Memorial Hospital	Medicine Lodge	13,125,293.00$	-12.20%	4.40%

Data provided by the CHQPR Data on Rural Hospitals was collected from the Medicare Cost Reports made available in July 2023.

Stormont Vail Health took over operations of Junction City hospital and clinic, now known as the Stormont Vail Health Flint Hills Campus, in the summer of 2022 and assumed ownership Jan. 1, 2023. Stormont Vail Health leaders tell 27 News that since then, they have seen steady and significant financial improvement as they regain the confidence of the community by delivering high quality, safe care.

Stormont Vail Health Vice President Marketing and Communications Anita Fry said the turnaround started as a result of a unique collaboration between Stormont Vail, the Geary County Commission, the hospital’s board of trustees and others. She said teamwork across the Stormont Vail teams in Topeka, Junction City, Manhattan and Emporia, all working together, has been pivotal in the success of this large transition.

“Not only have we seen improved financial performance at our Junction City facility, in the past couple of months we have been at or near the breakeven point,” Fry wrote in a statement to 27 News. “We are confident because of our team and the community we have supporting us that this will continue. There is no consideration of closing the Stormont Vail Health Flint Hills Campus.”

 

[bnew]

local politicians insuring wages stay low and weakening labor laws which doesn't leave a lot of income for people to spend on healthcare services. healthcare costs increases industry-wide and hospitals don't have enough paying customers to sustain themselves.

 

[Lucky_Lefty]

Somehow, the citizens will blame the ones who live in the eastern part of the state and they will further entrench themselves into their support of the Republican Party thereby further fukkin themselves. The NIMBY energy is strong here so I wouldn’t be shocked if they will look at Kelly’s proposal as the reason why they’ll lose their hospital

 

[Alix217]

You get what you vote for, no Obummer care for you cracker

 

[RickyDiBiase]

They voted for this. They wanna live like Age of Empires II all cause black people could benefit from proper amenities

fukk em

 

[Elim Garak]

This country is so shytty lol.

 

[King Poetic]

Republican plan to cut spending would hurt rural communities, USDA says​

Republican plan to cut spending would hurt rural communities, USDA says

The Department of Agriculture (USDA) on Wednesday hammered against the debt limit bill that House Republicans released this week, arguing it would harm rural communities by limiting federal program…

thehill.com

These same people will still go out and vote right, even though they healthcare will be fukked up

 

[kevin arnold]

fukk Kansas

 

[bnew]

Rural hospitals are closing maternity wards. People are seeking options to give birth closer to home - East Idaho News

Oregon — Alisha Alderson placed her folded clothes and everything she needed for the last month of her pregnancy in various suitcases. She never imagined she would have to leave the comfort of her home in rural eastern Oregon just weeks before her due date. But following the abrupt closure in...

www.eastidahonews.com

Rural hospitals are closing maternity wards. People are seeking options to give birth closer to home​

Published at 4:00 pm, September 17, 2023

Claire Rush and Laura Ungar, Associated Press​

Alisha Alderson, her husband, Shane, and their daughter, Adeline, 5, say goodbye to Alisha’s mother, Patricia Conway, at an assisted living facility in Baker City, Ore., on Friday, Sept. 1, 2023. The Alderson’s are headed to Idaho where Alisha is to give birth later in September, because of the closing of Baker City’s only obstetrical unit. | AP Photo/Kyle Green

Oregon — Alisha Alderson placed her folded clothes and everything she needed for the last month of her pregnancy in various suitcases. She never imagined she would have to leave the comfort of her home in rural eastern Oregon just weeks before her due date. But following the abrupt closure in August of the only maternity ward within 40 miles, she decided to stay at her brother’s house near Boise, Idaho — a two-hour drive through a mountain pass — to be closer to a hospital.
“We don’t feel safe being so far away from a birthing center,” said Alderson, noting her advanced maternal age of 45. “I was sitting in a hair salon a few days ago and some people started joking about me giving birth on the side of the road. And in that moment, I just pictured all the things that could go wrong with my baby and broke down in tears in front of strangers.”

A growing number of rural hospitals have been shuttering their labor and delivery units, forcing pregnant women to travel longer distances for care or face giving birth in an emergency room. Fewer than half of rural hospitals now have maternity units, prompting government officials and families to scramble for answers. One solution gaining ground across the U.S. is freestanding midwife-led birth centers, but those also often rely on nearby hospitals when serious complications arise.

