The Flickering Lights of the U.S. Rural Hospital

Rural hospitals continue to drop off the map, with an average of 11 hospitals closing each year since 2010. As the rural healthcare system slowly erodes, the aftermath leaves permanent gaps for local services in the small communities left behind.
Earlier this month, iVantage Health Analytics issued 2016 Rural Relevance: Vulnerability to Value Study, on rural hospitals. The study's key finding is that 673 rural hospitals, two-thirds of which are Medicare-designated "critical access hospitals" (CAH), are vulnerable to closure. The CAHs identified as vulnerable comprise 35 percent of all critical access hospitals in the nation.
The study is based on analysis of financial data from more than 2,000 hospitals across the U.S. and is a solid reflection of the recurring press reports of hospital closings.
Residents in Sayre, Oklahoma, population 4,400, are among the latest to understand this reality, with a recent sudden closure in their backyard. Like so many other rural hospitals, Sayre Memorial was not only one of the largest remaining employers in its community, it operated as a key safety-net provider for the 3,763 patients who visited the hospital's emergency room and 526 residents who were admitted to the hospital for care,according to data from U.S. News & World Report-Health.
In response to prior hospital closings, Diane Calmus with the National Rural Health Association said that final decisions to stop operations are often "due to a culmination of events." The reasons leading to closure shared by Sayre Memorial representatives sound like a perfect storm; the list, including revenue and reimbursement challenges while operating in the midst of a rural economy, mirrors almost identically the list of challenges faced by rural hospitals given by the NHRA.
Sayre Hospital officials said that in addition to Oklahoma's decision not to expand Medicaid after the passage of the Affordable Care Act, the hospital had been hit hard by declining Medicare reimbursements. Medicare cuts have been a recurring topic for discussion across the healthcare sector for quite some time.
News Oklahoma quoted hospital officials as stating that Sayre was impacted by Medicare cuts of two percent back in 2011, only to be followed by the Centers for Medicare & Medicaid Services' (CMS) reduction in Medicare reimbursements by 30 to 35 percent in 2012 for patients unable to pay their deductibles and co-payments.

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