Enough is Enough
"If you want to watch a rural community die, kill its hospital." (Miller & Weber, 2017).
It's been almost a month into the new semester and so far, we've learned about what it takes to be an authentic leader, how to build an excellent infrastructure, how to create excellent governance, what the foundations of excellent care are and a few other topics. These topics are meant to teach us what it takes to manage a hospital and the resources that come with it. However, what happens if your hospital is situated in a rural community and is on the brink of closing its doors?
After reading an article titled "A Hospital Crisis Is Killing Rural Communities. This State is 'Ground Zero' by Lauren Weber and Andy Miller- I was perplexed. This article gives an insight as to how bad the health system and the overall economy is in rural communities, especially in Wheeler County, Georgia. After the closing of Lower Oconee Community Hospital in 2014, the pharmacy and the bank had followed shortly afterwards. "With 39 percent of the central Georgia county's population living in poverty, there aren't enough patients with good insurance to keep a hospital from losing money" (Miller & Weber, 2017). Not only that, the hospital was the biggest health care provider in that county... which speaks volumes to the devastation they're facing.
Although I remember Professor Bonica mention slightly about the closing of hospitals, I was naive to believe we were actually having a crisis. "Since 2010, 82 rural hospitals have closed nationwide, and as many as 700 more are at risk of closing within the next 10 years" (Miller & Weber, 2017). Their closures are due to economic trouble in rural communities, a changing economy and an evolving health care system. The southern states are most at risk for hospital closures, which greatly affects the health of the population and leaves them with very little resources to rely on for help. In the South, 1 in 5 adults are living with poor health and 15 percent of adults are uninsured. To make matters worse, the states such as Georgia is one of the 10 states in the South that have chosen not to expand Medicaid under the ACA. The South has higher level of obesity, diabetes and hypertension: yet hospitals are shutting down when people need health services the most.
"In 2013, six rural hospitals in the state of closed their doors. Two of the six hospitals have reopened as modified medical facilities, but no longer function as full fledged hospitals" (Miller & Weber). Despite some hospitals reopening, residents are still not getting the appropriate medical care that they need. Especially when you're uninsured, you come to rely on emergency room services under the the federal Emergency Medical Treatment and Labor Act- which requires hospitals to screen and stabilize patients regardless of their ability to pay. However, it also means that hospitals end up absorbing the costs from those uninsured patients. Because Georgia (and other states with rural communities) has chosen not to expand Medicaid- it left with many people with a lower economic status unable to afford to pay for insurance and unable to take the opportunities that the Medicaid expansion offered. When a community has a larger rate of uninsured residents, it makes it harder for a hospital to stay afloat because many of them take advantage of ER services because they can't afford it. Expanding Medicaid access would've given hospitals more reimbursements and allowed them to take in more patients without it becoming a burden on their finances. When you live in a rural community, you already run the risk of not having as many resources as one would have living in an urban setting.
To be quite honest, if Georgia had expanded Medicaid, the majority of hospitals in rural communities probably would not be dealing with this situation right now. It sounds easier than done, but more should be done to assist hospitals, especially in an area with lower income groups, to be able to stay afloat without the risk of closure. When a hospital closes, it creates havoc on a town because the patients can't get better when there's nowhere to go. As a health administrator/manager, what would you do in that situation?
Miller, A., & Weber, L. (2017 September 22). A hospital crisis is killing rural communities. this state is 'ground zero'. Retrieved from http://www.huffingtonpost.com/entry/rural-hospitals-closure-georgia_us_59c02bf4e4b087fdf5075e38
It's been almost a month into the new semester and so far, we've learned about what it takes to be an authentic leader, how to build an excellent infrastructure, how to create excellent governance, what the foundations of excellent care are and a few other topics. These topics are meant to teach us what it takes to manage a hospital and the resources that come with it. However, what happens if your hospital is situated in a rural community and is on the brink of closing its doors?
After reading an article titled "A Hospital Crisis Is Killing Rural Communities. This State is 'Ground Zero' by Lauren Weber and Andy Miller- I was perplexed. This article gives an insight as to how bad the health system and the overall economy is in rural communities, especially in Wheeler County, Georgia. After the closing of Lower Oconee Community Hospital in 2014, the pharmacy and the bank had followed shortly afterwards. "With 39 percent of the central Georgia county's population living in poverty, there aren't enough patients with good insurance to keep a hospital from losing money" (Miller & Weber, 2017). Not only that, the hospital was the biggest health care provider in that county... which speaks volumes to the devastation they're facing.
