Challenges to rural healthcare

MARY REICHARD, HOST: Coming up next on The World and Everything in It: challenges to rural healthcare.

The United States Census Bureau says rural areas cover all but three percent of our land mass, but contain only about a fifth of the population. 

But we are talking about 60 million people, and so rural hospitals are important: Besides providing medical care, small town hospitals are local economic engines. They provide jobs. They attract businesses to communities.

NICK EICHER, HOST: But over the past decade many of these hospitals have struggled to keep their doors open. A report from 2016 warned that one in three of them are at risk of closing down.

Some healthcare experts and rural hospital administrators say there are ways to make rural hospitals healthy again. 

WORLD Radio’s Sarah Schweinsberg has our story.

SARAH SCHWEINSBERG, REPORTER: Rick Schroeder has managed the North Bighorn Hospital in Lovell, Wyoming for 10 years. The small town thrives on oil production, mining, and agriculture. 

SCHROEDER: We serve essentially the north half of Bighorn County. And there’s about 7,000 people in that area.

North Bighorn is one of 1,300 critical access hospitals in the country. That means it’s the only hospital in a 35 mile radius and has less than 25 beds. Because of that status, the federal and state governments guarantee to completely reimburse the hospital for Medicare patients. Those are patients older than 65. 

SCHROEDER: And that’s really important to us because about 50 percent of our patient base are Medicare recipients. 

But Medicare reimbursements aren’t keeping up with the cost of care. Critical access reimbursement payments have shrunk by 2 percent since 2014. Schroeder says that may not sound like a lot but that decrease has long-term ramifications. Especially because rural America also has another problem: higher rates of uninsured patients. 

A growing number of rural Americans can’t afford private health insurance but aren’t old enough for Medicare. And they make too much for Medicaid. Hospitals like North Bighorn have to eat the costs of caring for those patients.

SCHROEDER: And so it just, it gets harder and harder to make those two numbers match: expenses and revenue.

Powell, Wyoming is 30 minutes down the road from Lovell. Terry Odem is the CEO of Powell Valley Healthcare—another critical access hospital. 

ODEM: We extend to Big Horn County. So actually North Bighorn Hospital district. About 6,500 people.

Odem says her hospital also faces insurance challenges. But it also has another problem common in rural healthcare: doctor and medical staff shortages. 

ODEM: Resources. Human resources. It is hard in rural health care. 

Healthcare policy experts say there are solutions to some of these problems. 

Some say states could solve some of their issues by expanding Medicaid. Under the Affordable Care Act, states can raise the federal poverty level so more people qualify for Medicaid. So far 33 states have expanded their coverage. Wyoming has not. 

Critics of medicaid expansions say that’s not a solution because it takes more money from taxpayers and infringes on states’ rights. 

Dr. Anand Parekh is a healthcare policy expert at the Bipartisan Policy Center. He argues consumers need more private payer insurance options as well. 

PAREKH: I think it’s a combination of having both private payers available as well as Medicaid expansion, um, to ensure that we can get the uninsured rate down, which is going to be critical for rural hospitals.

Dr. Parekh says it’s also important for rural hospitals to assess what medical services their communities need and what cases they should refer to urban hospitals. Downsizing could help some hospitals keep their doors open.

PAREKH: Would some communities benefit from having a strong primary care infrastructure plus, uh, emergency care and an ambulance service as opposed to a full freestanding hospital? What are the opportunities to collaborate with neighboring communities in terms of sharing services? 

Parekh says the federal government also needs to tackle rising pharmaceutical and medical equipment costs. 

While rural hospitals wait for lawmakers to pursue overall healthcare solutions, CEOs Terry Odem and Rick Schroeder say growth in small town hospitals is still possible. But it takes careful financial management and community support. 

By applying for state grants and saving revenue, Odem’s hospital has added a pain management clinic and an orthopedic surgeon. It has also maintained its obstetrics unit. 

ODEM: So we do offer more services. It’s better to bring in revenue than to decrease expense.

To attract doctors, Odem says the hospital tries to offer competitive wages. 

ODEM: I think our pay is comparable to any other rural place and sometimes as good as urban areas. 

Rick Schroeder’s hospital has also pursued growth, adding beds, doctors and services like sleep tests and a speech pathologist. Schroder says that’s been possible because people in the county agreed to higher property taxes to help fund the hospital.

His hospital is also collaborating with Odem’s. The two now share a pharmacist and a radiologist. 

SCHROEDER: We’re friendly competitors. We help each other out.

Schroader says the long term future of rural hospitals depends on more people moving to rural America. And that growth possibility factors on the availability of quality healthcare. 

SCHROEDER: In order for a town to be thriving, one of the main pillars or cornerstones of a thriving community is ready access to health care.

Schroeder’s hospital is working alongside the city to create jobs, improve amenities, and keep young people in town. That in turn makes it easier to recruit doctors and their families. 

And while the town works to grow its population, Schroeder says his hospital is working to keep patients it already has from driving to the big city for healthcare. 

SCHROEDER: I think that we’re busier, not because our population base has grown, but because the confidence of our community and what we do and how we do it has grown.

For WORLD Radio, I’m Sarah Schweinsberg reporting from northwest, Wyoming.

(Photo/North Bighorn Hospital)

WORLD Radio transcripts are created on a rush deadline. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of WORLD Radio programming is the audio record.