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Small Towns, Big Fight for Continued Access to Care

Rural Hospitals Face Death by a Thousand Cuts By CINDY SANDERS

More than 60 million Americans – nearly one in five residents – live in rural communities. While these small towns and wide swaths of farmland are an integral part of the American fabric, the nation has seen the rural population drop from 54.4 percent in 1910 to 19.3 percent a century later, according to the U.S. Census Bureau. As Americans have migrated to urban areas and urban clusters, it has become increasingly difficult to sustain services, particularly access to healthcare, in many of these rural communities. Although a little more than 80 percent of the country lives in urban areas and the clusters surrounding them, the actual land urbanites use is only 3 percent of the country’s total. The remaining 19.3 percent of the population is spread across 97 percent of the nation’s landscape. In a

service industry where ‘minutes matter,’ closure of a rural hospital facility likely means adding significant time to get to the next closest medical facility. By the beginning of this year, the National Rural Health Association (NRHA) counted 95 rural hospital closures since

2010 and identified nearly 700 other facilities as being vulnerable for closing. “Everything that NHRA works on can be boiled down to one thing … and that’s access,” stated Diane R. Calmus, regulatory counsel for the NRHA. The reasons for the closures are mul-

tifactorial. “It would be really easy if there was a silver bullet to solve the issues, but this has been the result of a whole lot of small cuts,” said Calmus. “A lot of cuts that have happened in D.C. have impacted rural hospitals in a way that haven’t impacted urban counterparts with a different payer mix,” she continued. In its #SaveRuralHospitals action center, the NRHA noted, “The rate of closure has steadily increased since sequestration began and bad debt cuts began to hit rural hospitals, resulting in a rate six times higher in 2015 compared to 2010.” Rural hospitals often lack the specialty services that bring in higher reimbursement to offset losses on general inpatient care and surgeries. Add to that, (CONTINUED ON PAGE 6)

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