From Becker’s Hospital CFO Report

Obstetrics and delivery services are one of the leading money losers of all hospital services, and a growing number of rural hospitals are closing obstetric departments to protect the financial viability of the overall enterprise, according to a recent analysis by Kaufman Hall.

About 40% of rural hospitals are losing money on obstetrics programs, according to a recent study conducted by the University of Minnesota Rural Health Research Center. Many obstetrics programs hemorrhage money, and they are generally among the first services that financially struggling or low-volume rural hospitals cut.

Several hospitals scaled back or eliminated labor and delivery services last year, and Becker’s has reported on 15 hospitals that have cut these services so far in 2024.

Ultimately, it’s a money problem. Rising costs and staffing shortages have hit rural hospitals particularly hard, but low Medicaid reimbursement is the biggest challenge for obstetrics departments.

“This is especially detrimental in rural areas where a higher number of births are covered by Medicaid,” Eric Fish, MD, president and CEO of Schneck Medical Center, in Seymour, Ind., told Becker’s. “In Indiana, over half of babies born on an annual basis are covered by Medicaid, which pays 57 cents on the dollar of the cost of providing care. This means hospitals, specifically in rural areas, are experiencing significant financial losses. Increasing Medicaid reimbursement is imperative to keep these services open and to preserve access in the future.”

Medicaid reimbursement rates set by states do not cover the full cost of providing obstetric services. This translates to financial losses for hospitals providing these services in rural areas, where a higher proportion of births are covered by Medicaid.

Given that Medicaid funds 50% of deliveries in rural areas, hospitals would receive significant financial respite from improved Medicaid reimbursement for these services.

“To help cover the losses associated with obstetrics, perhaps rural hospitals offering obstetrics could qualify for a special exception through Medicaid with an add-on payment program or an annual lump-sum payment, similar to [prospective payment system] hospitals that have received disproportionate numbers of low-income patients, based on the hospital’s disproportionate OB patient percentage,” Brett Altman, DPT, CEO of Atlantic, Iowa-based Cass Health, told Becker’s.

The other challenge, particularly in rural America, is the lack of staff and expertise when it comes to obstetrics nurses and physicians.

“We have spent upwards of $3 million annually for traveling obstetric nurses to keep our unit staffed 24/7/365, but it is the right thing to do for southwest Iowans in order to decrease the excessive mileage required to reach the nearest obstetrics unit,” Dr. Altman said. “Low volume obstetrics is not profitable and is one of the key drivers for why so many obstetric units have closed in rural areas as these hospitals hit financial headwinds in addition to concerns of competency.”

From Becker’s Hospital CFO Report

Jellico (Tenn.) Regional Hospital, a 25-bed critical access facility, closed March 9, making it the 36th rural hospital to shutter or no longer provide inpatient services since 2020, according to data compiled by the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.

The closures highlight the heightened financial challenges that rural hospitals face amid persisting workforce shortages, rising costs and leveling reimbursement. In addition, only 45% of rural hospitals now offer labor and delivery services, and in 10 states, less than 33% do, according to the Center for Healthcare Quality and Payment Reform.

Below are the 36 rural hospitals that closed since 2020, beginning with the most recent.

Editor’s note: Facilities with an asterisk (*) signify converted closures (facilities that no longer provide inpatient services, but continue to provide some services, such as primary care, skilled nursing care or long-term care).

