On March 31, for-profit Parkway Regional Hospital in Fulton closed its doors after more than two decades of business in southwestern Kentucky. Rural Fulton County's only hospital employed nearly 200 and accounted for as much as 18% of the town's tax base.
But inpatient admissions had plummeted 50% over the past four years and Community Health Systems, which owned the 70-bed facility, decided it was no longer economically viable. “Our wheels haven't stopped turning since the day they announced that the hospital was closing,” said Cubb Stokes, Fulton's city manager. “We have been having almost daily meetings with some type of healthcare provider.”
Parkway was far from alone among rural hospitals struggling to survive. Less than a year before, Nicholas County Hospital, an 18-bed facility in Carlisle in north-central Kentucky, shut its doors, citing “insurmountable” financial challenges. A report issued in March by Kentucky's auditor of public accounts found that 15 of the 44 rural hospitals analyzed were in “poor” financial health. Those facilities served more than 250,000 Kentuckians in fiscal 2013, with about 60% of those patients enrolled in Medicare or Medicaid.
Nationwide, 51 rural hospitals have closed since 2010, according to the North Carolina Rural Health Research Program at the University of North Carolina at Chapel Hill. The number of annual closures has increased each year during that period, with 16 rural hospitals shutting down last year. Southern states have been disproportionately affected by the spike, with nearly two-thirds of the closed facilities located in that region. Texas has lost 10 rural hospitals in the past five years, while Alabama and Georgia each have lost five.
The National Rural Health Association has identified 283 more rural hospitals across the country that are in danger of going under—more than 10% of all such facilities. The group found that the financial conditions of the hospitals just hanging on are similar to facilities that already have closed. More than a third of rural hospitals operated at a deficit in 2013, according to the association.
Many rural hospitals “have been struggling on the cusp for a long time,” said Mark Holmes, director of the North Carolina Rural Health Research Program.
In June, Adam O'Neal, the mayor of Belhaven, N.C., plans to lead a walk from his town of 2,000 to Washington to raise awareness about the plight of rural hospitals. He hopes to attract participants from all 50 states for the nearly 300-mile journey. O'Neal garnered national media attention last year when he made the same trek after the sole hospital in Belhaven was shut down by not-for-profit Vidant Health. “To think that in our country, our government is going to sit back and watch 283 hospitals close blew my mind,” O'Neal said.