For more than a dozen years, leaders in the rural health care field have issued strong warnings: Rural hospitals are struggling financially.

Despite public attention and some changes in federal policies, difficulties continue. A new report from a private healthcare consulting company has found that nearly 20% of all rural hospitals are at risk of closing.

The report, issued annually by the Chartis Center for Rural Health, said the percentage of rural hospitals operating in the red jumped to 50%, up from 43% last year. Of the independent rural hospitals across the country, 55% were operating in the red. More than 60% of rural hospitals are affiliated with larger health-systems. Of those, 42% were operating in the red.

All told, Chartis identified 418 of the 2,115 of the rural hospitals as “vulnerable to closure.” Since 2020, 35 rural hospitals have closed, including nine last year. Nearly 200 rural hospitals have closed since 2005.

“I think we’re in a much, much worse situation,” Michael Topchik, national leader for the Chartis Center for Rural Health said in an interview with the Daily Yonder. “I mean, more than 15 years ago, I remember sharing some of these statistics… and there was a little bit of ‘Chicken Little’ in the air with a third of rural hospitals operating in the red… Now, to see half of rural hospitals operating in the red… in the absence of something being done, things have just gotten more challenging.”

Those increased challenges include changes to Medicare and Medicaid reimbursement rates, changes to how hospitals are categorized, and what services hospitals are able to provide, among other things.

Read more.

In a little more than two years as CEO of a small hospital in Wyoming, Dave Ryerse has witnessed firsthand the worsening financial problems eroding rural hospitals nationwide.

In 2022, Ryerse’s South Lincoln Medical Center was forced to shutter its operating room because it didn’t have the staff to run it 24 hours a day. Soon after, the obstetrics unit closed.

Ryerse said the publicly owned facility’s revenue from providing care has fallen short of operating expenses for at least the past eight years, driving tough decisions to cut services in hopes of keeping the facility open in Kemmerer, a town of about 2,400 in southwestern Wyoming.

South Lincoln’s financial woes aren’t unique, and the risk of hospital closures is an immediate threat to many small communities. “Those cities dry out,” Ryerse said. “There’s a huge sense of urgency to make sure that we can maintain and really eventually thrive in this area.”

A recently released report from the health analytics and consulting firm Chartis paints a clear picture of the grim reality Ryerse and other small-hospital managers face. In its financial analysis, the firm concluded that half of rural hospitals lost money in the past year, up from 43% the previous year. It also identified 418 rural hospitals across the U.S. that are “vulnerable to closure.”

Mark Holmes, director of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, said the report’s findings weren’t a surprise, since the financial nosedive it depicted has been a concern of researchers and rural health advocates for decades.

The report noted that small-town hospitals in states that expanded Medicaid eligibility have fared better financially than those in states that didn’t.

Leaders in Montana, whose population is nearly half rural, credit Medicaid expansion as the reason their hospitals have largely avoided the financial crisis depicted by the report despite escalating costs, workforce shortages, and growing administrative burden.

“Montana’s expansion of Medicaid coverage to low-income adults nearly 10 years ago has cut in half the percentage of Montanans without insurance, increased access to care and preserved services in rural communities, and reduced the burden of uncompensated care shouldered by hospitals by nearly 50%,” said Katy Mack, vice president of communications for the Montana Hospital Association.

Not one hospital has closed in the state since 2015, she added.

Hospitals elsewhere haven’t fared so well.

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From Becker’s Healthcare

Danville, Pa.-based Geisinger appointed Terry Gilliland, MD, as the next president and CEO of Geisinger Health.

Dr. Gilliland will succeed Jaewon Ryu, MD, JD, after he transitions to CEO of Risant Health, a nonprofit organization created by Kaiser Foundation Hospitals. Oakland, Calf.-based Kaiser Permanente agreed to acquire Geisinger last year as the first health system to join Risant, and the deal is waiting on regulatory approval.

Geisinger’s board conducted an extensive search for Dr. Ryu’s successor.

“The role of leading Geisinger is unique,” said Heather Acker, chair of the Geisinger board of directors, in a news release. “It requires passion for our mission–to make better health easier for our patients and members across Pennsylvania; a drive to innovate care delivery; and a commitment to educating future caregivers. We are confident that Dr. Gilliland is the right person to lead Geisinger on our path forward.”

In his new role as the eighth leader of Geisinger, Dr. Gilliland will oversee the system’s 25,000 employees, who serve more than 1 million people annually. The 10-hospital system also includes a health plan with more than 500,000 members, a research institute and Geisinger College of Health Sciences. Geisinger has more than 1,700 employed physicians.

