As rural hospitals struggle to survive, such institutions are working to introduce strategies that allow them to cut costs while maintaining high levels of patient care.
It’s a big challenge, but one that Jon Doolittle, regional president of Northwest Medical Center in Albany, says smaller hospitals are uniquely qualified to meet because of the close relationships between local healthcare providers and those they serve.
Rural hospitals are “positioned to thrive in the next paradigm of heath care,” said Doolittle, who foresees a new era in which payment models and treatment protocols will focus less on taking care of sick people and more on keeping well people healthy.
“Health care in the United States is changing radically,” Doolittle said, “and I think that’s a necessary evolution.”
Over the long term, he said, sustainability for rural healthcare institutions will require “reinventing ourselves to provide higher quality wellness at lower cost” while creating a fiscal environment in which hospitals are rewarded for “knowing and connecting with our patients” and emphasizing such pro-active treatments as appropriate screening and improved management of chronic conditions.
But in the mean time, Doolittle admits that providing high levels of patient care in the face of shrinking resources requires a “tricky balance” in a state like Missouri, which has yet to expand Medicaid under the federal Affordable Care Act, often referred to as Obamacare.
“The most obvious thing would be to reform and expand Medicaid here in Missouri,” said Doolittle, who added that the state is leaving an estimated $2 billion on the able in healthcare assistance to lower-income citizens.
He further noted that Missouri is currently funding a significant amount of care that would otherwise be paid for with federal dollars.
Another issues relates to Medicare compensation, which under federal budget sequestration guidelines implemented in 2013 was cut from 101 percent of allowable costs at small, “critical access” hospitals like Albany’s to 99 percent, meaning that such facilities, at least as far as Medicare goes, must technically operate at a loss.
Other economic challenges facing rural health care, Doolittle said, involve the cost of maintaining capability and readiness in parts of the state where the population is shrinking.
Expensive technology and expertise are needed less often in a town like Albany, Doolittle said, yet the 25-bed Northwest Medical Center has a physician “on call in our building every minute of every day” along with the resources to handle “whatever may walk into our doors,” from accident victims to patients stricken by stroke or heart attack.
But while Doolittle fervently believes rural Missourians should have access to the best medical treatment possible, he and other small-town hospital administrators face the reality that the kind of routine care their institutions are most often asked to provide is also the least compensated.
All payment sources, including private insurance, Doolittle said, reimburse procedures like cardiothoracic surgery and complex cancer treatments — the kind of services offered almost exclusively by large medical centers — at a higher rate than primary care.
This payment inequity exists despite a surprisingly large volume of healthcare services offered by rural hospitals statewide.
According to the Missouri Hospital Association, 37 percent of all Missourians live in rural areas, or about 2.2 million people. This population trends older and has higher rates of chronic disease.
MHS reports that the following services, presented as a percentage of all Missouri activity, were performed at the state’s rural hospitals during the three-year period from 2010 to 2012: thirty-three percent of all emergency room visits; 38 percent of all in-patient admissions; 25 percent of all childbirths; 38 percent of all treatment for poisonings; 36 percent of all treatment for burns; and 31 percent of all treatment for head injuries.
Doolittle said that in an attempt to gain ground in the fight for fiscal viability, Northwest Medical Center at the end of 2014 joined Mosaic Life Care. Formerly Heartland Health, Mosaic operates a regional medical center in St. Joseph and numerous clinics and other facilities throughout northwest Missouri, northeast Kansas, southeast Nebraska and the Northland portion of Kansas City.
Partnering with Mosaic, Doolittle said, has allowed Northwest Medical Center to acquire purchasing power and medical expertise and resources that would otherwise be unavailable.
Similar mergers are likely in the cards for a growing number of rural hospitals, he said, just as centralization has become a reality in a number of other industries.
But while the face of rural health care is changing, Doolittle said the goal remains the same — to provide the quality care.
“Communities are about the people who inhabit them,” he said, “Health care is like clean water or access to education or electricity, and the future of our communities depends on our ability to provide great care and fill those communities with great caregivers.”
Still, Doolittle said, there seems to be a “lack of understanding” on the part of policymakers with regard to the importance and possibilities embraced by rural healthcare institutions. So what he really wants people to understand is that rural health care matters, and that opportunities exist along with the problems.
“People who live in rural areas do essential work for our nation and require, in some ways, a different set of services — or at least different approaches to the same services,” Doolittle said. “What’s interesting is that rural hospitals are actually are more efficient in many ways than our urban counterparts.”
For example, he said, rural Medicare beneficiaries spend less each year than Medicare recipients who live in metropolitan areas.