Critical Point for Rural Communities
April 25, 2022
Despite the large number (1430) of Critical Access Hospitals (CAHs) in the US these hospitals continue to struggle with major challenges that compromise their sustainability. Prior to COVID Becker’s Hospital Review reported that 500 rural hospitals were at immediate or high financial risk of closure. Becker’s reports that number has climbed to 800 post COVID.
This is a critical point for rural communities, where more than 46 million Americans or 15% of the U.S. Population live. This is particularly critical given the fact that medical outcomes for patients were historically lower in rural areas. Rural populations are higher in age with more complex medical issues than in urban areas. Rural communities have a higher mortality rate for heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than urban health systems and areas. Additional contributing factors that lead to the poorer health outcomes in rural areas are:
- long travel distances to specialty and emergency care
- higher rates of cigarette smoking, high blood pressure, and obesity.
- less leisure-time physical activity and lower seatbelt use
- higher rates of poverty, less access to healthcare, and are less likely to have health insurance
Steele Memorial Medical Center is not unlike other Critical Access Hospitals facing the challenges of rural healthcare nationwide. A Critical Access Hospital is defined generally as a hospital:
- Having 25 or fewer acute care inpatient beds
- Located more than 35 miles from another hospital (exceptions may apply
- Maintaining an annual average length of stay of 96 hours or less for acute care patients
- Providing 24/7 emergency care services
The top four reasons that contribute to the financial challenges for CAHs pre – COVID are: challenging payment mechanisms, challenges to quality, limited access to capital, and difficulty attracting a skilled workforce. These four challenges create chaos for rural hospitals, and threatened their long-term viability and their ability to provide access to healthcare, even before the pandemic.
Recruiting and retaining clinical workforce of all levels and disciplines was challenging for rural hospitals prior to COVID, and worse now in the period called the “great resignation. “ When rural hospitals can attract the necessary clinical providers, it is continually difficult for providers to maintain their skills in a low volume setting.
The capital needs of a CAH are numerous with little access to the support afforded urban areas. Funding follows the numbers. Continual demands range from infrastructure items like fire suppression equipment, physical plant modification or replacement, and technology enhancements for the delivery of care. Many CAHs like SMMC struggle with an aging infrastructure, while trying to meet a positive bottom line just to support operations.
Post COVID the strain is greater. COVID placed an increase strain on workforce challenges and access to capital. The stress and strain COVID placed on healthcare providers and staff was tremendous. Lack of emergency training and education, ever changing rules and protocols, reduced staff well-being during surges, and the constant threat of mortality due to COVID taxed caregivers across the nation. Hospital finances were strained by insufficient and unreliable supply chain, federal and state support largely following volumes to urban areas with higher COVID numbers, and a dramatic reduction in patient volumes and income.
The COVID-19 pandemic exacerbated the existing threats to the sustainability of CAHs, and access to healthcare for people living in rural communities. COVID-19 has increased the vulnerability of CAHs given the historical challenges, and adds a range of new concerns that jeopardize the health and well-being of rural communities across the United States.