• Jellico (Tenn.) Regional Hospital
• St. Mark’s Medical Center (La Grange, Texas)
• Herington (Kan.) Hospital
• Spectrum Health Kelsey Hospital (Lakeview, Mich.)
• Indiana University Health Blackford Hospital (Hartford City, Ind.)*
• Martin General Hospital (Williamston, N.C.)
• Patients Choice Medical Center of Smith County (Raleigh, Miss.)
• St. Margaret’s Health-Spring Valley (Ill.)
• UPMC Lock Haven (Pa.)*
• St. Margaret’s Health-Peru (Ill.) (OSF Healthcare expected to reopen the hospital this spring)
• Ascension St. Vincent Dunn (Bedford, Ind.)
• Blessing Health Keokuk (Iowa)
• Audrain Community Hospital (Mexico, Mo.)
• Callaway Community Hospital (Fulton, Mo.)
• Acoma-Canoncito-Laguna Service Unit (Acoma, N.M.)*
• Galesburg (Ill.) Cottage Hospital*
• MercyOne Oakland Medical Center (Oakland, Neb.)*
• Community HealthCare System-St. Marys (Kan.)*
• Perry Community Hospital (Linden, Tenn.)
• Northridge Medical Center (Commerce, Ga.)*
• Southwest Georgia Regional Medical Center (Cuthbert, Ga.)
• Shands Lake Shore Regional Medical Center (Lake City, Fla.)
• Cumberland River Hospital (Celina, Tenn.)
• Bluefield (W.Va.) Regional Medical Center*
• Saint Luke’s Cushing Hospital (Leavenworth, Kan.)*
• Shands Live Oak (Fla.) Regional Medical Center*
• Shands Starke (Fla.) Regional Medical Center*
• Williamson (W.V.a) Memorial Hospital*
• Decatur County General Hospital (Parsons, Tenn.)
• Sumner Community Hospital (Wellington, Kan.)
• Edward W. McCready Memorial Hospital (Crisfield, Md.)*
• Mayo Clinic Health System-Springfield (Minn.)*
• Central Hospital of Bowie (Texas)*
• UPMC Susquehanna Sunbury (Pa.)*
• Mountain View Regional Hospital (Norton, Va.)*
• Pinnacle Regional Hospital (Boonville, Mo.)

The Pennsylvania Broadband Development Authority (PBDA) is excited to announce the launch of the new Pennsylvania Broadband Development Authority website. The PBDA has been working diligently to design a website that offers a more intuitive and visually appealing experience for its visitors. There are a number of new features added to this website and we’ve outlined some of those below:

1. A navigation Panel for ease in finding the information you’re seeking
2. Quick links that will take you directly to hot topic resources
3. Real-time data on unserved/underserved  locations, projects awarded, and funding allocated
4. Resources that are specifically tailored for various audiences

Lastly, we thank our many valuable partners who have helped to contribute to the enhancement of the PBDA website. We hope that you find this a more valuable resource as we work together to ensure Internet For All across the commonwealth!

U.S. Department of Agriculture (USDA) Rural Development Under Secretary Dr. Basil Gooden today announced that the Department is inviting applications for loans and grants to repair, improve or modify existing USDA financed multifamily housing properties for year-round and seasonal domestic farmworkers.

USDA is making the funding available under the Off-Farm Labor Housing Programs. These programs provide grants and loans of up to $40,000 per unit for farmers, nonprofits, local governments and federally recognized Tribes to improve, repair or modify properties that have previously received financing from USDA for farmworkers.

The funding may be used to make improvements, repairs and/or modifications to address accessibility compliance and health and safety issues.

USDA is particularly interested in applications that will advance Biden-Harris Administration priorities to:

• Reduce climate pollution and increase resilience to the impacts of climate change through economic support to rural communities.
• Ensure all rural residents have equitable access to Rural Development (RD) programs and benefits from RD-funded projects.
• Help rural communities recover economically through more and better market opportunities and through improved infrastructure.

Applications must be submitted by 12 p.m. ET on June 18, 2024.

For more information, see page 19400 of the March 18, 2024, Federal Register.

To subscribe to USDA Rural Development updates, visit GovDelivery subscriber page

The Department of Drug and Alcohol Programs (DDAP) announced the availability of $6.5 million in funding to expand drop-in center services for individuals with substance use disorders (SUD) across Pennsylvania.

Drop-in centers provide a safe, judgment-free place for people to receive daily essentials, engage with staff to learn about the possibility of recovery and treatment options, and, when ready, get connected to those services. They also provide harm reduction and recovery support services.

