I recently read the Bloomberg Law article authored by Alex Wolf that was reprinted in the American Bankruptcy Institute journal this week. Mr. Wolf’s points are accurate and reflect the “wait and see” attitude of the healthcare industry that, over the last 60 years, has maintained a reactive approach to healthcare delivery based upon the edicts of government (both State and Federal) and the health insurance industry.
As a result, access to critical healthcare services is eroding in the most vulnerable areas of our country; rural America. In addition, access to healthcare services is one of the four legs of the economic development stool for any municipality. Business and industry will look for: 1. adequate infrastructure, 2. good schools, 3. affordable housing and, 4. healthcare as the key “must-haves” to locate their businesses to that municipality. Without that fourth leg, they will look elsewhere and existing businesses may look to relocate, as well.
Ms. Lochner has already developed a dialogue with the City Manager of Bowie, TX, Bert Cunningham, who is living the downward spiral that began with his hospital closing in 2019. This scenario is repeating itself across the country. As a 41 year healthcare administrator, I have seen this happen all too frequently and, in most instances, there is no reason for it.
If we accept for fact that we will not see commercial insurance carriers or CMS creating special DRGs to keep rural facilities open in the face of declining volumes and aging physical plants and large, multi-facility healthcare systems (the “Haves” in Mr. Wolf’s article) coming to the rescue of these hospitals for altruistic reasons, rural healthcare is on its own to survive or fail.
The 1960 Hill-Burton, “Field of Dreams” model of healthcare as “build it and they will come” is long gone, never to return. The aging physical plants housing too many acute care beds in semi-private accommodations will no longer appeal to the healthcare consumer of today. Rural healthcare providers must accept that they cannot be all things to all people. With current NCQA guidelines, the push to recruit specialists to create “centers of excellence” in specialties such as cardiology or orthopaedic surgery are pipe dreams and financially unrealistic in today’s healthcare market.
As a hospital administrator, I understand the C-suite’s reluctance to accept the realities of this changing landscape and realize that they may be committing professional hari-kari by recommending a radical downsizing of the hospital in order for it to survive. However, I see no other viable alternative to maintaining a healthcare presence in rural America going forward.
The residents of a community need access to emergency, diagnostic, surgical (primarily ambulatory) and stabilization services that are available within minutes of a critical or traumatic event with effective EMS transport/medevac services to a larger facility. They need primary care and preventive health services. And, they need therapies and social services for those with mental health needs. They do not need inpatient beds, intensive care units, cath labs, robotic surgery, and other high end interventions that are very costly and have no place in a rural facility. Lastly, they do not need high priced administrators and all the attendant overhead, either.
Rural healthcare must innovate and re-imagine themselves instead of waiting for the inevitable. We had numerous healthcare providers declare Chapter 11 in late 2019 or early 2020 only to petition the Court to void their protection filing in order to be eligible for the CARES Act funds. Once the funds were received, they re-petitioned the Courts for protection. This may be smart but, it’s not innovative!!
The rural healthcare industry must embrace and lead change; not wait for it to be imposed upon them. Doing the latter is a disservice to the communities they serve.
Thanks for listening (reading).