Rural communities hit hard by hospital closures

Published 8:45 pm Saturday, November 14, 2015

At least nine rural Mississippi hospitals are at risk of closing, according to a new study.

Hospitals in Covington, Holmes, Tippah, Attala, Adams, Noxubee, Tallahatchie, Pearl River and Copiah counties were identified as running the risk of closure, the Clarion-Ledger reported.  That’s bad news for people living there.

In addition to those most in danger of closing, 22 more Mississippi hospitals were considered generally at risk. On Thursday, a hospital in rural Newton County announced it was closing its doors. In a statement the hospital said: “Due to Centers for Medicare & Medicaid Services’ re-interpretation of their Critical Access Hospital distance requirement regulation, we are regrettably announcing the closure of Pioneer Community Hospital of Newton.”

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Apparently, the hospital lost its CAH designation, which meant it would be reimbursed differently for Medicare and Medicaid patients. According to hospital officials, critical access hospitals are reimbursed for 99 percent of out-of-pocket costs for those patients. Losing the designation meant losing a lot of funding.

Researchers said they arrived at their list of hospitals at risk based on the hospitals’ profitability, uncompensated care and Medicaid shortfalls. According to the study, reasons for the hospitals’ struggles include the national recession that hit in 2008, population loss in rural areas and lack of capital.

“Rural hospitals across the nation are facing a crisis due to ever-changing economic, policy and population factors,” the report said.

Hospitals are closing at about the same rate in both urban and rural areas. But when a rural hospital closes, the impact tends to be greater as residents must travel much further to receive medical care.

Rural hospitals have struggled before. A change in how the federal government handled Medicare payments made in the 80s resulted in the closure of hundreds of hospitals. The Medicare payment system provided hospitals with a predetermined, fixed amount for services, and some hospitals found that the payments weren’t enough to keep the doors open.

In 1997, a new law created Critical Access Hospitals, which were paid by Medicare based on their costs. The CAH designation helped keep small, rural hospitals open.

So what’s changing now? According to The Associated Press, rural hospitals face several challenges: older and sicker patients, fewer patients on private insurance, Medicare budget cuts and reduced Medicare payments in Obamacare.

Regardless of the reason, the news is bleak for the communities served by these hospitals. The closings will leave patients with fewer healthcare options; they will also mean significant job losses. That’s a brutal, one-two punch that has the potential to hurt those communities for years to come.

What’s the solution?  Many hospitals were hoping the state would expand Medicaid coverage, which would have meant more money for hospitals.

Mississippi has about 139,000 residents without Medicaid because Gov. Phil Bryant blocked the expansion of the government insurance, according to the Mississippi Business Journal.  The federal government would pay for 100 percent of the expanded Medicaid through calendar year 2016, 95 percent in calendar year 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent 2020 and beyond.

Bryant said in a prepared statement earlier this year: “Mississippi is one of many, many states that have chosen not to saddle taxpayers with the crushing burden of additional Medicaid costs by expanding President Obama’s unraveling health care takeover.”

Rural taxpayers who no longer have a medical facility close by might disagree with Bryant’s logic.


Luke Horton is the publisher of The Daily Leader.