Those who need hospital care the most may have less access than ever before, according to a report on the waning state of rural healthcare.

Editor’s note — Rural hospitals like those in McPherson County are vulnerable to funding troubles, and one third of rural hospitals in the state are at risk of closing. This article illustrates some causes and prevention practices that local hospitals use to keep in service. Information from the National Rural Healthcare Association, iVantage Health Analytics, Kansas Hospital Association and local healthcare providers was used.

Those who need hospital care the most may have less access than ever before, according to a report on the waning state of rural healthcare.
One third of rural hospitals are at risk of closing, reported iVantage Health Analytics in a nation-wide study last month. The for-profit research group, who say they paid for the study, does not identify hospitals by name to avoid deteriorating those hospital’s financial problems.
The researchers found over half of the vulnerable rural hospitals are also serving communities that need healthcare the most — those with older, poorer residents with more chronic illnesses.
“If these hospitals were to close, the communities which can least afford it would lose access to care and the health disparities would worsen,” the report stated.
Kansas is close to the national average, with one third at risk, and Mississippi has the highest risk of hospital closures.
However, the report found that the problem is generally worse in states like Kansas that did not expand Medicaid, a federally funded insurance program for those with disabilities or low incomes.
The Kansas Hospital Association reports that 31 states and the District of Columbia expanded Medicaid and 19 states, including Kansas and Missouri, haven’t expanded, though the expansion would provide coverage to 150,000 low-income Kansans.
There tend to be more people without insurance in states that did not expand Medicaid, so rural hospitals receive less reimbursements for those patients who can’t afford care.
“We can’t control things like Medicare and Medicaid but we can control the quality of care and meeting standards to the best of our ability to maintain that level of reimbursement,” said Cyril Russell, director of marketing McPherson Hospital. “The healthcare climate is challenging right now, so what we’re trying to do is stay viable. We need to be sensitive to needs of community and be responsive.”
A coalition of health organizations is pushing for Medicaid expansion in Kansas. The topic gained attention after Mercy Hospital in Independence closed last October.
“(The Independence hospital closure) is always in the back of our minds because we’re not immune to that,” Russell said. “It comes down to people utilizing our services because we depend on people using our facilities.”
Gov. Sam Brownback and Republican legislators oppose the expansion because they don’t want to extend coverage to non-disabled adults and don’t believe that the federal government will cover 90 percent of costs as promised.
Legislation on the national scale looks into preventing rural hospital closures because these hospitals tend to have sicker, poorer and older populations than urban hospitals.
The Save Rural Hospitals Act, introduced by U.S. Reps. Sam Graves (R-Mo.) and Dave Loebsack (D-Iowa) last year, will provide rural hospitals with financial and regulatory relief to keep at-risk hospitals open.
Nationally, 55 rural hospitals have closed since 2010, and 283 more are at-risk, which could stifle care for more than 700,000 Americans.
“Rural hospitals are the bedrock of their communities, providing more than just high quality, local access to health care,” Loebsack said in the NRHA’s report. “Rural hospitals stimulate the local economy, creating jobs in the hospital and the community. Without local health care, lives and communities are lost.”
While the legislature debates the act, healthcare providers like those at McPherson Hospital are finding ways to meet emerging needs in the community while maintaining current costs.
“Instead of pulling back services, we’ve added the urgent care clinic and expanded services over the last year,” Russell said. “When you have a climate like now, many hospitals are moving from an in-patient philosophy to an out-patient philosophy and we have to adjust to that, so we’re doing more with the family practice we started a few years back.”