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CONSUMER CHOICE: Nearly half of patients who need elective surgery bypass their local rural hospital for care

The bypass rate for elective surgical procedures at rural CAHs is 48.3%, similar to other estimates on surgery-related bypass.  This rate indicates that rural CAHs are losing a significant portion of people with surgical needs in their community to outside hospitals, thereby affecting their ability to continue offering other services in their community.”

The number of patients who chose to travel for elective surgical procedures, bypassing a closer critical access hospital, was studied based on 2011 data for four states: Colorado, North Carolina, Vermont and Wisconsin.  Patients who were found to be more likely to bypass the small local hospital included those undergoing elective orthopedic, ophthalmology, and digestive system procedures.

Source: Weigel, P.A.M., and others. (2017, Spring). Rural bypass for elective surgeries. Journal of Rural Health, 33(2), 135-145.  Click here for access to publisher’s website: http://onlinelibrary.wiley.com/wol1/doi/10.1111/jrh.12163/full  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OBSTETRICS: Reasons OB units close in rural areas

The reasons why rural hospitals closed their labor and delivery services were studied based on a telephone survey of hospitals in nine states.  Of the 263 hospitals that responded, 19 (or 7.2 percent) closed their OB units during the study period of 2011 to 2014.  Here are the reasons that were identified as risk factors for closing:

  • Low birth volume
  • Private (as opposed to public) ownership of the hospital
  • Low number of family physicians practicing in the area
  • Low income surrounding area

Source: Hung, P., and others. (2016, August). Why are obstetrics units in rural hospitals closing their doors? HSR. Health Services Research, 51(4), 1546-1560.  Click here for publisher’s website: http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12441/full  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HOSPITAL CLOSURES: What is nurse executive’s role?

Five nurse executives who were employed at rural hospitals were interviewed about their experiences when their hospitals closed.  The researchers categorized key themes brought out in these interviews, which are discussed in this brief article.  They cover topics related to a flattening of the organizational structure of the hospitals, a strong sense of family among staff, development of crisis conditions concerning supplies and workforce and feelings of betrayal by the hospital owners.  They also mention the challenges of finding qualified board members and top administrators in small communities.  Another difficulty was the disposition of medical records after the closure.

Source: Warden, D.H., and Probst, J.C. (2017, January). The role of the nurse executive in rural hospital closure. JONA. Journal of Nursing Administration, 47(1), 5-7. Click here for publisher’s website: http://journals.lww.com/jonajournal/Abstract/2017/01000/The_Role_of_the_Nurse_Executive_in_Rural_Hospital.3.aspx   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

FACILITY CLOSURE: What happens when rural hospitals close? How are facilities reused?

This is a study of 47 rural hospitals that closed in 2010 to 2014.  It comes out of the North Carolina Rural Health Research Program.  The authors compare characteristics of hospitals that closed completely – which they term as “abandoned” – with those that are no longer providing inpatient care, but now have some other health care-related use – which they term as “converted.”

Of the 47 rural hospitals that closed, a little over half (26 hospitals) were in the abandoned category, and most of these were located in the South – particularly in Texas, Alabama, and Georgia.  The authors found that abandoned rural hospitals tended to be in markets with a higher percentage of non-white population compared to those hospitals that were converted to other health care use.

There is an interesting table included that looks at characteristics of rural hospitals in the year of closure.  Hospitals in the abandoned category had the lowest total margin in that final year – negative 10 percent, while those that were converted to other health care use were in somewhat better financial condition.  All of the rural hospitals that closed were small, with roughly 25 to 30 beds.

Ten of these hospitals converted to freestanding emergency or urgent care facilities; 4 converted to skilled nursing or rehabilitation facilities; and 7 converted to outpatient care.  The perceived impact of losing an inpatient hospital in a community is that patients will have to travel further to obtain care, that jobs will be lost (since the rural hospital is often the largest employer), and a loss of prestige in the community.

Source: Thomas, S.R., Kaufman, B.G., Randolph, R.K., and others. (2015, Apr.). A comparison of closed rural hospitals and perceived impact. Findings Brief.  http://www.shepscenter.unc.edu/wp-content/uploads/2015/04/AfterClosureApril2015.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

CLOSURE: Why do rural hospitals close?

Characteristics of 42 rural hospitals that closed between 2010 and 2014 were compared to hospitals that remained open in this study out of the North Carolina Rural Health Research Program.

Rural hospitals that closed

  • Were in worse shape financially – lower margin, fewer days cash on hand, higher debt levels
  • Had a higher Medicare patient mix
  • Had lower utilization rates
  • Had lower volume in key services – surgery, outpatient services, and obstetrics
  • Had fewer employees

The researchers also took a look at critical access hospitals that closed compared to other rural hospitals that closed.

Source: Kaufman, B.G., Thomas, S.R., Randolph, R.K., and others. (2016, Winter). The rising rate of rural hospital closures. The Journal of Rural Health, 32(1), 35-43.  http://onlinelibrary.wiley.com/doi/10.1111/jrh.12128/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Chart Book: 21st Century Rural Hospitals

Is there a typical rural hospital? A new report  from the Sheps Center for Health Services Research, a rural health research and policy center based at the University of North Carolina, provides a statistical profile, including these medians:

  • It has 25 beds
  • It has 7 inpatients every day
  • It employs 321 full-time equivalent workers
  • It serves a median population of 27,930 with 36 residents per square mile
  • Typical inpatient care includes surgical, obstetric, and swing bed services
  • Typical outpatient care includes surgical, cardiac rehab, breast cancer screening/mammography, and health fair services
  • Outpatient care represents 69.3% of total revenue

The report provides more data on hospitals, inpatient and outpatient services, the rural population, and hospital finances. In some cases, its contrasts rural hospitals with urban hospitals.

Freeman VA and others. The 21st century rural hospital: a chart book. Cecil G. Sheps Center for Health Services Research, University of North Carolina, March 2015. http://www.shepscenter.unc.edu/wp-content/uploads/2015/02/21stCenturyRuralHospitalsChartBook.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

List of Rural Hospitals That Have Closed Since 2010

The North Carolina Rural Health Research Center has compiled a list of 42 rural hospitals across the US that have closed since January 2010. Hospital names, addresses, closure date, bed size, and current status are included in the listing. A map showing locations of each closed facility is also provided.

Source: North Carolina Rural Health Research Program. Rural hospital closures: January 2010-present. University of North Carolina, Cecil G. Sheps Center for Health Services Research, Oct. 22, 2014. The original document has been superseded; for the latest update see: http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/

Posted by AHA Resource Center (312) 422-2003, rc@aha.org