Dive Brief:
- Rural hospitals across the U.S. are closing down, including 14 rural facilities last year, according to the National Rural Health Association.
- Observers disagree as to the reasons for the closures, with theories including the shift from cost-based to pay-for-performance payment, cuts to federal reimbursement, shifting demographics and states' decision not to expand Medicaid eligibility.
- Rural hospital operators say they're closing facilities largely because they expect to lose disproportionate share subsidies as required by the ACA without expanded Medicaid dollars to replace them.
Dive Insight:
The closing of rural hospitals is only a symptom of a larger problem. The reality is, the ACA was destined to cause tremendous problems for any hospital treating lots of uninsured or underinsured payments if Medicaid didn't expand. And in many cases, it hasn't. While the legislation assumed that states would expand Medicaid eligibility, 21 states have failed to do so, courtesy of a Supreme Court ruling allowing states to opt out.
With the ACA still cutting back on DSH payments to hospitals despite the lack of new Medicaid coverage, many—especially those serving largely poor and rural communities—are likely to face very difficult decisions in trying to keep their doors open. This will prove an especially difficult problem for rural communities, whose citizens may have to drive long distances to get emergency care if their local hospital closes. At present, it seems, no solution is in sight.
Read more on Healthcare Dive about rural health
Despite an ongoing rural health crisis that has resulted in closures across the nation, rural hospitals are on average less expensive and more efficient than their urban counterparts. Healthcare Dive took a trip to an isolated town in the mountains of eastern Tennessee to find out why.