“This funding is designed to help organizations looking to expand their community-driven harm reduction support services to increase overdose prevention and a connection to SUD support services.” said DDAP Secretary Dr. Latika Davis-Jones. “Drop-in centers provide a doorway for an individual’s recovery journey – we’re looking to make that doorway wider, and easier to walk into.”

Eligible applicants, including existing community organizations, Single County Authorities, and DDAP-licensed treatment providers, can find the grant application and project summary on the DDAP website. Approximately eight grants will be awarded up to $750,000. Some examples of services provided by drop-in centers include but are not limited to:

• Harm-reduction for substance use by incorporating overdose prevention and legally permissible harm reduction efforts into existing services;
• Addressing social determinants of health through the provision of daily essentials;
• Access to care and case management systems;
• Access to free healthcare including wound care, Hepatitis C/HIV testing, reproductive healthcare, and dental care;
• Referrals to SUD level of care assessments, treatment, including Medication for Opioid Use Disorder (MOUD), behavior health resources, case management services, benefits services, and legal services;
• Survival resources such as shelter and warmth or cooling;
• Public restrooms, shower, and laundry facilities;
• Clothing and hygiene product distribution;
• Mail services;
• Professionally facilitated support groups which offer education, emotional and social support, practical help, and more; and
• Advocacy and other supportive services required to navigate complex issues impacting special populations.

DDAP is placing a focus on health equity as a part of this grant opportunity. Applicants must include a description of their current engagement with diverse populations including communities of color, LGBTQ+ individuals, persons with disabilities, and those residing in rural and urban settings, and provide detailed information about how the project will engage and provide access to these diverse populations.

All applications must be submitted electronically by 12:00 PM on Friday, April 12, 2024. Applications will be competitively reviewed and scored based upon the applicant’s adherence to the funding announcement guidelines, and a timely submission to DDAP.

Funding for these grants is provided from the opioid settlement funding that was appropriated to DDAP by the General Assembly for the 2023-24 fiscal year.

Questions regarding the grants and the application process should be forwarded to RA-DAGrantsMgmt@pa.gov.

The President’s Fiscal Year 2025 Budget proposal for the Health Resources and Services Administration addresses many of the most pressing health care challenges facing American families, including taking action on:

Youth mental health crisis: Recent data highlights the disturbing trends in youth mental health including nearly one-third of youth reporting experiencing poor mental health and 1 in 5 students reporting seriously considering attempting suicide. To respond to this moment, we need to make mental health and substance use disorder treatment readily available. The keys to increasing access to care are growing the behavioral health workforce and better supporting primary care providers in meeting behavioral health needs. We also need to build supports for young people among those they trust, which is often their peers.

The President’s Budget invests in:

• Training 12,000 new behavioral health providers to expand access to behavioral health treatment and services across the country.
• Creating an innovative new youth peer-to-peer mental health support and career pathway program to train youth and young adults to support one another’s mental health needs while building an early behavioral health career pathway program for youth peers.
• Supporting mental health training and support for pediatricians where pediatricians can directly access tele-consultation with psychiatrists and other mental health clinicians to support the mental health needs of their young patients and training.
• Making mental health and substance use disorder a required service in community health centers that are the primary source of health care services, regardless of ability to pay, to more than 30 million people—including more than 8.5 million children—in some of the highest need urban and rural communities across the country.

Maternity Care Deserts: More than eight million women of childbearing age live in counties that lack a hospital with labor and delivery services. The March of Dimes estimates that nearly 150,000 babies a year are born in “maternity care deserts” that lack a hospital or birth center providing obstetric care and lack obstetricians or midwives. Well-trained health care providers are essential to improving health outcomes, identifying and addressing pregnancy-related complications, protecting women’s health, and ensuring every birth provides the best opportunity for a strong start.

