When I was in 9th grade in rural Virginia, I felt stomach cramps one morning while in class. As the day progressed, the cramps became so painful my parents had to take me to one of only two local physicians in my small hometown. Upon examination, he determined I had appendicitis and immediately sent me to the nearest hospital. This rural facility had three surgeons and the one on call performed the appendectomy at approximately 6 p.m. Incidentally, he was also the physician for the high school football team and needed to attend a game at 7:30 p.m.
The operation was successful, with a small six-inch incision followed by hospitalization for five days. Today, it would have been a quick outpatient procedure. This small but vitally important rural hospital played a key role in saving my life. On a side note, all beds were occupied except for a few in the maternity ward, so when my school friends visited they teased me for “having a baby.”
The Washington, D.C., legislative discussion on repeal, delay and replace has created business turmoil for all hospitals no matter the location. Can you imagine running a business not knowing your revenue stream, expenses and regulations? North Texas hospitals have faced this business dilemma for many months. This uncertainty has been especially difficult for our rural facilities as more than 15 have closed over the past four years in Texas.
There are approximately 5,000 short-term acute care hospitals in America, half of which are in rural areas. Forty percent of rural hospitals are located within the southern part of the U.S. Over half of the rural facilities are Critical Access Hospitals, which have 25 or fewer beds.
Both large health systems and rural hospitals alike are understandably concerned about modifications to the Affordable Care Act, Medicaid block grants and the Medicaid 1115 Waiver. Rural hospitals generally are reliant on governmental payments thus, reimbursement changes to Medicare and Medicaid could have a profound impact upon their operations.
Hospitals have served their communities since the beginning of history. Perhaps none more so than our vital rural providers who not only treat patients, but stabilize emergency situations for transfer to larger facilities for life-saving treatment. Our rural hospitals are key players in North Texas healthcare delivery and sadly, many are currently operating on thin margins without a clue as to what the political future holds.