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Do Hospital Closures Impact Rural Patient Access to Care?

A GAO report found that increased hospital closures in rural areas is negatively impact patient access to care.

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Source: Thinkstock

By Sara Heath

- Rural regions are experiencing hospital closures at a disproportionate rate, putting patient access to care at risk, according to a recent Government Accountability Office (GAO) report.

Between 2013 and 2017, 64 of the 2,400 rural-designated hospitals closed. That is more than twice the number of hospital closures that occurred in the previous five-year period, GAO found.

That is also more than the share of urban hospitals that closed, despite the fact that there are significantly more hospitals located in urban areas.

Finally, more rural hospitals closed between 2013 and 2017 than opened, underscoring the net loss in patient care access.

GAO noted several trends among rural hospital closures.

“GAO’s analysis further shows that rural hospital closures disproportionately occurred in the South, among for-profit hospitals, and among hospitals that received the Medicare Dependent Hospital payment designation, one of the special Medicare payment designations for rural hospitals,” GAO reported.

Noting these trends could help the Department of Health & Human Services (HHS) and other relevant stakeholders to identify strategies for aiding these organizations and slowing down the rate of hospital closures.

Hospital closures disproportionately affected rural hospitals in the south that received special rural health payments from Medicare, were for-profit, and had more than 25 beds, the report found. These closures were largely due to financial strains.

Patients accessing care at federally-qualified health centers (FQHCs) or further away health systems impacted hospital finances, as well as the general decrease of individuals living in rural areas.

Rural hospital closures have a considerable impact on the patients who still want to access them, however. Because there are fewer care options, it becomes harder for patients to obtain an appointment and increases the likelihood of major geographic barriers impacting care.

What’s more, patients living in rural areas tend to be less healthy, older, and face other adverse social determinants of health, making the effects of limited care access more profound.

“Research has shown that hospital closures can affect rural residents’ access to health care services and that certain rural residents— particularly those who are elderly and low income—may be especially affected by rural hospital closures,” GAO explained in its report.

HHS currently has numerous projects underway to understand patient care access amidst rural hospital closures. For example, the agency tracks closures and hospital profitability, and monitors critical access hospitals’ financial standing.

HHS also keeps track of patient care access by monitoring external studies on the matter. For example, a 2018 assessment looking at healthcare access in North Carolina found that 4.4 million North Carolina residents live in a community without an acute care hospital, posing a significant care access hurdle.

The agency also looks at research on patient access to certain treatments or services. A study taking place in Minnesota found that the number of hospitals without obstetrics services increased from 45 percent to 54 percent in a 10-year period.

Finally, HHS consults research on how to preserve patient access to care following a hospital closure. A recent report from the National Advisory Committee on Rural Health and Human Services, an independent agency that advises HHS, developed a set of recommendations for designing alternative models and seeking public comment on rural health access gaps.

“HHS uses the results of its monitoring activities on rural hospitals’ financial viability and rural residents’ access to inform related research, primarily conducted by HHS-funded research centers, and to determine future areas of research,” the GAO report explained.

Currently, HHS aids struggling rural hospitals by offering Medicare payments that are adjusted for rural designation. In these cases, a hospital meets certain parameters qualifying it as a rural hospital, and receives increased payments. HHS also offers rural health grants and is working to design new approaches to rural care and payment models.

The GAO report did not offer further action HHS can take to slow the rate of rural hospital closures or fill in patient care access gaps. However, the report does make it clear that hospital closures do pose a considerable threat to patient care access. Industry experts may consider strategies to both address financial issues before hospital closures as well as action plans to preserve patient care access following closures.

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