Researchers develop risk assessment tool to predict rural hospital closures

“Predicting Financial Distress and Closure in Rural Hospitals,” a new article in the Journal of Rural Health by George M. Holmes, PhD, Brystana G. Kaufman and George H. Pink, PhD, looks at rural hospitals which have closed since 2010 at an increasing rate.

The researchers from the North Carolina Rural Health Research and Policy Analysis Center studied the financial performance of closed rural hospitals compared to those which remain open.

The study uses a sequence of financial events associated with risk in order to create an improved predictive model. The authors studied financial and community data for 2,466 rural hospitals from 2010 to 2013 and developed a risk assessment tool specifically for rural hospitals.

As the report states, “all of the financial performance (lower profitability, less reinvestment, poorer benchmark performance), government reimbursement (lack of critical access hospital status and lower relative Medicaid reimbursement), organizational characteristics (smaller hospital size), and market characteristics (lower market share, poorer economic condition in the market area, and smaller market size) variables are associated with a higher probability of financial distress. The only finding contrary to that hypothesized is ownership: For-profit status is associated with a higher probability of financial distress, which is curious given previous research that showed for-profits are most likely to offer relatively profitable medical services; government hospitals are most likely to offer relatively unprofitable services; and nonprofits often fall in the middle.”

This study echoes the concerns the National Rural Health Association has about the increasing rate of rural hospital closures and the vulnerability to closure of far too many additional rural hospitals.

Continued Medicare cuts in hospital payments have taken their toll, forcing rural hospitals across the country to shut their doors. These hospitals provide essential, lifesaving local access to health care close to home for the 62 million Americans living in rural and remote communities.

Seventy-six rural hospitals have closed since 2010, and another 673 facilities – or one-third or rural hospitals – are at risk of closing. These hospitals serve vulnerable rural Americans who are older, sicker and poorer than their urban counterparts. Specifically, they are more likely to have a chronic disease that requires monitoring and follow-up care, making convenient, local access to care necessary to ensuring patient compliance with the services that are necessary to reduce the overall cost of care and improve the patients’ outcomes and quality of life.

Medical deserts are appearing across rural America, leaving many of our nation’s most vulnerable populations without timely access to care. Legislation is the solution. NRHA urges members of Congress to co-sponsor H.R. 3225, the Save Rural Hospitals Act, introduced by Reps. Sam Graves (R-Mo.) and Dave Loebsack (D-Iowa). NRHA asks that the Senate introduce a companion bill.

The Save Rural Hospitals Act will stop the impending flood of rural hospital closures and provide needed access to care for rural America by stabilizing rural hospitals (reversal of “bad debt” reimbursement cuts; permanent extension of current Low-Volume and Medicare Dependent Hospital payment levels; elimination of Medicare and Medicaid DSH payment reductions) and regulatory relief (elimination of the CAH 96-Hour condition of payment; modification of supervision requirements for outpatient therapy services at CAHs and rural PPS facilities; modification to the two-midnight rule and RAC audit and appeals process).

It will also create an innovative delivery model that will ensure emergency access to care and allow hospitals the choice to offer outpatient care that meets the health needs of their community with a payment structure that will allow these hospitals to remain open to serve their communities into the future.

NRHA urges members of Congress to save rural hospitals and patients by supporting this bipartisan bill.

AAFP endorses H.R. 3225, the Save Rural Hospitals Act

The National Rural Health Association applauds the American Academy of Family Physicians (AAFP), which represents 124,900 family physicians and medical students across the country, for supporting the Save Rural Hospitals Act.

In a letter to the bill’s cosponsors, Reps. Sam Graves (R-MO) and Dave Loebsack (D-IA), AAFP acknowledges the unique challenges faced by rural hospitals and recognizes the payment inequities that rural hospitals operate under and believes that they should be abolished.

Seventy-six rural hospital have close since 2010. Even more concerning is the 673 additional vulnerable rural hospitals, which equates to one-third of all rural hospitals in the U.S., are at risk of closure. These closures are a result of continued Medicare cuts in hospital payments. Rural hospitals are especially critical because the 62 million Americans who call rural America home are older, sicker, and poorer than their urban counterparts. These hospital closures have devastated rural communities and left residents with inadequate access to essential health care services.

The solution is legislation. NRHA urges members of Congress to co-sponsor this important legislation. NRHA also asks the Senate to introduce a companion bill. The Save Rural Hospitals Act will stop the flood of rural hospital closures and provide needed access to care for rural Americans. The bill will stabilize rural hospitals by reversing cuts that are devastating rural hospitals including “bad debt” reimbursement cuts, permanently extending current Low-Volume and Medicare Dependent Hospital payment levels, and eliminating Medicare and Medicaid DSH payment reductions.

The bill will provide regulatory relief by eliminating the CAH 96-Hour condition of payment, rebasing the supervision requirements for outpatient therapy services at CAHs and rural PPS facilities, and modifying the 2-Midnight Rule and RAC audit and appeals process. The bill also looks to the future to create an innovative delivery model that will ensure emergency access to care and allow hospitals the choice to offer outpatient care that meets the health needs of their rural community with a payment structure that will allow these hospitals to remain open and serving their communities.

