THA Searches for Solutions as Another Hospital Closes
In the last few years, nearly 10 percent of Tennessee hospitals have closed their doors, leaving communities without easy access to emergency services and inpatient care. On March 1, Cumberland River Hospital in Celina, Tenn., became the 10th rural hospital and 12th overall to cease operations since 2012.
"Reasons for these closings included declining volumes, difficulties in the recruitment of healthcare providers, the burden of uncompensated care, and limited financial resources and capital, as well as a reimbursement model that is inpatient-focused and largely not aligned with prevention and chronic care needs," noted Craig Becker, president and CEO of the Tennessee Hospital Association.
Becker added recent conversations regarding federal healthcare reform could signal even more challenges to rural hospitals when it comes to financial viability. "There are certainly more rural hospitals in Tennessee at risk for closure, and it is unfortunate that more of them likely will shutter in 2019. THA's work at the federal level to establish regulatory 'glide-paths' for rural hospitals to transition to alternative models of care - and at the state level with the Rural Transformation program passed by the General Assembly in 2018 - is critical to stabilizing and ensuring the future of rural healthcare."
Bill Jolley, senior vice president of rural health issues for THA, agreed the Tennessee Rural Hospital Transformation Act, signed into law last year by former Gov. Bill Haslam, was a first step to address the changing healthcare landscape. "It provided a mechanism to provide support to those rural hospitals that are really in dire straits," Jolley said. He explained the law makes funding available for the state to contract with consultants and professional firms with expertise in hospital turnaround strategies to assess strategic partnerships ranging from joining forces with other hospitals in contiguous geographic regions to partnering with a larger tertiary facility to improve economies of scale and overall financial viability.
THA worked closely with legislators on the plan, which is under the oversight of the Tennessee Department of Community and Economic Development. Jolley said the legislation allows for potentially $3 million over three years to create such transformation plans. While funding must be reauthorized annually, the first $1 million has been approved for work in 2019.
He added the expectation is that some hospitals would ultimately need to transition to new delivery models. "The hope would be they could sustain themselves in their current state ... but if that's not possible, then at a minimum maintaining a medical presence in these communities. There are some innovative ways of delivery care in rural Tennessee and across the country."
Jolley pointed to Johnson County Community Hospital, part of Ballad Health, in Mountain City, Tenn., as an example of rethinking the traditional delivery model. The critical access hospital has a 24/7 emergency department, two inpatient beds for either general care or to stabilize a patient before transferring to a larger facility, and a host of outpatient services focused on primary care, prevention and chronic care management.
Not surprisingly, communities have fought hard to keep local hospitals, even when swimming against the tide of mounting financial losses. "We're seeing it now all throughout the state with communities desperately trying to keep their hospitals open," said Becker.
"It's a real hard pill to swallow to give up a full-service hospital. It's part of the social fabric of the community," he added of the role hospitals play beyond care delivery. Becker said a hospital closure causes a ripple effect. Not only is there the loss of high-paying jobs, but it also makes it more difficult to attract new businesses to the area.
"Typically, the hospital ranks in the top three employers in a community, and sometimes as the top employer," noted Jolley.
"The population left behind that doesn't leave these communities tend to be the elderly and the uninsured," continued Becker. He said the Rural Hospital Transformation Act allows for the assessment of the most appropriate level of care to meet the needs of the population. "It gives them another road to keep a medical presence in that community," he added.
Telemedicine offers another opportunity to link rural communities to providers and specialists. Increased broadband access and greater acceptance by insurers have opened the door to expand the technology. "It provides an opportunity for some of our urban-based practices to partner with rural communities by linking through telemedicine," said Jolley.
Although Gov. Bill Lee has expressed opposition to traditional Medicaid expansion under the Affordable Care Act, he has signaled his desire to focus on strengthening rural communities. Similarly, Becker said national lawmakers are increasingly cognizant of the rural healthcare crisis across the country. "Awareness ... that's the first step, and then you look at how to fix it," he noted.
Becker added not every rural hospital in Tennessee is failing. Some, in fact, are doing quite well. He pointed to Henry County Medical Center and Hardin Medical Center in West Tennessee as examples of stand-alone hospitals that have served their counties continuously for nearly seven decades. Backed by the power of TriStar Health, Cheatham County in Middle Tennessee is served by TriStar Ashland City Medical Center, a 12-bed critical access hospital that has won national recognition for quality and leadership.
Becker also applauded Maury Regional Health in Columbia, Tenn., for stepping in to offer robust community-based services in nearby counties that have lost hospitals. "They probably have the prototype of how to handle regional care," he noted.
While there is excitement about the building momentum to address rural access to care, both Becker and Jolley said a sustained focus is critical. Tennessee is second only to Texas in the number of rural hospital closures, and there are several more Tennessee hospitals currently hanging on by a thread.
"It's a lot more than a critical condition, and it's not going to get any better until we address it," concluded Becker.
THA Small & Rural Health Resources
Tennessee Office of Rural Health
Rural Health Association of Tennessee