The closures have worsened so-called “maternity care deserts” — counties with no hospitals or birth centers that offer obstetric care and no OB providers. More than two million women of childbearing age live in such areas, the majority of which are rural.

Ultimately, doctors and researchers say, having fewer hospital maternity units makes having babies less safe. One study showed rural residents have a 9% greater probability of facing life-threatening complications or even death from pregnancy and birth compared to those in urban areas — and having less access to care plays a part.
“Moms have complications everywhere. Babies have complications everywhere,” said Dr. Eric Scott Palmer, a neonatologist who practiced at Henry County Medical Center in rural Tennessee before it ended obstetric services this month. “There will be people hurt. It’s not a question of if — simply when.”

Reasons behind the closures​

The issue has been building for years: The American Hospital Association says at least 89 obstetric units closed in rural hospitals between 2015 and 2019. More have shuttered since.

The main reasons for closures are decreasing numbers of births; staffing issues; low reimbursement from Medicaid, the federal-state health insurance program for low-income people; and financial distress, said Peiyin Hung, deputy director of the University of South Carolina’s Rural and Minority Health Research Center and co-author of research based on a survey of hospitals.

Officials at Saint Alphonsus, the hospital in Baker City where Alderson wanted to give birth, cited a shortage of OB nurses and declining deliveries.
“The results are devastating when safe staffing is not provided. And we will not sacrifice patient safety,” according to an emailed statement from Odette Bolano and Dina Ellwanger, two leaders from the hospital and the health system that owns it.

While they said financial concerns didn’t factor into the decision, they underlined that the unit had operated in the red over the last 10 years.

A lack of money was the major reason why Henry County Medical Center in Paris, Tennessee, closed its OB unit. CEO John Tucker told The Associated Press that it was a necessary financial step to save the hospital, which has been struggling for a decade.

The percentage of births there covered by Medicaid — 70% — far exceeded the national average of 42%. Tennessee’s Medicaid program paid the hospital about $1,700 per delivery for each mom, a fraction of what the hospital needed, Tucker said.

Private insurance pays hospitals more — the median topped $16,000 for cesarean sections in Oregon in 2021. State data shows that’s more than five times what Medicaid doles out.

Tucker also said the number of deliveries had dropped in recent years.
“When volumes go down, losses actually get bigger because so much of that cost is really fixed,” he said. “Whether we’ve got one baby on the floor or three, we still staff at the same level because you kind of have to be prepared for whatever comes in.”

The last week in a delivery ward​

Six days before the Tennessee unit closed, just one woman was there to deliver. All of the other rooms contained empty beds and bassinets. The special care nursery was silent — no beeping machines or infants’ cries. Art had been removed from the walls.

Lacy Kee, who was visiting the ward, said she’ll have to drive 45 minutes and cross the state line into Kentucky to give birth to her third child in early October. She’s especially concerned because she has gestational diabetes and recently had a scare with her fetus’ heart rate.

Kee also had to switch from the Henry County obstetrician she trusted for her other pregnancies, Dr. Pamela Evans, who will stay at the hospital as a gynecologist.

Evans fears that things like preterm deliveries, infant mortality and low-birthweight babies — a measure in which the county already ranks poorly — are bound to get worse. Prenatal care suffers when people must travel long distances or take lots of time off work for appointments, she said. Not all insurance covers deliveries out of state, and some alternative in-state hospitals families are looking at are an hour or more away.

Evans’ office and exam rooms contain bulletin boards covered with photos of infants she’s brought into the world. During a recent visit, Katie O’Brien of Paris handed her a new photo of her son Bennett — the third of her children Evans delivered. The two women cradled the baby and hugged.

The closure “makes me absolutely want to cry,” said O’Brien, 31. “It’s a horrible thing for our community. Any young person looking to move here won’t want to come. Why would you want to come somewhere where you can’t have a baby safely?”

A place to turn​

About two hours away, inside a house in the woods, a handful of women sat in a circle on pillows for a prenatal group meeting at The Farm Midwifery Center, a storied place in Summertown, Tennessee, that’s more than a half-century old.

