Some facilities close beds to win new designation
Shift to emergency-only care runs risk of confusing potential patients
As rural hospitals continue to struggle financially, a new type of hospital is slowly taking root, especially in the Southeast.
Rural emergency hospitals receive more than $3 million in federal funding a year and higher Medicare reimbursements in exchange for closing all inpatient beds and providing 24/7 emergency care. While that makes it easier for a hospital to keep its doors open, experts say it doesn’t solve all of the challenges facing rural health care.
People might have to travel farther for treatments for illnesses that require inpatient stays, like pneumonia or COVID-19. In some of the communities where hospitals have converted to the new designation, residents are confused about what kind of care they can receive. Plus, rural hospitals are hesitant to make the switch, because there’s no margin of error.
“It’s ironic” the facilities that might need the most help can’t afford to take the risk, said Carrie Cochran-McClain, chief policy officer at the National Rural Health Association. She pointed to having to give up certain services and benefits, such as a federal discount program for prescription drugs.
The government, which classifies hospitals by type, rolled out the rural emergency option in January 2023. Only 19 hospitals received rural emergency status last year, according to the University of North Carolina’s Sheps Center for Health Services Research.
The majority are in the South, with some in the Midwest, and hospitals in Nebraska and Florida recently started to explore the option.
The designation is aimed at a specific population, said George Pink, deputy director of the Sheps Center’s Rural Health Research Program: rural hospitals on the brink of closure where few people are receiving inpatient care.
That was the case for Irwin County Hospital in Ocilla, Ga., the second rural emergency hospital established in the U.S.
Weeks before converting, the hospital received at least $1 million in credit from the county so it could pay employees — money county board of supervisors chairman Scott Carver doubted he’d see returned. Quentin Whitwell, the hospital’s CEO, said it was an ideal candidate for the conversion. “We’re still finding out what some of the impacts are, given that it’s a new thing,” said Whitwell, whose company, Progressive Health Systems, owns and manages six hospitals in the Southeast, most of which are rural emergency hospitals or have applied for the designation. “But the change to a rural emergency hospital has transformed this hospital.”
A combination of state programs and tax credits, plus the new designation, means the hospital has $4 million in the bank, Carver said. Simply put, the work was worth it to him.
Traci Harper, a longtime Ocilla resident, isn’t so sure. About a year ago, she rushed her son to the hospital for emergency care for spinal meningitis.
Because the designation requires a hospital to transfer patients to a larger hospital within 24 hours, Harper’s son was sent to another in-state facility and three days later ended up getting the care he needed in a hospital in Jacksonville, Fla. “That’s two hours away,” she said. “The whole time I could have taken him there myself, but nobody told me that.”
The potential lifeline has proven difficult to hold onto for Alliance Healthcare System in Holly Springs, Miss., another one of Whitwell’s hospitals and the fourth facility in the country to convert.
Months after being approved as a rural emergency hospital in March 2023, the Centers for Medicare and Medicaid Services reneged on its decision. Hospital CEO Dr. Kenneth Williams told The Associated Press the government said the hospital isn’t rural because it is less than an hour away from Memphis. A CMS spokesperson said the facility was “inadvertently certified.”
The hospital has until April to transition back to full service, but many in the community of largely retirees believe the hospital has closed, Williams said. Patient volume is at a record low. If the federal payments stop coming, Williams isn’t sure the hospital will survive.