Rural Hospitals Face Choice Between Closing Or Becoming Urgent Care Facilities

March 18, 2024
Some residents in these rural communities reportedly feel abandoned as urgent care facilities are limited in the medical care they can provide.
A report from KFF Health News indicates that nearly half of rural hospitals across America lose money, and 418 hospitals in those communities are in danger of closing. To combat this, the White House rolled out a program in January 2023 requiring rural hospitals to become urgent care centers in exchange for $3 million in funding and increased Medicare reimbursement payouts. While this solves the solvency problem for some hospitals, as ABC News reports, residents in these rural communities often feel abandoned as urgent care facilities are limited in the medical care they can provide. 
Irwin County Hospital, located in Oscilla, Georgia, is a prime example of these tensions. Shortly before converting to a rural urgent care center, the hospital took a $1 million loan from the county whose name it bears to pay its employees. The County Board of Supervisors Chairman Scott Carver doubted he would see that money repaid, but he told ABC News that he felt it was worth the risk. 
“We operate on a $6 million budget for the county, so to extend that kind of line of credit was dangerous on our part to some degree,” Carver said. “But … we felt like we had to try.”
Irwin County Hospital CEO Quentin Whitwell told the outlet that it ended up being a boon to the hospital, which now has $4 million in the bank after receiving tax credits and participating in state programs. Whitwell also manages six other rural hospitals across the Southeast, most of which have made the transition to rural emergency care facilities or are in the process of doing so.
“We’re still finding out what some of the impacts are, given that it’s a new thing,” Whitwell said. “But the change to a rural emergency hospital has transformed this hospital.”
Residents of the city, like Traci Harper, found out the hard way that the hospital’s new policies can create a barrier to prompt medical care if they can’t handle a patient’s needs within 24 hours. Harper’s son needed care for spinal meningitis, and was transferred to another hospital in Georgia before eventually being transferred to a facility in Jacksonville, Florida, where he received care. Harper, meanwhile, felt as though she could have gotten care for her son faster if she had been informed of her options sooner. 
“That’s two hours away,” Harper said. “The whole time I could have taken him there myself, but nobody told me that.”
Regarding the financial peril many rural hospitals face, Michael Topchik, the head of the Chartis Center for Rural Health, told KFF News that he expects their condition to worsen. 
“In healthcare and in many industries, we say, ‘No margin, no mission,’” Topchik said, speaking of the difference between income and expenses. Rural hospitals, he said, “are all mission-driven organizations that simply don’t have the margin to reinvest in themselves or their communities because of deteriorating margins. I’m very, very concerned for their future.”
Alan Morgan, the CEO of the National Rural Health Association, a nonprofit advocacy group, told KFF News that he believes the Rural Emergency Hospital designation is ultimately not a good policy to address the specific needs of rural communities and the hospitals that serve them. Topchik, meanwhile, stressed that Congress will need to provide rural hospitals with more funding to keep them from closing. 
According to Morgan, “It’s a good thing that now we keep the emergency room care, but I think it masks the fact that 28 communities lost inpatient care just last year alone. I’m afraid that this hospital closure crisis is now going to run under the radar.”
Morgan concluded, “It ends up costing local and state governments more, ultimately, and costs the federal government more, in dollars for healthcare treatment. It’s just bad public policy. And bad policy for the local communities.”
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