Close or go to urgent care?

A KFF Health News report shows that almost half of rural hospitals across America are experiencing financial losses, and 418 hospitals in these communities are susceptible to closing. To address this, in January 2023, the White House launched a program requiring rural hospitals to convert to urgent care centers in exchange for $3 million in funding and increased Medicare reimbursements. While this solves the solvency problem of some hospitals, according to ABC News, residents of those rural communities often feel abandoned since the medical care that urgent care facilities can provide is restricted.

An ideal example is Irwin County Hospital in Oscilla, Georgia. Soon before conversion for the agricultural urgent care center, the hospital took out a $1 million loan from the county for which it is called pay their employees. County Board of Supervisors Chairman Scott Carver doubted he would have the opportunity to return the cash, but told ABC News he thought it was well worth the risk.

“We operate on a $6 million county budget, so it was somewhat dangerous on our part to extend this type of line of credit,” Carver said. “But… we felt we had to try.”

Irwin County Hospital CEO Quentin Whitwell told the ability it has been a boon for the hospital, which now has $4 million within the bank after receiving tax credits and participating in state programs. Whitwell operates six other rural hospitals within the Southeast, most of which have converted to rural acute care facilities or are within the means of doing so.

“We’re still figuring out what some of the impacts are, given that this is a new case,” Whitwell said. “But the change to a rural emergency hospital changed the hospital.”

City residents, like Traci Harper, learned the hard way that a brand new hospital policy could create a barrier to providing timely medical care if the hospital was unable to meet a patient’s needs inside 24 hours. Harper’s son needed take care of meningitis and was transferred to one other hospital in Georgia after which to a facility in Jacksonville, Florida, where he received treatment. Harper felt like she could have gotten her son taken care of more quickly if she had been informed about her options earlier.

“It’s in two hours,” Harper said. “I could have taken him there myself all along, but no one told me.”

As for the financial risks many rural hospitals face, Michael Topchik, director of the Chartis Rural Health Center, told KFF News he expects their condition to worsen.

“In healthcare and many industries we say, ‘No margin, no mission,’” Topchik said of the difference between revenues and expenses. Rural hospitals, he said, “are mission-driven organizations that simply do not have the margin to reinvest in themselves or their communities due to deteriorating margins. I’m very, very worried about their future.”

Alan Morgan, CEO of the National Rural Health Association, a nonprofit advocacy group, told KFF News that he believes the agricultural emergency hospital designation is ultimately not a superb policy to address the particular needs of rural communities and the hospitals that serve them. Meanwhile, Topchik stressed that Congress will need to provide rural hospitals with more funding to prevent them from closing.

According to Morgan, “It’s good that we’ve retained emergency room care now, but I think it masks the fact that 28 communities lost hospital care last year alone. I fear the hospital closure crisis will now fly under the radar.”

He concluded: “Ultimately, this means more costs for local and state governments and more for the federal government in treatment dollars. This is simply bad public policy. And bad policy towards local communities.”