Latest news with #CenterforHealthcareQualityandPaymentReform
Miami Herald
27-05-2025
- Health
- Miami Herald
Rural patients face tough choices when their hospitals stop delivering babies
WINNER, S.D. - Sophie Hofeldt planned to receive prenatal care and give birth at her local hospital, 10 minutes from her house. Instead, she's driving more than three hours round trip for her appointments. The hospital, Winner Regional Health, recently joined the increasing number of rural hospitals shuttering their birthing units. "It's going to be a lot more of a stress and a hassle for women to get the health care that they need because they have to go so much further," said Hofeldt, who has a June 10 due date for her first child. Hofeldt said longer drives mean spending more on gas - and a higher risk of not making it to the hospital in time. "My main concern is having to give birth in a car," she said. More than 100 rural hospitals have stopped delivering babies since 2021, according to the Center for Healthcare Quality and Payment Reform, a nonprofit organization. Such closures are often blamed on shortages of staff and money. About 58% of South Dakota counties have no birthing facilities, the second-highest rate among states, after North Dakota, according to March of Dimes. And the South Dakota health department says pregnant womenand infants in the state, especially those who are Black or Native American, experience high rates of complications and death. Winner Regional Health serves rural communities, including parts of the Rosebud Sioux Indian Reservation, in South Dakota and Nebraska. It delivered 107 babies last year, down from 158 in 2021, said CEO Brian Williams. The nearest birthing hospitals are in rural towns an hour or more from Winner. But several women said driving to those facilities would take them through areas without reliable cellphone service, which could be a problem if they have an emergency along the way. KFF Health News spoke with five patients from the Winner area who planned to deliver at Avera St. Mary's Hospital in Pierre, about 90 miles from Winner, or at one of the large medical centers in Sioux Falls, 170 miles away. Hofeldt and her boyfriend drive every three weeks to her prenatal appointments at the Pierre hospital, which serves the small capital city and vast surrounding rural area. She'll have to make weekly trips closer to her due date. Neither of their jobs provides paid time off for such appointments. "When you have to go to Pierre, you have to take almost the whole day off," said Hofeldt, who was born at the Winner hospital. That means forfeiting pay while spending extra money on travel. Not everyone has gas money, let alone access to a car, and bus services are scarce in rural America. Some women also need to pay for child care during their appointments. And when the baby comes, family members may need to pay for a hotel. Amy Lueking, Hofeldt's doctor in Pierre, said when patients can't overcome these barriers, obstetricians can give them home monitoring devices and offer phone- or video-based care. Patients can also receive prenatal care at a local hospital or clinic before connecting with a doctor at a birthing hospital, Lueking said. However, some rural areas don't have access to telehealth. And some patients, such as Hofeldt, don't want to split up their care, form relationships with two doctors, and deal with logistics like transferring medical records. During a recent appointment, Lueking glided an ultrasound device over Hofeldt's uterus. The "woosh-woosh" rhythm of the fetal heartbeat thumped over the monitor. "I think it's the best sound in the whole wide world," Lueking said. Hofeldt told Lueking she wanted her first delivery to be "as natural as possible." But ensuring a birth goes according to plan can be difficult for rural patients. To guarantee they make it to the hospital on time, some schedule an induction, in which doctors use medicine or procedures to stimulate labor. Katie Larson lives on a ranch near Winner in the town of Hamill, population 14. She had hoped to avoid having her labor induced. Larson wanted to wait until her contractions began naturally, then drive to Avera St. Mary's in Pierre. But she scheduled an induction in case she didn't go into labor by April 13, her due date. Larson ended up having to reschedule for April 8 to avoid a conflict with an important cattle sale she and her husband were preparing for. "People are going to be either forced to pick an induction date when it wasn't going to be their first choice or they're going to run the risk of having a baby on the side of the road," she said. Lueking said it's very rare for people to give birth while heading to the hospital in a car or ambulance. But last year, she said, five women who planned to deliver in Pierre ended up delivering in other hospitals' emergency rooms after rapidly progressing labor or weather made it too risky to drive long distances. Nanette Eagle Star's plan was to deliver at the Winner hospital, five minutes from home, until the hospital announced it would be closing its labor and delivery unit. She then decided to give birth in Sioux Falls, because her family could save money by staying with relatives there. Eagle Star's plan changed again when she went into early labor and the weather was too dangerous to drive or take a medical helicopter to Sioux Falls. "It happened so fast, in the middle of a snowstorm," she said. Eagle Star delivered at the Winner hospital after all, but in the ER, without an epidural pain blocker since no anesthesiologist was available. It was just three days after the birthing unit closed. The end of labor and delivery services at Winner Regional Health isn't just a health issue, local women said. It also has emotional and financial impacts on the community. Eagle Star fondly recalls going to doctor appointments with her sisters when she was a child. As soon as they arrived, they'd head to a hallway with baby photos taped to the wall and begin "a scavenger hunt" for Polaroids of themselves and their relatives. "On both sides it was just filled with babies' pictures," Eagle Star said. She remembers thinking, "look at all these cute babies that were born here in Winner." Hofeldt said many locals are sad their babies won't be born in the same hospital they were. Anora Henderson, a family physician, said a lack of maternity care can lead to poor outcomes for infants. Those babies