A hospital’s heart: Rural struggles a common thread
Despite a grim outlook for big-picture rural health care, McGuire is a traveling advertisement giving reason and energy to fight the status quo.
In his figurative attache case, McGuire carries a couple of PowerPoints illustrating the situation of rural hospitals like
The next slideshows what McGuire sees as his primary job in health care -- a cartoon of one person trying to plug numerous leaks bearing labels such as "staffing" and "quality" in a dike holding back a potential flood.
"Plugging holes is what I do all day long," he said.
His humor can be a welcome relief as not much else is funny about rural hospitals in America at the moment.
A report in August from Bloomberg found hospitals in general have been closing at a rate of about 30 per year, according to analysts looking at data from about 6,000
According to this Bloomberg report, the next 18 months is likely to see an increase in shutdowns.
And the North Carolina Rural Health Research Program says the rates of rural hospital closures are the highest seen in the last few decades. CNBC reported 83 closed from 2010 to
And while
The situation is most dire in states that didn't opt to expand Medicaid but carry a high percentage of residents who rely on the federal health insurance to pay for medical care.
"And rural communities do not have a lot of volume," True said.
Such facilities are the central hub of health services in their communities, state health officials say.
According to
Dayton General CEO McGuire pointed out that 33 or 38 of
What many don't realize is how important support of the rural life here is to every American, McGuire said, outlining the following:
60 percent of that wheat comes from the southeastern corner of the state.
46 percent of nation's soft white wheat (think cakes, cookies, pastries and muffins, McGuire suggests) comes from
50 percent of the state's wind energy is generated in
Rural health is at risk, and its providers face many overlapping and complex challenges, said
Those issues include sicker, aging populations, revenue ups and downs, workforce recruitment and retention, fewer resources with which to make changes that increase revenue, and the ability to stay current in technology, training and physical infrastructure.
Yet these facilities serve more than one million Washingtonians, according to a report by
Most of those hospitals do not have healthy operating margins but are tasked with treating an average of 188 patients per day largely through outpatient services, which bring in less money than inpatient care.
In
"We're the fourth oldest county in the state, and second oldest in those over 85," he said.
In rural towns such as
When advocating for his community and health system, McGuire uses his PowerPoints to explain some barriers to legislators and policymakers, including the following:
Medicaid is not paying the true costs of care, and reimbursement often doesn't fully cover operational requirements, such as ambulance, clinic and emergency department services.
The area has no local in-home health or hospice agencies, meaning people needing those services have to relocate.
Many rural residents have mental health needs; in
The majority of local health care dollars get spent outside of
Still,
It helps that the community is willing to tax itself to support the district, McGuire said, but much brainstorming is being done on behalf of keeping residents healthy and in the place they want to be.
Steps taken include:
Providing efficient staffing -- nursing resources are shared between departments, and primary-care providers cover everything from emergency medicine to the nursing home.
Participating in
Addressing the area's mental-health needs, including depression and anxiety screening for all patients age 12 and up, regardless of ability to pay. The hospital added a social worker last fall for counseling services; a contract with the
Managing the costs of caring for aging patients, including implementing a palliative care program and developing aging-in-place resources to keep people out of high-cost institutions. That includes a transportation service for people who are unable to drive themselves, a designated retail center that's senior-friendly and ways to reduce isolation.
Educating area residents and out-of-area physicians what services can be accessed at the hospital or its clinics.
The center's January report said that to survive, rural health care systems must "right size" health care services to fit community needs, create workable funding mechanisms, build and support the primary-care physician workforce and expand tele-medicine services.
Adding services and therapies needed, plus partnering with
"We have also recognized that there exists unique needs in areas of skilled nursing, rehabilitation and wound care that can bring patients to us from around the region while also allowing us to support the needs of the areas larger health system like Providence (in
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