The rural hospital crisis has introduced dozens of closures across the country. Since 2010, Texas has seen 21 closures while Tennessee comes in second for rural hospital closures, at 16.
Large health systems have moved into the more profitable rural hospitals to take over operations while those with deeper problems have been left to legal troubles with insurers and law enforcement agencies for questionable billing practices.
In other cases, the hospitals are being sold off to whoever the highest bidder may be. Because there are often few bidders, the hospitals are sold for next to nothing to organizations with limited experience running hospitals. After a brief stint of trying to eek out a profit, the hospital may be sold off again.
This revolving door of shoddy managers degrades care quality and reputation, often irreparably and whilst worsening the chances for rural residents to get quality healthcare.
Some notable exceptions hold. Some officials in Tennessee are hopeful about a revival of a community hospital led
by Braden Health, however the scope of the problems of rural hospitals likely require public support, especially when in many cases
, closures were driven by corporate business decisions as opposed to local needs or planning.
Federal COVID-related aid helped some hospitals stay afloat amidst the pandemic, but once again, those were temporary measures.
Because many individuals receiving care in rural America may have low incomes or are elderly, the policies of the Medicaid and Medicare programs have massive effects on these hospitals. Recent years have seen Medicare cut the amount it reimburses hospitals for certain treatments.
Even more detrimental, in an effort to reduce unnecessary readmission of patients to hospitals, Medicare reduced reimbursement to hospitals with high readmission. However, because individuals in rural America cannot as easily participate in follow-ups and preventative services, readmissions remain high, and instead of getting crucial support to build out access to care that would drive down readmissions, this incentive program has hurt rural hospitals.
As is often the theme in healthcare policy, public support for rural healthcare services will mean public support to transition to new strategies that reward keeping patients out of the ER and prioritizing value over volume of patient care. This also would require support to build out community-based healthcare services that would make rural America less dependent on centralized hospitals while giving rural residents a better opportunity to manage healthcare rather than reacting to emergencies.