Vir­ginia’s ru­ral hos­pi­tals aren’t healthy

The Washington Post Sunday - - LOCAL OPINIONS - The writer, a Demo­crat, rep­re­sents Ar­ling­ton in the Vir­ginia House of Del­e­gates.

As we dis­cuss gov­ern­ment’s role in health care in this coun­try, one prob­lem in­creas­ingly stands out need­ing im­me­di­ate at­ten­tion: the state of med­i­cal care in our ru­ral ar­eas, in­clud­ing in Vir­ginia.

Ru­ral hos­pi­tals play a unique role in the com­mu­ni­ties they serve. They are not just cru­cial to the well-be­ing and health-care needs of lo­cal res­i­dents; they also are among the lead­ing eco­nomic driv­ers in their re­gions. Ac­cord­ing to the Vir­ginia Hos­pi­tal and Health care As­so­ci­a­tion ( VHHA), in 82 per­cent of Vir­ginia’s ru­ral coun­ties, health care is among the top five largest em­ploy­ers.

Vir­ginia’s ru­ral hos­pi­tals di­rectly em­ploy more than 17,000 work­ers, the VHHA re­ports. Th­ese are jobs that pay well above av­er­age wages and have his­tor­i­cally of­fered sta­ble em­ploy­ment and ad­vance­ment up the eco­nomic lad­der.

Be­yond their own eco­nomic ac­tiv­ity, ru­ral hos­pi­tals en­hance the abil­ity to de­velop eco­nom­i­cally. When choos­ing a com­mu­nity, em­ploy­ers view the pres­ence of a hos­pi­tal as a sig­nal of the area’s strength and rely on hos­pi­tals to help them main­tain a healthy and pro­duc­tive work­force.

De­spite their out­size im­por­tance, both med­i­cally and eco­nom­i­cally, ru­ral hos­pi­tals are bat­tling the tough­est fis­cal en­vi­ron­ment they have ever en­coun­tered. Ac­cord­ing to the North Carolina Ru­ral Health Re­search and Pol­icy Anal­y­sis Cen­ter, al­most 50 ru­ral hos­pi­tals have closed na­tion­ally in just the past four years. Here in Vir­ginia, one of our ru­ral fa­cil­i­ties closed in 2013. The fi­nan­cial out­look for our other hos­pi­tals is daunt­ing.

Nearly half of Vir­ginia’s ru­ral hos­pi­tals had neg­a­tive op­er­at­ing mar­gins in 2012, the VHHA says, and more than 20 per­cent have a neg­a­tive net worth. Our ru­ral hos­pi­tals ex­pect to be paid in full by only 1 in 5 pa­tients they see. Most pa­tients at our ru­ral hos­pi­tals are cov­ered by Medi­care, which al­ready pays only about 90 per­cent of a hos­pi­tal’s cost of care.

Now, our hos­pi­tals face nearly $1 bil­lion in di­rect cuts to Med­i­caid and Medi­care in 2015 and 2016, with no end in sight to such re­duc­tions. For Vir­ginia’s ru­ral hos­pi­tals, the sit­u­a­tion is se­ri­ous, and it is only grow­ing more dif­fi­cult by the day. The VHHA es­ti­mates that with th­ese cuts op­er­at­ing mar­gins at our ru­ral hos­pi­tals will fall to zero by the year 2022.

In the face of th­ese chal­lenges, ru­ral hos­pi­tals con­tinue to faith­fully ad­here to their solemn obli­ga­tion to pro­vide ser­vice to any­one who comes through their doors. That care is pro­vided re­gard­less of whether the per­son can pay. They strive to meet the needs of their com­mu­ni­ties and, as a re­sult, nearly ev­ery Vir­ginian is within 20 miles of a fully func­tional hos­pi­tal that is open 24 hours a day, seven days a week, 365 days a year.

Of course this com­mit­ment cre­ates very real fi­nan­cial pres­sures that other busi­nesses do not con­front. But that care is cru­cial to the suc­cess of eco­nomic devel­op­ment and job cre­ation in the com­mon­wealth. Busi­nesses sim­ply can­not be ex­pected to open in com­mu­ni­ties that lack health-care in­fra­struc­ture. If we are se­ri­ous about en­sur­ing the eco­nomic vi­tal­ity of our ru­ral com­mu­ni­ties, a ma­jor com­po­nent of that ef­fort must be en­sur­ing they re­tain ex­cel­lent hos­pi­tals that are ac­ces­si­ble and af­ford­able.

While Vir­ginia has many dif­fer­ent re­gions, and those re­gions have many spe­cific needs, we can­not stand by and watch some ar­eas move for­ward as oth­ers fall back. Our ru­ral hos­pi­tals face the same chal­lenges as their coun­ter­parts na­tion­ally, and it is in­cum­bent on those of us in state gov­ern­ment to find the pol­icy so­lu­tions nec­es­sary to ad­dress th­ese chal­lenges.

While we can ar­gue about spe­cific pol­icy de­tails, the re­al­ity is our ru­ral hos­pi­tals need se­ri­ous, im­me­di­ate fi­nan­cial help. They face a sit­u­a­tion that is only grow­ing worse. Med­i­caid ex­pan­sion would be the sim­plest and most fi­nan­cially sen­si­ble course. I con­tinue to ad­vo­cate strongly for it. But I also con­tinue to urge all law­mak­ers to look for any means by which we can pro­vide the fi­nan­cial sup­port our ru­ral health­care providers need to con­tinue to serve the Vir­gini­ans who de­pend upon them ev­ery sin­gle day, in ev­ery sin­gle com­mu­nity.

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