Decline in rural hospitals

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The closing of the city’s lone hospital was the talk of the town. It’s been nearly four months since the closing of Cochise Regional Hospital in Douglas, but some Douglas residents talk about it like it happened yesterday.

“People were shocked and appalled,” said Tom Allen, owner of a local café in town. “Suddenly, they didn’t have a place to go to if they suffered from a heart attack and 70 people were screwed out of their job.”

The hospital had been a staple of the city for a number of years. But after learning the hospital had committed multiple safety violations and citing patient-safety concerns, the federal government stopped funding Medicare to the facility.

The hospital closed within the month, sparking health concerns on a national level. An alarming number of rural hospitals have closed down in the last five years, and many more are on the brink of closing.

A Cause for Concerns

Since 2010, 55 rural hospitals have closed according to research by the North Carolina Rural Health Research Program. 283 more rural hospitals are at risk of closure.

“It’s a big problem that needs to be addressed,” said Daniel Derksen, the director of Arizona Center for Rural Health. “When a rural or critical access hospital closes, you lose the foundation of community health infrastructure.”

“Once you lose you that health safety net, you might lose a pharmacy. You might lose a nursing home. You might start losing physicians,” said Derksen.

In Douglas, many feared the closing of the hospital would lead to an erosion of health care.

“Now you had to look elsewhere if you were in an emergency,” said Allen. “You either had to go to Sierra Vista or Bisbee.”

Many of the residents opted to go to the Copper Queen Community Hospital in Bisbee. The Bisbee hospital has opened its facility to Douglas residents with open arms. They’ve even expanded their emergency room by 50 percent.

But, the hospital is more than 25 miles away.

“When you delay emergency access and services, it does affect health outcome and also the community,” said Derksen.

In recent months, Douglas residents have relied on the city’s fire department for transportation to the Bisbee hospital.

The fire department has had to increase its staff to accommodate the workload. On average, the department has to provide transportation for 10 to 15 people on a daily basis, according to Al Hurtado, DFD’s captain.

“It’s placing a bit of strain on the city,” said Hurtado. “They’ve had to do more like paying for overtime, fuel and upkeep of the transportation vehicles.

A one-way trip to the hospital will cost Douglas residents $1,200 a pop if they’re not covered by insurance. In emergencies, it’ll take about 20 minutes to get to the Copper Queen and an hour for the emergency vehicle to return back to Douglas, said Hurtado.

On an economic level, while 40 people found jobs at the Copper Queen hospital and Douglas’s Quick Care, more than 30 workers at the former Douglas hospital had to scramble to find new jobs.

“The economic side of it can’t be understated,” said Derksen. “These are real people with real jobs.”

There are a number of reasons why rural hospitals are struggling to stay opened.

One of which relies on whether or not a state expands its Medicare program. In some rural hospitals, Medicare funding accounts for nearly half of their funding. Under the Affordable Care Act, a state can cover adults under 65 with income up to 133 percent of the federal poverty level. This effectively means more free or low-cost coverage is available for states with expanded Medicare.

Texas was a state that chose not to expand its Medicare program. Since 2010, they’ve seen 11 rural hospitals close down.

“Even a slight change in how a hospital gets funded can be a huge challenge,” said Derksen. “Their margins are thin to begin with. These smaller hospitals don’t have a reserve.”

Another problem is the difficultly of the 96 hour rule. This rule says that critical access hospitals, which are 24-hour, 7-day-a-week hospital with less than 25 inpatient beds and located 35 miles away from another hospital, are required to transfer or discharge patients within 96 hours. Otherwise, they don’t qualify for Medicare pay.

“It’s a rule that makes everyone unhappy, especially Medicare patients, who may be forced to pay more for services that are ruled outpatient,” said Derksen.

Last, rural hospitals suffer when uninsured patients receive treatment but don’t have the money to pay back compensation.

“There are about 431,000 uninsured Arizonans right now,” said Derksen. “The biggest thing we can do to help is to make sure these people know what kind of benefits they’re eligible to get.”

Solutions Moving Forward

Some rural hospitals are making it work despite all of the difficulties. The Copper Queen Community Hospital in Bisbee is one of them, showing some of the best operating margins in the state, according to the hospital’s CEO, James Dickson.

The hospital created a partnership with Tucson Medical Center and three other rural hospitals to form the Southern Arizona Hospital Alliance. The alliance allows each rural hospital to connect with one another and collaborate on medical practices and technology learning.

Furthermore, the hospital is moving away from inpatient to outpatient care. Inpatient care means the patient has to be treated in the hospital. Outpatient means treatment can take place outside the hospital and the patient does not require hospital admission.

“If you concentrate services on inpatient side, you’re going to close,” said Dickson. “You’re not going to be successful.”

A Look Towards the Future

While there has been a negative trend in rural hospital for the last few years, Derksen said there are steps that can be taken to remedy the situation.

“It’s just going to take the federal government leveraging Medicare dollars to reinvent health professions education.”

Kethia Kong is a reporter for Arizona Sonora News, a service from the School of Journalism with the University of Arizona. Contact him at kkong@email.arizona.edu

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