As rural hospitals continue to struggle financially, a new type of hospital is slowly gaining traction, especially in the Southeast.
Rural emergency hospitals receive more than $3 million in federal funding per year and higher Medicare reimbursements in exchange for closing all inpatient beds and providing 24/7 emergency care. While this makes it easier for a hospital to keep its doors open, experts say it doesn’t solve all the challenges rural health care faces.
People may need to travel further for treatment for illnesses that require hospitalization, such as pneumonia or COVID-19. In some of the communities where hospitals have converted to the new designation, residents are confused about what type of care they can receive. Additionally, rural hospitals are reluctant to make the switch because there is no margin for error.
“It’s ironic” that facilities that might need more help can’t afford to take the risk, said Carrie Cochran-McClain, policy director at the National Rural Health Association. She stressed the need to give up some services and benefits, such as a federal prescription drug rebate program.
The government, which classifies hospitals by type, launched the rural emergency option in January 2023. Only 19 hospitals in the United States received rural emergency hospital status last year, according to the Sheps Center for Health Services Research from the University of North Carolina.
Most are in the South, with some in the Midwest, and hospitals in Nebraska and Florida have recently begun exploring this option.
The designation is aimed at a very specific population, said George Pink, deputy director of the Sheps Center’s Rural Health Research Program, and those are rural hospitals on the brink of closure with few people already receiving hospital care.Save the rural assistance
This was the case at Irwin County Hospital in Ocilla, Georgia, which was the second rural emergency hospital established in the United States
Weeks before the conversion, the hospital had received at least $1 million in credit from the county so it could pay employees — money that county Board of Supervisors Chairman Scott Carver doubted he would see returned.
“We operate on a $6 million budget for the county, so extending that type of credit line was to some extent dangerous on our part,” he said. “But… we felt we had to try.”
Irwin County Hospital became a rural emergency hospital on Feb. 1, 2023. Quentin Whitwell, the hospital’s CEO, said it was an ideal candidate.
“We’re still finding out what some of the impacts will be, since this is a new thing,” said Whitwell, who through his company Progressive Health Systems owns and operates six hospitals in the Southeast, most of which are rural emergency or have requested designation. “But the move to a rural emergency hospital has transformed this hospital.”
A combination of state programs and tax credits, plus the new designation, means the hospital has $4 million in the bank, Carver said. Simply put, it was worth it for him.
Traci Harper, a longtime Ocilla resident, isn’t so sure. About a year ago, she rushed her son to the hospital for emergency treatment for spinal meningitis.
Because the new designation requires the hospital to transfer patients to larger hospitals within 24 hours, Harper’s son was sent to another state facility and three days later received the care he needed at a Jacksonville hospital , Florida.
“It’s two hours away,” he said. “I could have carried him there the whole time, but no one told me.” “Barely Survived”
Nebraska’s first rural emergency hospital opened in February in a town called Friend.
Warren Memorial Hospital had reached a breaking point: Federal pandemic relief money had run out. The city, which owns the hospital, had to start extending lines of credit so that hospital employees could get paid. A major road repair project was even delayed, said Jared Chaffin, the hospital’s chief financial officer and one of three co-CEOs.
“In the summer, we could barely survive,” said Amy Thimm, the hospital’s vice president of clinical services and quality and co-CEO.
Although residents expressed concerns at a September town hall about the closure of hospital services, the importance of having emergency care outweighed other concerns.
“We have farmers, ranchers and people who don’t have time to drive an hour to get service, so they’re going to go without,” said Ron Te Brink, co-CEO and chief information officer. “Rural health care is extremely important to many Nebraska communities like ours.”
The first federal payment, about $270,000, arrived on March 5. Chaffin expects the hospital’s revenue to be $6 million this year, more than it has ever made.
“It’s just crazy, especially for our little hospital here,” he said. “We still have Mount Everest to climb and we still have a lot of work ahead of us. The designation alone is not a savior for the hospital — it’s a lifeline. “Rural problems
That lifeline has proven difficult to maintain for Alliance Healthcare System in Holly Springs, Mississippi, another of Whitwell’s hospitals and the fourth facility in the country to be converted.
Months after being approved as a rural emergency hospital in March 2023, the Centers for Medicare and Medicaid Services reneged on their decision.
The hospital’s CEO, Dr. Kenneth Williams, told The Associated Press that the government has argued the hospital is not rural because it is less than an hour from Memphis. A CMS spokesperson said the facility was “inadvertently certified.”
The hospital has until April to return to full service, but many in the largely retiree community believe the hospital has closed, Williams said. Patient volume is at an all-time low. If the federal payments stop coming, Williams isn’t sure the hospital will survive.
“We could have closed if we hadn’t become a rural emergency hospital, so … something had to be done,” he said. “Do I regret all the problems that for some reason we had to deal with that other (hospitals) didn’t have to deal with? I do not know.”
While Alliance appears to be one of the few facilities negatively impacted by conversion to a rural emergency hospital, Pink said it’s too early to know whether the federal designation is a success.
“If my intuition is correct, it will probably work well for some communities and may not work well for others,” he said.
Cochran-McClain said her organization is trying to work with Congress to change regulations that have been a barrier to rural facilities, such as closing behavioral hospital beds that are already in short supply.
Brock Slabach, chief operating officer of the National Rural Health Association, told the AP that more than 30 facilities are interested in converting to rural emergency hospitals this year.
As Whitwell sees it: “As this program evolves, there will be more people who I think will understand the value of it.”
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