Bill doesn’t do enough to help rural hospitals

Sens. Al Franken (D-Minn.) and Heidi Heitkamp (D-N.D) recently introduced a bill that establishes a core set of health care quality measures for rural providers and provides grants for rural providers to participate in quality improvement and reporting programs.
 
The National Rural Health Association is pleased with steps working toward including rural providers in Medicare and Medicaid quality measurement and improvement programs based on the recommendations of the National Quality Forum’s Rural Health Committee of which NRHA is a member.
 
However, NRHA is disappointed the bill fails to address the needs of the many rural hospitals struggling with continued Medicare cuts that have resulted in negative average Medicare margins and have made one in three rural hospitals vulnerable to closure.

Without addressing the rural hospital closure crisis, we risk leaving the most vulnerable rural Americans without access to a hospital,” says Maggie Elehwany, NRHA government affairs and advocacy vice president. Hospital quality improvement programs cannot help a community that has lost their hospital.

NRHA supports senators’ letter to HHS

The National Rural Health Association applauds the co-chairs of the bipartisan Senate Rural Health Caucus for their letter to U.S. Department of Health and Human Services Secretary Sylvia Burwell urging the agency to work toward including rural providers in Medicare and Medicaid quality measurement and improvement programs based on the recommendations of the National Quality Forum’s Rural Health Committee of which NRHA is a member.
 
The caucus co-chairs, Sens. John Barrasso (R-WY), Al Franken (D-MN), Heidi Heitkamp (D-ND), and Pat Roberts (R-KS), urged HHS to convene a rural workgroup to identify measures and measure gaps for rural health care improvement to ensure quality programs are tailored to the unique experiences and challenges of rural health care.
 
NRHA supports this effort and will continue to work with our rural champions on Capitol Hill to shape these efforts going forward.

Support bill to protect rural hospitals

By Katherine Hall,
NRHA intern

A markup will be held July 7 to consider the Continuing Access to Hospitals Act (HR 5613) sponsored by rural champions Reps. Lynn Jenkins (R-Kan.) and Dave Loebsack (D-Iowa).

This bill will provide relief to rural critical access hospitals by temporarily delaying the enforcement of the physician supervision requirement for outpatient therapy services through 2016.

NRHA supports this bipartisan legislation.

Seventy-five rural hospitals have closed since 2010, according to the Sheps Center for Health Services Research at the University of North Carolina. At this rate, one-quarter of all hospitals will close in less than a decade.

Cuts in Medicare have led to negative Medicare margins according to the MedPAC report released in March. Additionally, burdensome regulations increase the cost of running these rural hospitals that provide essential medical care to rural residents. Imposing regulations such as the physician supervision requirement impacts these small rural hospitals the most since they are usually short staffed and have the lowest profit margins.

Contact your member of Congress today, and let them know just how important this bill is for health care in rural America.

And watch the live hearing at 2 p.m. EST July 7.

NRHA members, staff participate in Democratic Rural Summit

By Katherine Jane Hall,
NRHA intern

On June 29, National Rural Health Association members Tim Putnam and Nikki King spoke to the Democratic Steering Committee’s Rural Summit on the opioid crisis and other pressing concerns in rural health.

NRHA staff and interns also attended the summit in D.C., which focused on improving the quality of life for rural Americans.

During opening remarks, committee members were adamant about ensuring fellow legislators understand the epidemic of opioid abuse is no longer just an “inner city” problem, as described by Sen. Dick Durbin (D-Ill.). Durbin went on to emphasize that no family is safe from being touched by this crisis.

Sen. Debbie Stabenow (D-Mich.) spoke on maintaining and strengthening the rural way of life. She said we must provide a pathway for comprehensive mental and physical health care for rural America.

Sen. Chuck Schumer (D-N.Y.) discussed expanding rural broadband access through a program similar to the New Deal from the FDR administration to ensure access for telehealth and schools.

USDA Secretary Tom Vilsack gave the keynote about the importance of rural populations to the economy, and how without them, we could not enjoy the same quality of life we are accustomed to as a nation. He also highlighted a wealth of improvements to the programs for rural areas as well as a decrease in poverty and unemployment in rural areas under the current administration.

The panel discussion opened with Sen. Joe Donnelly (D-Ind.) discussing the HIV outbreak in Austin, Ind., and the strain that 197 new cases of HIV has put on the already struggling local health care system.

Donnelly then asked Putman to explain how health care is different in rural areas. Putnam said access is the main issue and in many cases the reason people die of opioid overdose.

As an EMT, Putnam sees overdoses frequently and explained that when you overdose on opioids, you stop breathing and long transport times due to rural hospital closures make it more difficult to save lives once the patient has stopped breathing.

Also a rural hospital CEO, Putnam added that when a hospital is forced to close, there is no transition program (to a 24-hour emergency room, for instance), so communities are left without access health care.

