Georgia's four closings last year were nothing new, said Jimmy Lewis, CEO of HomeTown Health, an organization of rural hospitals in Georgia. “We have no clue how to stop it, it's so far gone,” he said.
The problem, Lewis said, is a lack of funding. He said that there are 62 hospitals in rural Georgia, and that it takes a population of 40,000 to support a rural hospital in the state. With about 1.8 million rural Georgians, that leaves only 45 hospitals that can be supported, Lewis said.
States such as Georgia confronting the likelihood of more closings in the years ahead face an uphill battle to persuade the federal government to increase its support for critical-access hospitals. Last year, a report released by HHS' Office of the Inspector General urged the re-evaluation (PDF) of enhanced Medicare funding for critical-access hospitals less than 35 miles from another hospital. Since 1997, critical-access hospitals have been paid 101% of what it costs them to provide services in remote areas, while traditional hospitals receive 93% of costs of Medicare patients.
To alleviate the stress of hospital closings, Georgia is considering creation of rural, free-standing emergency rooms. Pamela Keene, media relations manager of the Georgia Department of Community Health, said the model's viability is still being evaluated.
But industry officials are skeptical it will be a financially viable approach. Brock Slabach, senior vice president for member services at the National Rural Health Association, said emergency departments are typically the most expensive part of the hospital to operate. “It's hard to see how these could be sustainable,” Slabach said.
The NRHA is recommending Congress and the CMS reverse cuts in rural hospital reimbursements. The uncertainty around rural provider reimbursements, Slabach said, causes providers to focus on the short-term at the expense of long-term planning.
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