Nationally, nearly a quarter of all rural hospitals are struggling to stay open. In West Virginia, almost 40 percent of rural hospitals are at risk of closure. There are several reasons for that.
“Inability to recruit physicians to small communities, declining population base, roughly 10,000 people a day go on Medicare and Medicare [which] doesn’t cover the cost of care in a hospital environment,” explained Dave Ramsey, CEO and president of Charleston Area Medical Center.
And yet some hospitals in rural areas are doing well -- or at least growing. Those that are succeeding are often the largest facilities, such as WVU Health System. Over the past ten years, the university health system has exploded.
“We’re building out a statewide footprint with the intention of making sure we have locally controlled healthcare that improves the health of the population in the state of West Virginia,” said Albert Wright, president and CEO of the WVU Health System.
In the beginning of July, Summersville Regional Medical Center became the latest addition to the WVU system. Since 2005, about a dozen hospitals have either entered a management agreement or become full members of the university health system.
“We have an increasingly large and growing subspecialized academic medical center,” said Wright. “And if we want to be able to provide all care instate and do things like advanced heart and vascular procedures, transplantation, you need to be able to have a population base that feeds those programs. So we work to coordinate with those local hospitals. If we can provide the care in the community, that’s where we do it. If they need the higher level services they come to Morgantown.”
Meanwhile a new regional health care system has appeared in the mid-Ohio Valley. Cabell-Huntington Hospital and St Mary’s Medical Center recently merged to create Mountain Health Network.
“This merger came together not for the intention to just survive but to thrive in the future,” said Michael Mullins, president and CEO of Mountain Health Network. The network also includes a management agreement at a third hospital. He says the goal is to continue to grow the Mountain Health Network over the coming years.
“The small rural hospitals just don’t have enough volume in order to cover their overhead,” said Mullins. “So a couple of tough decisions need to be made by those communities. One, do you continue to fight to try and be an in-patient provider? Or do you reshape what is needed for the community to be more of an ambulatory footprint? nd then find that larger regional system that you can be affiliated with to potentially reduce your costs of services.”
Mullins said a larger health system allows for lower overhead for everyone while simultaneously helping to keep some form of medical care in local communities. But keeping a hospital open may mean discontinuing inpatient accommodations. In order to survive, a medical facility might need to be a freestanding emergency room, or an outpatient center only.
“They’re going to have to redefine what they do in regards to the services and what truly makes sense and what could be done more in a regional setting,” he said.
In southern West Virginia, Charleston Area Medical Center is taking a different approach to managing rural health facilities.
“Our history has been to work with folks to keep the care and the management of their hospital local,” said Dave Ramsey, president and CEO of CAMC. “Would we work with a hospital and purchase them? Yes.”
But Ramsey added that acquisition is not CAMC’s focus.
Instead they have partnered with about 30 other doctors, hospitals, federally qualified health centers and free clinics. These facilities all want to remain independent but are working together to do things like implement a single, shared electronic medical record platform. Ramsey also points out that nationally, the trend is increasingly to do everything possible to keep people out of hospitals.
“Hospitals are very expensive places,” said Ramsey. “So that’s where we’re headed – where hospitals will generally be, we believe in the future, is mostly largely ICUs. So much of the care can be delivered on an outpatient basis.”
Totally independent rural hospitals may be a thing of the past. Instead, to survive the pressure is to grow, affiliate, change. To keep-on-keeping-on is to die.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.