The President’s Budget invests in:

• Building obstetric capacity in maternity care deserts to respond to obstetric-related emergencies in rural, urban, and suburban areas without ready access to labor and delivery services.
• Training more Labor and Delivery Nurses and Certified Nurse Midwives to increase access to maternal and perinatal health care, particularly in rural and underserved communities.
• Building a community-based doula workforce to support pregnant individuals and ensure their voices are heard and needs are met.
• Expanding access to maternal mental health support to respond to maternal depression and increase access through the National Maternal Mental Health Hotline at 1-833-TLC-MAMA.

Closing gaps in access to primary care: Delayed care is often the result of barriers such as lack of primary care and behavioral health providers located in many rural or underserved communities, workforce challenges across the health care system, and lack of access to transportation, limited appointment availability, and limited operating hours for patients who require care outside of standard working hours. In 2020, 46 percent of households surveyed nationwide reported negative health consequences as a result of not being able to get an appointment when they needed it.

The President’s Budget invests in:

• A plan to create a pathway to double the federal investment in the community health center program to ensure that it can reach over 37 million people in need of and struggling to access primary care.
• Expanding health center street medicine services to ensure people experiencing homelessness have access to primary care.
• Expanding health center hours of operation to make it easier for people who work later shifts or face childcare or transportation issues to access primary care.

Meeting the opioid treatment and recovery needs of rural communities: Opioid use disorder is particularly concerning in rural communities and accessing treatment can be challenging due to geographic isolation, transportation barriers, and limited substance use disorder providers. In support of President Biden’s Unity Agenda, HRSA launched a Rural Opioid Treatment and Recovery Initiative to support establishing and expanding comprehensive substance use disorder treatment and recovery services in rural areas, including by increasing access to medications for opioid use disorder, such as buprenorphine.

The President’s Budget invests in:

• Creating more access to treatment in rural communities for people to receive medications such as buprenorphine to treat opioid use disorder and get recovery supports.
• Supporting rural community activities such as mobile units providing medication for opioid use disorder and integration of this treatment into rural primary care settings.
• Integrating supportive services—such as food access, housing support and employment training and opportunities, transportation to treatment, and other social determinants of health.
• Expanding the rural substance use disorder workforce, including clinical providers and peer support professionals who help individuals find and sustain a path to recovery.

Growing the health care workforce: The National Center for Health Workforce Analysis has identified current projected shortages through 2035 in a wide range of health care occupations. At the same time, many training curricula and models for training health professionals, particularly in medicine, remain unchanged from decades ago; they do not fully leverage the technology available today. HRSA is committed to growing the health care workforce by funding new, leading-edge health profession education and training models and expanding the supply of health care professionals in underserved and rural areas.

The President’s Budget invests in:

• Providing scholarships and loan repayment to over 24,000 clinicians, nurses, and health professionals to provide health care in underserved and rural areas.
• Making it possible for more than 1,800 medical and dental residents to work and train in underserved and rural communities.
• Seeding new approaches to recruit and grow the health care workforce and deliver a more modern, robust, and diverse workforce pipeline.

Transforming the Organ Matching System to Better Serve Patients and Families: HRSA oversees the Organ Procurement and Transplantation Network (OPTN), which was established by Congress nearly four decades ago and consists of a comprehensive network of transplant professionals and community members charged with increasing organ donation and operating and overseeing a fair and accountable system for allocating and transplanting organs in the United States. Across the nearly 40-year history of the OPTN, all functions of the OPTN have been managed by a single vendor and not competed separately based on technical expertise in areas like IT or operations. In 2023, Congress adopted the Administration’s proposal to update the decades-old statute, including allowing HRSA to make multiple different contract awards to benefit from best-in-class vendors in different areas to improve performance and innovation. Congress also adopted HRSA’s proposal to require the OPTN Board of Directors support contract be distinct from OPTN operations support contractors to strengthen OPTN accountability and oversight. The new law also eliminated the arbitrary appropriation cap to support this work.

The President’s Budget invests in:

• Doubling funding for the organ transplant system to increase competition and better serve the more than 100,000 people on the organ donor waitlist.

Read HRSA’s FY 2025 Congressional Budget Justification.