Rural hospitals cut maternity and oncology care due to financial constraints

The Community Medical Center hosted deliveries in Falls City, Nebraska, for more than a century until it closed its obstetrics unit in November 2019.

According to Community Medical Center CEO Ryan Larsen, annual critical access hospital supplies have steadily declined, making it difficult to attract and retain anesthesiologists, specialty nurses and surgeons. This meant that administrators had to pay high rates to doctors on call and medical practitioners who were at their limit.

There were times when the surgeon on duty would drive 100 miles an hour across the state to perform an emergency C-section, Larsen said. “When we finally stopped, there was a sense of relief. But there was also heartache. Our employees have donated so much over the years,” he said. “Besides, it was very hard for society. It was part of our identity.”

This scenario is more often implemented in rural areas. Maternity services are often the first to go when finances are cut. Quality suffers as patients are forced to travel farther for care, and low-income, underserved communities usually bear the brunt.

Pampa Regional Medical Center in Pampa, Texas, ended its obstetric care in April 2021. “Despite the community’s strong desire to resume service delivery, hospitals are under such intense pressure from staff and supply chain costs that we cannot afford to take a financial loss in this line of service,” CEO John Gill wrote in an email. letter.

The number of rural hospitals ending midwifery services increased by 9% from 2019 to 2020, leaving nearly 220 communities without access to obstetric care, according to data from the Chartis Rural Health Center released Tuesday.

The elimination of maternity care services can have cascading financial consequences. Surgeons and anesthesiologists are often fired, reducing incomes. The number of patients receiving Medicaid services tends to drop, and hospitals may lose their 340B drug rebate and/or access to additional payments.

“Line cuts continue,” said Michael Topczyk, national leader for the Charti Rural Health Center. “This poses huge challenges in terms of access. Rural communities are the epicenter of health disparities.”

More and more rural hospitals are refusing chemotherapy. More than 350 rural communities did not have access to appropriate cancer care as of 2021, up 13% from 2020, according to Chartis.

Hospitals are cutting services as their margins are shrinking. Nationwide, 43% of rural hospitals were operating at a loss as of the end of 2022, according to Chartis data, which excludes COVID-19 relief funds and adjusted for a 2% annual reduction in Medicare reimbursement under the Budget Control Act of 2011 Rural hospitals had a median operating margin of 1.8% last year, and facilities in states that expanded Medicaid under the Affordable Care Act outperformed those in states that did not.

Meanwhile, three rural hospitals have closed in the past two months, bringing the total to 143 since 2010, according to data from the University of North Carolina.

Rural hospital patient numbers have not returned to pre-pandemic levels and aid funds have dried up, said Brock Slabach, chief operating officer of the National Rural Health Association. “This could lead to more closures over the next two years,” he said.

Rural hospitals did receive some help from the Year-End Expenditure Act, which extended the Medicare Low Volume Payment Adjustment and the Medicare Dependent Hospital Program through September 20, 2024. The law also delayed the expiration of additional payments for land. ambulance until 2025.

Some hospitals are pushing for a new status as a rural emergency hospital, which provides pay increases and an estimated $3.3 million annual inflation-adjusted service fee for hospitals that are phasing out inpatient services. While Chartis has identified 77 hospitals likely to convert, many are resisting because they will have to waive their 340B eligibility, among other factors.

Still, rural hospitals need more help, including ending automatic Medicare cuts, Larsen said. “The fact that someone lives in a rural area should not mean that they are doomed to second-rate healthcare or that their life is not as valuable as that of those who love in an economically prosperous area.”