A System on the Brink? Health Care in Rural Arkansas Faces Uncertainty by Ashlyn Ussery
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ccess to a health care facility is critical to any community, yet rural hospitals face challenges that are vastly different than those in more populated areas. Financial stress, lack of technological advancements and the isolation of living in rural areas all contribute to health care challenges and hinder rural Arkansans ability to maintain a healthy living, and these problems have been highlighted during the ongoing pandemic. COVID-19 has caused economic devastation around the globe, but for rural health care, these challenges are far from new. In the southern United States, 55 rural hospitals have been forced to close their doors over the last 10 years. Arkansas is responsible for only one of those closures. Since passage of the Affordable Care Act, facilities in the state have seen an increase in revenue, a decline in uncompensated care costs and, in some cases, expansions and added locations. “In 2014 the uncompensated care cost was $254 million, by 2018 that number was around $212 million,” said Jodiane Tritt, executive vice president of Arkansas Hospital Association. “This decrease in cost is a result of more people being covered by Medicaid.” According to a 2019 Navigant study on rural hospital sustainability, 18 hospitals in Arkansas are at high financial risk; that is more than one-third of the state’s rural hospitals. “Though the 2014 expansion has helped Arkansas rural health care in recent years, it does not provide a long term fix,” said Arkansas Farm Bureau director of leadership development Jennifer Craig, who coordinates the organization’s rural health efforts. “Issues with the current payment and service delivery models need to be addressed in
order to find ways for rural hospitals to be sustainable.” Many critical access hospitals, or hospitals that are located 35 miles from any other hospital, are struggling to maintain the requirements needed to be reimbursed by Medicare and Medicaid. These reimbursements are given to facilities that are able to uphold a specific standard of care to a certain number of patients. Business plans for rural hospitals were designed in the late 1990s, when more inpatient procedures where being performed. Mellie Bridewell, CEO of Arkansas Rural Health Partnership, explains that most of the rural facilities either do not know how to change their business plans or that they even need to. “A critical access hospital has to have no more than 25 beds and an emergency department, but when you are only seeing 6 patients at a time, that does not equal a financial win,” said Bridewell. “There are so many financial gaps that could be filled if the business plans were focused on converting beds and departments to medical elements that are needed in each region.” Shifting the rural health facilities to “urgent care only” or designating beds to other departments are some of the tactics that Tritt says could help, but they could also lead to other challenges. “One of the problems that rural hospitals have is being able to recruit physicians with specialized skill sets that the patients in each community need,” said Tritt. “We can have all of the beds and ventilators in the world, but if a facility does not have appropriately trained staff who are eligible to work on particular cases, then they will continue to find themselves in a really hard spot.” continued on page 8>>
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ARKANSAS FARM BUREAU • SUMMER 2020