Although I remember Professor Bonica mention slightly about the closing of hospitals, I was naive to believe we were actually having a crisis. "Since 2010, 82 rural hospitals have closed nationwide, and as many as 700 more are at risk of closing within the next 10 years" (Miller & Weber, 2017). Their closures are due to economic trouble in rural communities, a changing economy and an evolving health care system. The southern states are most at risk for hospital closures, which greatly affects the health of the population and leaves them with very little resources to rely on for help. In the South, 1 in 5 adults are living with poor health and 15 percent of adults are uninsured. To make matters worse, the states such as Georgia is one of the 10 states in the South that have chosen not to expand Medicaid under the ACA. The South has higher level of obesity, diabetes and hypertension: yet hospitals are shutting down when people need health services the most.
"In 2013, six rural hospitals in the state of closed their doors. Two of the six hospitals have reopened as modified medical facilities, but no longer function as full fledged hospitals" (Miller & Weber). Despite some hospitals reopening, residents are still not getting the appropriate medical care that they need. Especially when you're uninsured, you come to rely on emergency room services under the the federal Emergency Medical Treatment and Labor Act- which requires hospitals to screen and stabilize patients regardless of their ability to pay. However, it also means that hospitals end up absorbing the costs from those uninsured patients. Because Georgia (and other states with rural communities) has chosen not to expand Medicaid- it left with many people with a lower economic status unable to afford to pay for insurance and unable to take the opportunities that the Medicaid expansion offered. When a community has a larger rate of uninsured residents, it makes it harder for a hospital to stay afloat because many of them take advantage of ER services because they can't afford it. Expanding Medicaid access would've given hospitals more reimbursements and allowed them to take in more patients without it becoming a burden on their finances. When you live in a rural community, you already run the risk of not having as many resources as one would have living in an urban setting.
To be quite honest, if Georgia had expanded Medicaid, the majority of hospitals in rural communities probably would not be dealing with this situation right now. It sounds easier than done, but more should be done to assist hospitals, especially in an area with lower income groups, to be able to stay afloat without the risk of closure. When a hospital closes, it creates havoc on a town because the patients can't get better when there's nowhere to go. As a health administrator/manager, what would you do in that situation?
Miller, A., & Weber, L. (2017 September 22). A hospital crisis is killing rural communities. this state is 'ground zero'. Retrieved from http://www.huffingtonpost.com/entry/rural-hospitals-closure-georgia_us_59c02bf4e4b087fdf5075e38
I agree with you in theory and in practice. I live in Texas which has the highest uninsured rate in the country (as per the Texas Tribune 17%). Dr. Bonica will debate all day about the efficacy of having government run healthcare but people are still sick and suffering. I believe it is you and I leaders that can fix this problem as our state's and country's leaders with their infinite resources have chosen not to do so. The opportunity now is to create a new model that will address the needs of the rural communities.
ReplyDeleteI'm glad you agree! Unfortunately, it's not surprising that Texas has the highest uninsured rate in the country- as they decided not to expand on Medicaid as well. I wonder how much of a difference would it have made on the uninsured rate if they expanded on Medicaid, and on the 12 hospitals (shown on chart above) that closed. I guess at this point, it's better to look forward and figure out new solutions rather than looking back on the past and wondering "What if?". With that being said, I do agree that the focus should be on creating a new model that not only addresses the needs of the state as a whole, but more specifically on the needs of the rural communities. It's inhumane to allow these residents to suffer with adequate/lack of care just because of their zip code and income status. We all deserve the same amount of care.
DeleteOh, Anna.
DeleteMegan - fantastic post! Love the research.
DeleteThank you, Professor Bonica!
DeleteSorry I haven't responded sooner. The newest uninsured rate is down to 14%. I did want to clarify, I have had the discussion about private vs public healthcare with many different people, including Dr. Bonica and I think the arguments pro and con are important. We have to understand and adapt to the weaknesses of each system. Dr's spend vast resources to become qualified and therefore deserve the chance to be compensated for their work and a more capitalistic system supports that. I really do feel we can find a way to incentivize the best practitioners and provide low cost care, we just haven't yet and that is not serving our market at all.
Delete