Springfield, MO

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Opinion: Rural hospital closures will continue without changes

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Fourteen hospitals closed in the United States so far in 2019, and over the last five years, more than 100 have closed. We’re talking primarily rural hospitals.

According to iVantage Health Analytics, the average rural hospital runs an average operating margin of negative 11%. Why? Decline of inpatients, poor payer mix, aging facilities and the inability to recruit physicians. Current market data forecasts that this trend will continue unless we see passage of favorable legislation, such as Medicaid expansion and federal government intervention. Most of the recently closed hospitals have been in states, like Missouri, that have not passed Medicaid expansion.

So, what are rural hospitals supposed to do? We must create and maintain a culture where our staff want to work, patients in our communities and surrounding areas want to come for care, and our physicians want to practice medicine. While creating this cultural environment, we also must make sure we have processes that are followed consistently to provide evidenced-based practice – giving our patients the highest level of quality care.

Rural hospitals must continue to provide exceptional care for patients in their service areas. Critical access hospitals are needed to provide primary care, as well as lifesaving emergency and surgical care. The outcomes of the work in rural hospitals and clinics must remain competitive or exceed the larger urban hospitals.

The motivation to not only survive, but also thrive, must come from serving patients, listening to and understanding their challenges or goals, educating them about their treatment and then maximizing time with them to achieve the results. It is imperative that we maintain this philosophy about making sure the patient stays at the center of our operations. Many times, we have to understand the “why” behind what we do. Once we gain that awareness, it becomes the tool to unite the staff and achieve results that deep down we knew we could achieve but may have seemed unattainable.

What are the health care expert opinions on improving the rural picture?

Individually, these are complex, multifaceted challenges. Together, they are immense, requiring policymakers, stakeholders and communities to work together, innovate and embrace value-based approaches to improving rural health. The federal government must play a principal role by updating policies and investing new resources in rural America.

In addition, there are other issues:

•Consumerism. Putting decision-making and economic purchasing power in the patients’ hands to become fully involved in their health care decisions.

•Nontraditional competitors. Payers employing providers, pharmacies opening clinics and teleservices.

•Scaling. Mergers of health systems to multibillion-dollar levels to counter value-based financial pressures.

•Social determinants. Conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes. 

What are we going to see? In the future, more and more hospitals serving the rural population will continue to align themselves with larger health systems, and of course, technology will be key to growth. Telehealth services and virtual visits allow patients to seek medical care without traveling to see a provider or specialists; this becomes especially vital for people living in rural communities who may not have the means or resources to travel.

In addition, shortages of providers and specialty providers is another reason telehealth is the future. Rural hospitals are going to compete for a declining workforce, and we have to find a way to connect our patients to the providers, sometimes without them being on-site, in order to keep patients in our area.

Rural hospitals operate lean. So, the challenge becomes to continue to deliver the services that our patients need, while looking for promising new service lines for revenue.

One last thought: It is imperative we continue to tell our story of how rural hospitals save lives. The best way to do this is through the voice of our patients. There are so many wonderful stories that deserve to be captured and shared – stories that will warm our hearts and make us proud of the care being delivered by hospitals in rural communities.

Darren Bass is the president of Cox Monett Hospital. He can be reached at


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