Putnam also discussed the importance of rural training tracks and that we must “…grow and train our own” to ensure workforce security.

Another NRHA member, and panel participant, Nikki King gave a heartfelt testimony about her experiences growing up in rural Kentucky.

“When I left my rural community, my goal was to make rural communities more sustainable,” she told senators.

She said while growing up in Appalachia, she witnessed people in her hometown dying of black lung and overdosing on opioids that were prescribed to them. She spoke of more and more children being raised by people other than their parents due to drug abuse and the rising death toll of the current drug crisis.

King said people from Appalachia are hardworking, ready to fight for our country, and occasionally do the jobs that no one else wants to do.

She ended her testimony saying, “We’re worth fighting for in Appalachia. We need our hospitals, and we need help to stand.”

Donnelly concluded the panel discussion by adding, “When rural America works, everything works.”

NRHA members attend Senate Democratic Steering Committee Rural Summit

The Senate Democratic Steering and Outreach Committee will hold a Fostering the Next Generation of Rural America hearing Wednesday, June 29. The Committee facilitates an ongoing conversation between Senate Democrats and the public.

NRHA members Tim Putnam, President and CEO, and Nikki King, Administrative Fellow at the Margaret Mary Health, Batesville, Indiana will be sharing their personal stories about the economic challenges and solutions for rural America’s health care system.

NRHA is pleased that rural health care and our NRHA members will have a voice during this important hearing. Senator Klobuchar, Reid, Durbin, Schumer, Donnelly, Manchin and Shaheen will be among those in attendance.

NRHA applauds Senate Appropriations Committee for rural funding

The National Rural Health Association applauds the Senate Appropriations Committee for recognizing the importance of a strong investment in rural health delivery for fiscal year 2017.

NRHA thanks Chairman Cochran, Vice Chairwoman Mikulski, and the Committee members for the increase of funding for the Rural Outreach and Network Grants and Telehealth, both important programs for rural America. NRHA also applauds the Committee for the strong funding for the Rural Hospital Flexibility Grants which are used by each state to implement new technologies, strategies and plans in Critical Access Hospitals (CAHs). CAHs provide essential services to a community and their continued viability is critical for access to care and the health of the rural economy.

NRHA also thanks the Committee for recognizing the importance of Graduate Medical Education (GME), and its concern that the current funding for GME does not adequately address the needs of rural communities and the changing demands on the health care system. NRHA applauds the Committee for directing CMS to submit a report to Congress on what steps can be taken to address physician shortages.

Rural health programs assist rural communities in maintaining and building a strong health care delivery system into the future. Most importantly, these programs help increase the capacity of the rural health care delivery system and true safety net providers.

Programs in the rural health safety net increase access to health care, help communities create new health programs for those in need and train the future health professionals that will care for the 62 million rural Americans. With modest investments, these programs evaluate, study and implement quality improvement programs and health information technology systems.

Funding for the rural health safety net is more important than ever as rural Americans are facing a hospital closure crisis. Since 2010, 75 rural hospitals have closed, 10,000 rural jobs have been lost and 1.2 million rural patients have lost access to their nearest hospital. The most recent hospital closed in Georgia on Monday. Even more concerning is that 673 rural hospitals are at risk of closure, meaning sustained Medicare cuts threaten the financial viability of 1 in 3 rural hospitals. The loss of these hospitals would mean 11.7 million patients would lose access to care in their community.

NRHA asks Congress to support strong funding for these important rural health programs.

Rural broadband bill heads to president’s desk

The National Rural Health Association applauds the passage of S. 1916, the Rural Health Care Connectivity Act, which will expand the Universal Service Fund’s (USF) Rural Health Care Program (RHCP) to skilled nursing facilities (SNF).  This program provides funding for telecommunications and broadband services used to provide health care in rural communities. SNFs are an important source of health care for many seniors in rural America, and this bill will help these facilities have access to the broadband and telecommunications services that are so important to providing the care their patients need.

This important legislation sponsored by rural champion Sen. John Thune (R-SD), was included in the Toxic Substances Control Act conference report. The president is expected to sign the conference report.

No resolution yet for “Little Sisters of the Poor”

This morning, the U.S. Supreme Court issued an opinion in Zubik v. Burwell (more commonly known as the “Little Sisters of the Poor” case), the lawsuit challenging the Affordable Care Act birth control coverage requirement for religious, nonprofit employers. Yet, far from establishing a conclusion to the dispute, the case was sent back to the lower court with instructions for the parties to come to a solution that works for everyone. The Court explicitly stated they express “no view on the merits of the cases.”

After the case was argued before the Supreme Court, the justices requested additional information from the parties. Both parties agreed that “contraceptive coverage could be provided to petitioners’ employees, through petitioners’ insurance companies, without any such notice from petitioners.” In other words, if the employer is not required to do anything, they agreed their religious freedom is not infringed.

The process will take more time, and the ultimate agreement is still unknown.