Bacon's Rebellion

Democracy Thrives in Sunlight

Asking the Tough Questions: Are Broke Rural Hospitals Worth Saving?

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by

James A. Bacon
in

Shuttered: Pioneer Community Hospital. Photo credit: The Enterprise

I have posted frequently on the high level of profitability — and the lack of accountability for that profitability — among Virginia’s nonprofit hospitals. The Virginia Hospital and Healthcare Association (VHHA) responds that, while the hospital industry as a whole may be profitable, many individual hospitals are not.

A case in point is the Pioneer Community Hospital in Patrick County, which closed in September due to financial difficulties. The Virginia House of Delegates voted unanimously Monday, in the words of the Richmond Times-Dispatch, to extend the license of the shuttered hospital in the hope of speeding the process of finding a new operator and reopening the facility.

The VHHA has a point: Many of Virginia’s rural hospitals are in trouble. When a hospital like Pioneer Community shuts down, thousands of people find it far more difficult to access health care.

The question is: what do we do about it? Do we enact blunderbuss legislation (such as Medicaid expansion) under the pretext of helping rural hospitals even though most Medicaid dollars will go to urban and suburban hospitals? Do we craft a narrow-bore approach that focuses scarce public resources on rural hospitals, or, more specifically, ailing rural hospitals?

Or, to really think outside the box, do we acknowledge that a “hospital” is simply a bundle of diverse, often unrelated, medical services served under one roof, and that perhaps it makes economic sense to de-bundle those services and provide them in the format of free-standing urgent care clinics, ambulatory surgery centers, and other outpatient facilities? Do we acknowledge that, even though it may require Patrick County residents to drive to a hospital in Martinsville or Roanoke or Winston-Salem for a few more procedures than otherwise, some procedures are more efficiently handled, and have better outcomes, when performed on a volume basis in a larger, urban hospital? Shouldn’t we allow medical services in Patrick County restructure in a way that is more financially self sustaining?

Just asking the questions no one else dares to ask….

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6 responses to “Asking the Tough Questions: Are Broke Rural Hospitals Worth Saving?”

  1. ebardwell Avatar
    ebardwell

    I see what you’re saying, but I think you’re underestimating the importance of having a facility nearby to handle emergencies, where the patient doesn’t have the luxury of time. I work as a cardiac nurse (formerly neuro), and in both heart attack and stroke what matters in survival and disability is how quickly the patient reached an emergency room.

    I’m at a major urban hospital, so I don’t know to what extent little rural hospitals lack important facilities (like cath labs) that are key to rapid intervention. Still, any hospital will have a prepped OR, a general surgeon, IV fluids and a stash of antibiotics should, for instance, someone have a burst appendix or get hit by a car. Even if the person ultimately requires evaculation to a bigger hospital, getting stabilized at a little hospital would be the key to surviving long enough to be airlifted out.

    So, no, I can’t agree with you — a hospital is not (only) a bundle of medical services that can be unbundled. If small outlying hospitals close, people are going to die.

    1. James A. Bacon Avatar
      James A. Bacon

      From your account, what needs to be subsidized and supported is the emergency service, not the full-fledged hospital. Would it be less expensive to support a free-standing emergency room than an entire community hospital?

      1. ebardwell Avatar
        ebardwell

        I think there are parts that could be peeled off, mainly the medical/surgical nursing floors, but only if you want to commit to evacuating every acute patient in a timely manner, which is a bit of a tall order. Even so, besides an emergency room, you’d definitely need operating theaters and a cardiac cath lab — those things can’t wait. Also an MRI so eligible stroke patients can get brain blood clots dissolved with a drug called tPA (so-called “door-to-needle” time is critical in how messed up and/or dead a stroke patient is going to end up). Plus some kind of ICU to house these people in the time between stabilization and evacuation.
        Of course, in a rural hospital these facilities will sit idle much of the time, which isn’t “efficient.” The flip side of that is that they’re indispensible when needed. So, I think you could get by with about half a hospital, perhaps, without condemning rural people to truly substandard care.

        1. James A. Bacon Avatar
          James A. Bacon

          That’s an interesting response. I wonder if anyone has studied what are the indispensable components of a rural general hospital without which the quality of patient care suffers, and how much it would cost (in subsidies) to maintain those services.

  2. LarrytheG Avatar
    LarrytheG

    the thing is it’s not a ” lets twiddle our thumbs for a few years while we figure this out which seems to be the preferred approach of those who are opposed to expanding Medicaid or subsidizing “blunderbuss” style.

    The issue is how do you want to deal with it now… not “can we figure this out over the next few years” while we still oppose proposals we don’t like.

    to not deal with it now – is to watch people actually die from lack of access.

  3. DLunsford Avatar
    DLunsford

    ebardwell gets it. Response time is everything during CV events. Perhaps some kind of micro-trauma center (with a helo pad) to take the place and provide coverage to the very rural areas. Sorta like what’s on the Outer Banks for rapid evac of vacationers. Or better yet, instead of the state university health systems moving into the lucrative urban zones, maybe get them more into the boonies.

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