Dr. Gilliland has previous experience as chief medical officer and chief science officer of Cogitativo, an artificial intelligence and machine learning company focused on healthcare. He was also executive vice president of healthcare quality and affordability for Blue Shield of California and senior vice president and chief medical officer of Norfolk, VA.-based Sentara Healthcare.

Dr. Gilliland also spent time in leadership roles at Mid-Atlantic Permanente Medical Group and Colorado Permanente Medical Group early in his career.

The Rural Health Value team is pleased to announce the release of an updated version of the Catalog of Value-Based Initiatives for Rural Providers. The catalog summarizes rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI). Its purpose is to help rural leaders and communities identify HHS value-based programs appropriate for rural participation.

Related resources on the Rural Health Value website:

• RHV’s “Get Ahead of AHEAD in rural!” webinar recording & handout. This webinar discussed the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. The webinar was designed to help rural health leaders (including state agencies such as Medicaid and public health) interested in the AHEAD model identify opportunities and next steps. Find the CMS website for AHEAD here States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model | CMS
• 2023 Uniform Data Set (UDS) Measure Crosswalk to Other Quality Reporting Programs This crosswalk highlights alignment between Uniform Data Set (UDS) measures and other quality reporting programs. Intended to help health centers identify which UDS measures are being utilized by other programs such as CMS Accountable Care Organizations (ACOs), and the CMS Quality Payment Program (QPP).

Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations
This summary is of changes made to the Medicare Shared Savings Program taking effect in 2023 and 2024. This Rural Health Value analysis outlines how the changes may reduce barriers to participation for potential or reentering ACOs that operate in rural contexts.

Did you know… rural Americans are at greater risk for premature death from five leading causes, including heart disease?

Call for Applications: Million Hearts^® 2024 Hypertension Control Challenge

 Million Hearts® is a national initiative to prevent 1 million heart attacks and strokes within 5 years. It focuses on implementing a small set of evidence-based priorities and targets that can improve cardiovascular health for all.

If you’re a rural healthcare professional, or represent a rural practice or health system with hypertension control rates of 80% or better, please consider applying for the “Challenge.” Moreover, colleagues with the Million Hearts program would welcome an opportunity to spotlight the success of a 2024 Hypertension Control Champion serving a rural community, as would we!

The Million Hearts^® 2024 Hypertension Control Challenge recognizes and celebrates health care professionals, practices, and health systems that have achieved exceptional hypertension control rates of at least 80%. Practices and clinicians in the U.S. and its territories are eligible for possible recognition as a Champion. The submission deadline is April 5, 2024.

 Learn more about the Challenge rules and eligibility

Application form

he Rural Health Value team is pleased to announce the release of an updated version of our Value-Based Care (VBC) Assessment Tool. The structure of the assessment, including eight categories with capacities or best practices, remains the same; however, language has been updated in the capacity statements to add clarity and specificity. This online tool helps organizations assess readiness and supports strategic planning for the shift to value-based care and payment. The resulting report and additional tools can be used to help guide the development of action plans.

Value-Based Care Assessment Resources include:

• Introductory Letter – An overview of the VBC tool
• Survey instrument – A .pdf “hard copy” of the VBC tool
• VBC Online Tool – Record responses to the 80 different value-based care capacities
• Sample Report – A sample report from the VBC tool
• VBC Tool Action Plan – Prioritizing Capacities and Planning for Action
• Preparing for a VBC Contract – Brief guide to assist leaders in preparing for VBC

Related resources on the Rural Health Value website:

• Engaging Your Board and Community in Value-Based Care Conversations (uiowa.edu) – this document will help healthcare organization leaders start value-based care conversations with board and community members. These conversations will lay the groundwork for informed strategic planning and operational decision-making.
• Rural Health Value Summit: Driving Value through Community-Based Partnerships (uiowa.edu) – this report shared experiences from four rural communities driving value through community-based partnerships. Several opportunities for policymakers, payers, and health system leaders for building and supporting social needs infrastructure in rural communities are highlighted.

Demonstrating Your Value: A Guide to Potential Value-based Care Partnerships for Rural Health Care Organizations– this Rural Health Value resource assists CAH leadership in demonstrating the value CAHs bring to networks, affiliations, payers, community-based organizations, or accountable care organizations.