Led by midwife Corina Fitch, the women shared thoughts and concerns, and at one point tied on scarves and danced together. One by one, Fitch pulled them into a bedroom to measure bellies, take blood, listen to fetal heartbeats and ask about things like nutrition.
Members of a prenatal group at The Farm Midwifery Center dance during a meeting Thursday, Aug. 31, 2023, in Summertown, Tenn. Led by midwife Corina Fitch, the women shared thoughts and concerns. | AP Photo/George Walker IV

Betsy Baarspul of Nashville said she had an emergency C-section in a hospital for her first child. She’s now pregnant with her third, and described the difference between hospital care and birth center care as “night and day.”
“This is the perfect place for me,” she said. “It feels like you’re held in a way.”

Some states and communities are taking steps to create more freestanding birth centers. Connecticut Gov. Ned Lamont recently signed legislation that will license such centers and allow them to operate as an alternative for low-risk pregnancies.

Alecia McGregor, who studies health policy and politics at the Harvard T.H. Chan School of Public Health, called midwife-led birth centers “a major sort of contender among the possible solutions” to the maternity care crisis.
“The kinds of lifesaving procedures that can only be conducted in a hospital are important for those very high-risk cases,” McGregor said. “But for the majority of pregnancies, which are low-risk, birth centers can be a very important solution to lowering costs within the U.S. health care system and improving outcomes.”

A lack of data and the small number of births in freestanding centers or homes prevents researchers from fully understanding the relationship between birth settings and maternal deaths or severe injuries and complications, according to a 2020 report from the National Academies of Sciences, Engineering, and Medicine.

The Farm said fewer than 2% of clients end up having C-sections, and a report on deliveries in its first 40 years showed 5% of clients were transported to the hospital — which Fitch said can happen because of things like water breaking early or exhaustion during labor. Clients usually give birth at The Farm or in their own homes.
“We always have a backup plan,” she said, “because we know birth is unpredictable and things can come up.”

Rural hospitals will need to be part of the equation, doctors told the AP, and they believe governments must do more to solve the maternal care crisis.

Oregon politicians mobilized when the Baker City hospital announced in June that it was shutting down its birth center — including Oregon Gov. Tina Kotek, U.S. Sen. Ron Wyden and Baker County Commissioner Shane Alderson, Alisha’s husband. As a temporary fix, they suggested using OB nurses from the U.S. Public Health Service Commissioned Corps, a branch of the country’s uniformed services that largely responds to natural disasters and disease outbreaks.

It was a novel and “innovative” idea to request federal nurses to boost staffing at a rural maternity unit, Wyden’s office said. While it didn’t end up panning out, the public health service sent experts to Baker City to assess the situation and recommend solutions — including looking into establishing a freestanding birth center.

Shane Alderson wants to help people who are facing the same tough decisions his family had to make. He said rural communities shouldn’t be stripped of health care options because of their smaller size or because of the number of low-income people with public insurance.
“That’s not equitable,” he said. “People can’t survive like that.”

 

[Neuromancer]

Talk about voting against your interests.

 

[Richard Glidewell]

Rural areas deserve everything they get......they asked for it and now they have to live it.........they want the others to experience the unfortunate circumstances.........

 

[bnew]

“Crisis”: Half of Rural Hospitals Are Operating at a Loss, Hundreds Could Close

A new report paints a grim picture for small-town health care—especially in states that have not expanded Medicaid.

inthesetimes.com

RURAL AMERICA

“Crisis”: Half of Rural Hospitals Are Operating at a Loss, Hundreds Could Close​

A new report paints a grim picture for small-town health care—especially in states that have not expanded Medicaid.​

JAZMIN OROZCO RODRIGUEZ​

GETTY IMAGES

Editor’s Note: This article was originally published by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism. Learn more about KFF.

In a little more than two years as CEO of a small hospital in Wyoming, Dave Ryerse has witnessed firsthand the worsening financial problems eroding rural hospitals nationwide.

In 2022, Ryerse’s South Lincoln Medical Center was forced to shutter its operating room because it didn’t have the staff to run it 24 hours a day. Soon after, the obstetrics unit closed.

Ryerse said the publicly owned facility’s revenue from providing care has fallen short of operating expenses for at least the past eight years, driving tough decisions to cut services in hopes of keeping the facility open in Kemmerer, a town of about 2,400 in southwestern Wyoming.

South Lincoln’s financial woes aren’t unique, and the risk of hospital closures is an immediate threat to many small communities. “Those cities dry out,” Ryerse said. “There’s a huge sense of urgency to make sure that we can maintain and really eventually thrive in this area.”

