- Residents in rural communities with low-margin hospitals may struggle to get emergency medical care should their local hospital close, according to an analysis released Monday from the Center for American Progress, a Democratic think tank. That's because low-margin rural hospitals with emergency departments were, on average, 22 miles from the closest hospital-based emergency department in 2017, and 10% of them were more than 35 miles away from the next ER facility, the study found.
- Overall, the research showed that rural hospitals were more likely to be struggling financially. They had a median loss on patient-care operations of 4.9%, compared with a median loss of 0.1% for hospitals in urban metropolitan areas.
- Low-margin rural hospitals were concentrated primarily in the South and parts of the Midwest and Mountain States. Texas, New Mexico and Kansas had the most struggling rural hospitals, with 30% or more of each state's pool of such facilities qualifying as low-margin, the analysis found.
Many rural hospitals are struggling to survive. More than 100 of the facilities have closed since 2010 and numerous others are on the brink. Last month, two sister facilities — West Virginia-based Ohio Valley Medical Center and East Ohio Valley Regional Hospital — announced that they plan to close Oct. 7.
Consulting firm Navigant released a study earlier this year, finding that as many as one in five rural hospitals are in danger of closing unless they receive some type of financial relief. And 65% of those hospitals are "highly essential" to the health and well-being of their communities, the study found.
The closures make it harder for nearby residents in these rural communities to get medical care because they are often forced to drive longer distances. This is particularly problematic for emergency care. Indeed, a recent study in Health Affairs found that patients who drive 30 minutes or more to an emergency department after a closure near them risk negative health outcomes, particularly when the next closest facility is considered a high-occupancy hospital.
The study from the Center for American Progress, which was released days before the Democratic presidential hopefuls debate in Houston, also sought to assess the impact of rural hospital closures on access to emergency medical care. The authors analyzed data on 4,147 acute-care hospitals, including 1,954 hospitals in rural areas, from the CMS Healthcare Cost Report Information System.
They divided hospitals into three groups based on their operating margin: the lowest 10%, the middle 80% and the top 10%. They defined hospitals in the lowest group — with losses on patient-care operations greater than 20.5% — as low-margin hospitals.
A total of 246 rural hospitals were in the low-margin category, making up 59.7% of hospitals in that category. Only 27.9% of rural hospitals were among the top 10% of hospitals, which were facilities with operating margins greater than 12.1%.
CMS recognized the plight of rural facilities in the final Inpatient Prospective Payment System rule, which it released last month. Starting in fiscal year 2020, CMS will increase the wage index for hospitals below the 25th percentile for at least four years.
"With this change, low-wage and rural hospitals will be able to increase employee compensation and have sustainability," CMS Administrator Seema Verma said in a call with reporters then.