In 2019 the U.S. experienced more rural hospital closures than in any other year in the past decade according to the National Rural Health Association. Another 700 are in danger of closing.
Even before COVID-19, rural hospitals throughout the U.S. were financially challenged by multiple issues. State-level COVID-19 executive orders banning elective medical procedures only made it worse.
According to the American Farm Bureau Federation (AFBF), rural communities have lost 128 hospitals since 2010 – and another 700 are in danger of closing nationwide.
In a May 8 letter to Ag Committee leadership in both the U.S. House and Senate, including Sen. Debbie Stabenow, AFBF, along with six other national agriculture and rural health associations, called attention to the plight of rural hospitals.
They’re also seeking legislation to allow Farm Credit System financing and technical assistance for projects eligible under the USDA Rural Community Facilities program like hospitals, skilled nursing facilities, assisted-living facilities, fire stations, schools and daycare centers.
“As our nation faces an unprecedented health care crisis, the health care infrastructure in many rural communities has been in crisis for years. As the rest of America’s health care system works to recover, rural health care could be left even further behind,” the groups wrote.
Under the legislative proposal, a Farm Credit bank would be allowed to offer rural facility financing for an amount up to 15% of its asset base. According to AFBF, Farm Credit’s regulator, the Farm Credit Administration, discontinued a previous program utilized to make investments in rural health care facilities and has indicated an unwillingness to restart the program without legislative guidance.
“Unfortunately, we know firsthand the challenges facing rural health care systems and we fear without additional support, COVID-19 could make it even more difficult for rural Americans to receive the health care services they need,” the letter stated. “That’s why we support including language in upcoming COVID-19 relief legislation to provide Farm Credit the explicit authority to help finance health care and other vital rural community facilities.”
According to AFBF, including such language would be at no cost to the federal government and would provide rural communities the flexibility they need to upgrade, expand and build facilities that fit the needs of their residents.
In 2019 the U.S. experienced more rural hospital closures than in any other year in the past decade, according to the National Rural Health Association.
Payer mix degradation, referring to the decline of patients with private insurance coverage, continues to erode with the decline in agricultural and manufacturing jobs. Residents who remain tend to be either very old or very young, and often have higher rates of uninsured, Medicaid, and Medicare patients, leading to more uncompensated and under-compensated care. Medicare payment reductions are also a major factor, with the average rural hospital counting on Medicare for 46% of gross patient revenue.
Declining inpatient care is also resulting in excess capacity in rural hospitals. According to a study by the Kaiser Family Foundation, the average rural hospital has 50 beds and 321 employees, but a daily census of just seven patients.
Even so, data from USDA’s Economic Research Service and the Health Resources and Services Administration suggest that 88.2% of rural counties in the U.S. are considered medically underserved. For counties whose population is dependent on farming, 91.9% are medically underserved.
The statistics are alarming for Hillsdale County Farm Bureau members.
Jennifer Lewis operates a third-generation dairy- and cash-crop farm with husband Bruce in Jonesville, 10 miles from the Hillsdale Hospital (see related story) — a distance she and her family don’t take for granted.
Lewis, who serves on the Michigan Farm Bureau board of directors in District 2, representing farmer members in Branch, Calhoun, Hillsdale, Jackson and Lenawee counties, often hears concerns about health care access in the district.
“For our family and employees at Pleasant View Dairy, having access to a hospital relatively close to our farm is vitally important,” Lewis said. “To lose our local hospital, where we are comfortable going and knowing we’ll be well-cared for, would be a huge loss not only for us but for our community.
“Our rural hospital is a major player in healthcare for the citizens and farmers in Hillsdale County,” she continued. “Because of that, I would encourage county Farm Bureau members statewide to engage in discussions with your local hospital boards and administrators to discuss what you might be able to do to assist during these unprecedented times before it’s too late.”
Mark Wiley, chair of the Hillsdale County Commissioners, served for several years on both the Hillsdale County Farm Bureau board and MFB’s State Policy Development Committee.
Wiley raises feeder cattle and farms roughly 500 acres of corn, soybeans, alfalfa, wheat and rye about 11 miles west of Hillsdale Hospital, where his wife worked for 38 years as a surgical nurse before being laid off due to the governor’s EO and the financial woes of the hospital.
“With my wife being furloughed at the present, it makes us both appreciate our local hospital all the more,” Wiley said. “I can tell you, for the most part, we on the County Commission strongly support the hospital and are very sympathetic to what they’re up against.
“We hear from residents from every corner of Hillsdale County just how important the hospital is to them. There is no question that Hillsdale and the entire area would be at a huge loss and inconvenience without it.”
Stuart Welden, president of the Hillsdale County Farm Bureau, says the potential loss of the Hillsdale Hospital, located 15 minutes from his farm, would require extended travel times to the next closest hospitals in Coldwater (30 minutes), Marshall (45 minutes), and Montpelier (45 minutes).
“Based on these estimates and in the event of an emergency, my travel time to the closest emergency rooms would double if (we’re going) to Coldwater and triple if I went to either Marshall or Montpelier,” Welden said. “It’s very concerning to all of us in the county, so we’re going to attempt to do something about it.”
Welden said the Hillsdale County Farm Bureau’s Policy Development Committee has focused on drafting new policy that is specific to the support of local and rural hospitals, not only in Hillsdale County but throughout Michigan.
“It’s my hope that we’ll have policy to be reviewed and voted on at our County Annual Meeting in August,” Welden said. “I’m hopeful it can be duplicated in other county Farm Bureaus and potentially be passed at the state level during the next State Annual Meeting.”
(See Related Story: Michigan’s rural hospitals in critical condition)
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