A recently released report from the health analytics and consulting firm Chartis paints a clear picture of the grim reality Ryerse and other small-hospital managers face. In its financial analysis, the firm concluded that half of rural hospitals lost money in the past year, up from 43% the previous year. It also identified 418 rural hospitals across the United States that are “vulnerable to closure.”

“We’re really talking about the future of rural here."

Mark Holmes, director of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, said the report’s findings weren’t a surprise, since the financial nosedive it depicted has been a concern of researchers and rural health advocates for decades.

The report noted that small-town hospitals in states that expanded Medicaid eligibility have fared better financially than those in states that didn’t.

Leaders in Montana, whose population is nearly half rural, credit Medicaid expansion as the reason their hospitals have largely avoided the financial crisis depicted by the report despite escalating costs, workforce shortages and growing administrative burden.

“Montana’s expansion of Medicaid coverage to low-income adults nearly 10 years ago has cut in half the percentage of Montanans without insurance, increased access to care and preserved services in rural communities and reduced the burden of uncompensated care shouldered by hospitals by nearly 50%,” said Katy Mack, vice president of communications for the Montana Hospital Association.

Not one hospital has closed in the state since 2015, she added.

Hospitals elsewhere haven’t fared so well.

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Michael Topchik, national leader for the Chartis Center for Rural Health and an author of the study, said he expects next year’s update on the report will show rural hospital finances continuing to deteriorate.

“In health care and in many industries, we say, ‘No margin, no mission,’” Topchik said, referring to the difference between income and expenses. Rural hospitals “are all mission-driven organizations that simply don’t have the margin to reinvest in themselves or their communities because of deteriorating margins. I’m very, very concerned for their future.”

People living in rural America are older, sicker and poorer than their urban and suburban counterparts. Yet, they often live in places where many health care services aren’t available, including primary care. The shorter life expectancies in these communities are connected to the lack of success of their health facilities, said Alan Morgan, CEO of the National Rural Health Association, a nonprofit advocacy group.

“We’re really talking about the future of rural here,” Morgan said.

Like South Lincoln, other hospitals still operating are likely cutting services. According to Chartis, nearly a quarter of rural hospitals have closed their obstetrics units and 382 have stopped providing chemotherapy.

“It’s just bad public policy. And bad policy for the local communities.”

Halting services has far-reaching effects on the health of the communities the hospitals and their providers serve.

While people in rural America are more likely to die of cancer than people in urban areas, providing specialty cancer treatment also helps ensure that older adults can stay in their communities. Similarly, obstetrics care helps attract and keep young families.

Whittling services because of financial and staffing problems is causing “death by a thousand cuts,” said Topchik, adding that hospital leaders face choices between keeping the lights on, paying their staff, and serving their communities.

The Chartis report noted that the financial problems are driving hospitals to sell to or otherwise join larger health systems; it said nearly 60% of rural hospitals are now affiliated with large systems. South Lincoln in Wyoming, for example, has a clinical affiliation with Utah-based Intermountain Health, which lets the facility offer access to providers outside the state.

In recent years, rural hospitals have faced many added financial pressures, according to Chartis and other researchers. The rapid growth of rural enrollment in Medicare Advantage plans, which do not reimburse hospitals at the same rate as traditional Medicare, has had a particularly profound effect.

Topchik predicted sustainability for rural health facilities will ultimately require greater investment from Congress.

In 1997, Congress responded to a rural hospital crisis by creating the “Critical Access Hospital” designation, meant to alleviate financial burdens rural hospitals face and help keep health services available by giving facilities cost-based reimbursement rates from Medicare and in some states Medicaid.

But these critical access hospitals are still struggling, including South Lincoln.

In 2021, Congress established a new designation, “Rural Emergency Hospital,” which allows hospitals to cut most inpatient services but continue running outpatient care. The newer designation, with its accompanying financial incentives, has kept some smaller rural hospitals from closing, but Morgan said those conversions still mean a loss of services.

“It’s a good thing that now we keep the emergency room care, but I think it masks the fact that 28 communities lost inpatient care just last year alone,” he said. “I’m afraid that this hospital closure crisis is now going to run under the radar.”

“It ends up costing local and state governments more, ultimately, and costs the federal government more, in dollars for health care treatment,” Morgan said. “It’s just bad public policy. And bad policy for the local communities.”