Federal repair for rural hospitals will get few takers thus far : Photographs

KEOKUK, Iowa — Of us on this Mississippi River city hope a brand new federal program can revive the optimism engraved way back in a plaque on the aspect of their hospital.

“Devoted to the Way forward for Well being Care within the Tri-State Space,” the signal declares. “Could 11, 1981.”

Newer placards posted on the facility’s entryways are ominous, nonetheless. “Closed,” they are saying. “No Trespassing.”

The Keokuk hospital, which served rural areas of Iowa, Illinois, and Missouri, closed in October 2022. However new house owners plan to reopen the hospital with the assistance of a brand new federal cost system. The Rural Emergency Hospital program ensures hospitals further money if they supply emergency and outpatient companies however finish inpatient care.

“We have been with no hospital for over a yr — and I do not assume anyone in Keokuk or the encircling areas might be choosy in any approach, form, or kind,” says Kathie Mahoney, mayor of the city of about 9,800 individuals. She says residents would favor to have a full-service hospital with inpatient beds, although these varieties of beds had been used sparingly lately.

The revival of the Keokuk hospital would mark a small victory within the nationwide wrestle to save lots of rural hospitals, which proceed to shut attributable to staffing shortages, low reimbursement charges, and declining affected person numbers. The brand new federal program, which went into impact in January 2023, is supposed to stem the closures. However there have been rising pains, says George Pink, deputy director of the North Carolina Rural Well being Analysis Program, which tracks hospital closures and conversions.

Simply 18 of the greater than 1,700 eligible rural hospitals nationwide have utilized for and received the brand new designation. Many hospitals are reluctant to surrender inpatient companies solely, and a few are involved about how different cost streams might be affected, rural well being leaders say. The brand new designation’s unclear definition of “rural” has additionally prompted confusion.

“We’re nonetheless in an period of rural hospital closures,” Pink says. 9 hospitals closed in 2023, and that quantity may rise in 2024, he says. An inflow of federal aid funds in the course of the pandemic saved struggling hospitals afloat, however now that cash is basically gone.

The Rural Emergency Hospital program is the primary new federal cost mannequin for hospitals since 1997. Dr. Dora Hughes, performing chief medical officer of the Facilities for Medicare & Medicaid Companies, says the brand new mannequin’s standards are outlined by statute and “hospitals ought to take into account particular circumstances earlier than making the choice to use.”

The federal company is offering outreach to rural communities and welcomes suggestions, Hughes wrote in an e mail to KFF Well being Information.

Now, rural well being leaders and federal lawmakers are working shortly to tweak the brand new program to draw extra candidates, says Carrie Cochran-McClain, chief coverage officer of the Nationwide Rural Well being Affiliation.

Presently, services that convert to rural emergency hospitals obtain a 5% enhance in Medicare funds, plus a median annual cost of about $3.2 million, in trade for giving up their costly inpatient beds and focusing solely on emergency and outpatient care. Rural hospitals with not more than 50 beds, like Keokuk’s, that closed after the legislation was signed on Dec. 27, 2020, are eligible to use for this system and reopen with emergency and outpatient companies.

Greater than 100 rural hospitals nationwide have inquired about changing, says Janice Walters, interim government director for the Rural Well being Redesign Middle, which has a federal grant to supply technical help to hospitals that need to apply.

However solely a few quarter of these inquiries are more likely to change into a rural emergency hospital, and persuading extra troubled hospitals to make the leap would require regulators to make adjustments, Walters says.

Her recommendation? “Give them 10 beds to simply care for their neighborhood.”

In a journal article printed final yr, Dr. Sara Schaefer, a surgeon, worries in regards to the unintended penalties of eliminating rural inpatient beds. Schaefer, who spent six months of medical college at a small rural Idaho hospital, says she noticed firsthand how troublesome it was for the hospital to switch sufferers to larger services, which have been typically too full to take them.

“There needs to be a greater approach,” says Schaefer, who can also be a analysis fellow on the Middle for Healthcare Outcomes & Coverage on the College of Michigan.

The agricultural well being affiliation’s Cochran-McClain says lawmakers are contemplating adjustments that would enable the hospitals to:

• Maintain in a single day beds for sufferers who want average ranges of care, equivalent to these with pneumonia or in want of bodily remedy after surgical procedure.
• Enable participation in a federal drug low cost program known as 340B, which offers hospitals with further income.
• Maintain inpatient
• Make clear eligibility, together with which services qualify underneath the definition of “rural” and whether or not the hospitals that closed earlier than the 2020 date within the legislation can apply.

Updates to the legislation may have an effect on communities nationwide. In Fort Scott, Kansas, the place the hospital closed in late 2018, Mayor Matthew Wells says the neighborhood desires the eligibility date pushed again. U.S. Sen. Jerry Moran (R-Kan.) launched a invoice in Decemsber that, if handed, would push eligibility again to 2015.

“It is a matter of life and demise to my neighborhood,” Wells says. “I see a transparent path, however the federal rules specifically make that path practically unattainable.”

In Holly Springs, Mississippi, hospital chief government Dr. Kenneth Williams says he does not perceive the federal definition of “rural.” His hospital, Alliance Healthcare Hospital, was one of many first to win the brand new Rural Emergency Hospital designation in early 2023. He laid off workers and shut down his inpatient beds. Then, CMS officers known as to inform him they’d made a mistake.

“And I stated, ‘Wait a minute,'” Williams says. The hospital, which is about an hour south of Memphis, Tennessee, does not meet the present standards of rural, they informed him. Williams, an inside medication physician, purchased the hospital in 1999 and has been attempting to maintain it working since.

Federal regulators are actually asking Williams to transform the power into one other sort of Medicare cost mannequin, equivalent to the only real neighborhood hospital with inpatient beds that it was earlier than. Williams says that might be troublesome: “What sort of transition can I make, particularly with decreased companies?”

In Keokuk, the hospital suits the present necessities. Perception Well being Group, the Michigan firm that purchased the shuttered facility final March, plans to use for the brand new federal designation as quickly because it obtains state permits underneath new Iowa rules tailor-made to rural emergency hospitals. It could be the primary such hospital within the state.

Like many different rural hospitals struggling to outlive, Keokuk’s shuttered a number of key departments years in the past, together with its maternity and inpatient psychiatric models. In 2021, the final full yr it was open, the hospital averaged fewer than three inpatients per evening, in line with knowledge posted by the Iowa Hospital Affiliation.

Greater than half of the three-story constructing would stay mothballed if the power reopened underneath the brand new designation, however the emergency division may serve sufferers once more as quickly as late summer time, says Atif Bawahab, Perception’s chief technique officer.

Bruce Mackie has labored 32 years on the hospital, together with 10 years as director of plant operations. The brand new house owners saved him on to look at over the constructing. Beds, high-tech scanners, and lab gear stay, however many of the clocks have stopped. “It is spooky,” he says.

Even when the companies are extra restricted than earlier than, Mackie says, “all people desires the hospital to reopen. This metropolis wants an ER.”

KFF Well being Information, previously often known as Kaiser Well being Information (KHN), is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications at KFF — the impartial supply for well being coverage analysis, polling, and journalism.