WellSpan Health and Evangelical Community Hospital have entered into a definitive agreement to enhance community-based health care across the region. Pending regulatory approval, Evangelical Community Hospital will become WellSpan Evangelical Community Hospital on or about July 1, 2024. Their accompanying network of care serving the Central Susquehanna Valley will also join WellSpan, expanding the combined reach of the organizations across 12 counties in Central Pennsylvania and Northern Maryland.

A mutual commitment to reimagining healthcare through exceptional, innovative clinical care along with WellSpan’s successful approach to value and superior outcomes which are affordable and convenient serves as the cornerstone of the affiliation.

“We recognize the shared vision WellSpan has for community-based care, and we were deliberate in the decision to choose a partner who would ensure our patients continue to receive the high quality care they have come to expect from Evangelical Community Hospital,” said Kendra Aucker, president and CEO of Evangelical Community Hospital. “The industry is facing strong financial and workforce headwinds, and this integration will provide the best path forward, so we may continue to provide for the health and wellness needs of our communities well into the future.”

Serving the Central Susquehanna Valley, Evangelical Community Hospital is the only Centers for Medicare and Medicaid Services (CMS) 5-star rated hospital in the region. It employs 1,900 individuals and has more than 170 employed and non-employed physicians on staff at its hospital licensed to care for patients in its 131 licensed beds. The hospital provides a comprehensive array of services in both inpatient and outpatient settings and serves residents in Lycoming, Northumberland, Snyder, and Union counties.

The affiliation joins Evangelical with WellSpan’s integrated health care delivery system, which includes more than 21,000 team members, 2,000 employed providers, 220 locations, and eight award-winning hospitals, including the region’s largest behavioral health network and a Level 1 Trauma Center. WellSpan currently serves residents in Adams, Cumberland, Lancaster, Lebanon, Franklin, and York counties in Pennsylvania and Frederick and Washington counties in Maryland.

Combined, the organizations will serve more than 1.3 million patients across 12 counties.

Read more.

From the Pittsburgh Post-Gazette

Pinned to the door of Stephanie Zuroski’s refrigerator is a curling black and white ultrasound image of her baby at 11 weeks, 1 day old.

The baby’s delivery is still months off, but her worry these days is whether she will get to a maternity hospital from her rural Elk County home in time for the birth. Penn Highlands Healthcare Elk Hospital, 20 miles away, is closing its obstetrics unit May 1, leaving a six-county area of north-central Pennsylvania — twice the size of Delaware — without hospital maternity care. “I like being in the woods, surrounded by the Allegheny National Forest,” Ms. Zuroski, 32, said about the home she shares with husband, Nathan, 30, but “this is the downfall of living in rural Pennsylvania.”

Rural hospitals are in crisis, experts say, and shuttering maternity units is the just latest cost-cutting move to stem the flow of red ink. In addition to Elk County, maternity units in Clarion and McKean counties have closed in recent years at a time when infant mortality rates exceeded the statewide average.

McKean County, population 39,866, had an average infant mortality rate of 7 deaths per 1,000 births for the years 2016 through 2020, the most recent numbers available and well above the statewide average of 5.9 infant deaths before the age of 1, according to the state Department of Health. Infant mortality rates for the other five counties were not available from the health department. Cameron, Clinton, and Forest counties are the other areas without hospitals to care for new moms.

At a meeting Friday at the St. Marys hospital, which was closed to the public, health system executives said the hospital only had 147 births last year, far short of the 1,000 births needed for such a program to break even, according to Ridgway Borough Council member Zack Pontious, who was in attendance. Mr. Pontious didn’t think there was any chance the decision would be reversed. “I don’t think anything’s going to change,” he said.

Meanwhile, the population of the new maternity care desert will grow to 156,664 — four times bigger than Cranberry Township in Butler County, north of Pittsburgh, which is served by four hospitals, including one offering maternity care that opened in 2021. Cranberry’s population is about 33,000.

Read the full article.

Federal policymakers have been trying for a long time to lure more primary care providers to understaffed areas. The Biden administration boosted funding in 2022 to address shortages and Sen. Bernie Sanders (I-Vt.) pushed sweeping primary care legislation in 2023.

But when KFF Health News set out last year to map where the primary care workforce shortages really are — and where they aren’t — we encountered spotty data and a whole lot of people telling us the absence of better information makes it hard to know which policies are working. Turns out, consistent national data is a pipe dream.

We analyzed the public data that does exist: the federal government’s official list of primary care health professional “shortage areas,” created to help funnel providers where they’re most needed. We found that more than 180 areas have been stuck on the primary care shortage list for at least 40 years.

Read more.