may develop health problems that will require lifelong, often expensive care and other public support. "There is a community effect," she said. "It's just not as visible and it's farther down the road." Henderson resigned in May from Winner Regional Health, where she delivered vaginal births and assisted on cesarean sections. The last baby she delivered was Eagle Star's. To be designated a birthing hospital, facilities must be able to conduct C-sections and provide anesthesia 24/7, Henderson explained. Williams, the hospital's CEO, said Winner Regional Health hasn't been able to recruit enough medical professionals trained in those skills. For the last several years, the hospital was only able to offer birthing services by spending about $1.2 million a year on temporary physicians, he said, and it could no longer afford to do that. Another financial challenge is that many births at rural hospitals are covered by Medicaid, the federal and state program serving people with low incomes or disabilities. The program typically pays about half of what private insurers do for childbirth services, according to a 2022 report by the U.S. Government Accountability Office. Williams said about 80% of deliveries at Winner Regional Health were covered by Medicaid. Obstetric units are often the biggest financial drain on rural hospitals, and therefore they're frequently the first to close when a hospital is struggling, the GAO report said. Williams said the hospital still provides prenatal care and that he'd love to restart deliveries if he could hire enough staff. Henderson, the physician who resigned from the Winner hospital, has witnessed the decline in rural maternity care over decades. She remembers tagging along with her mother for appointments before her sister was born. Her mother traveled about 100 miles each way after the hospital in the town of Kadoka shuttered in 1979. Henderson practiced for nearly 22 years at Winner Regional Health, sparing women from having to travel to give birth like her mother did. Over the years, she took in new patients as a nearby rural hospital and then an Indian Health Service facility closed their birthing units. Then, Henderson's own hospital stopped deliveries. "What's really frustrating me now is I thought I was going to go into family medicine and work in a rural area and that's how we were going to fix this, so people didn't have to drive 100 miles to have a baby," she said. Copyright (C) 2025, Tribune Content Agency, LLC. Portions copyrighted by the respective providers.
Yahoo
21-05-2025
- Health
- Yahoo
The Republicans' Medicaid Cuts Could Cause a Rural Unemployment Crisis
Rural hospitals are in crisis. 'More than 700 rural hospitals—one-third of all rural hospitals in the country—are at risk of closing because of the serious financial problems they are experiencing,' according to an April report from the Center for Healthcare Quality and Payment Reform. 'Over 300 of these rural hospitals are at immediate risk of closing because of the severity of their financial problems.' And this doesn't even account for what might happen if Republicans in Congress pass a budget bill that would cut $880 billion from Medicaid to cover tax cuts to the rich. Those cuts not only threaten health care coverage for millions of vulnerable Americans but also would endanger many rural hospitals, which are more likely than urban hospitals to rely on government health care spending to stay in business. Severe cuts to Medicaid could force many struggling rural hospitals to close, further diminishing work opportunities in areas where good, steady jobs are already scarce. Rural hospitals are of course critical for patient care—often there's only one serving a geographically broad swath of territory—but they're also a major employer in their communities. They employ hundreds or even thousands of people, including nurses, administrative aids, filing clerks, nurses, nursing assistants, and doctors. If Medicaid cuts force rural hospitals to close, as experts suspect they could, rural America could face an unemployment crisis. Nationwide, hospitals employ about 4 percent of the U.S. workforce, making them America's sixth-largest employer. It's harder to tease out exactly how much of the rural workforce they employ, but by some estimates the health care sector accounts for about 14 percent of employment in those areas; there are many rural counties where hospitals are the largest or second-largest employer. (The stereotype of the rural American farmer is a bit outdated, as most agricultural work disappeared decades ago. By 2016, the biggest employment sectors for rural counties were educational services, health care, and social assistance.) More than a third of hospitals in the U.S. are classified as rural, and they're more likely to be operating in the red than their urban counterparts. The reasons are tied to the fortunes of rural communities more generally. The hospitals serve smaller populations and so have fewer patients. On top of that, many rural counties are shrinking in population, and the people who remain tend to be older and poorer than the country as a whole. These smaller hospitals have less power than bigger chains when negotiating reimbursement rates with insurance companies, making the government's health care programs a more important component of their funding. They're also serving populations that are more likely to be in poor health, and at the same time facing shortages of primary care physicians. Those problems led 136 rural hospitals, or about 3 percent, to close between 2010 and 2021. Almost three-fourths of those were in states that hadn't expanded Medicaid through the Affordable Care Act, or had expanded it only within the previous year, hinting at how big a role the program plays in keeping those hospitals open. Not all rural hospitals are in crisis, though: Those in states that did expand Medicaid under the ACA are doing better. (However, the Center for Healthcare Quality and Payment Reform study found that 190 of the rural hospitals facing risk of immediate closure are in states that expanded Medicaid.) If the past is any indication, the magnitude of the proposed new cuts could severely impact states and the hospitals that rely on those programs. 'It's kind of hard to specifically say that there's a specific policy with a discrete and direct impact on hospital employment,' Zachary Levison, project director of the KFF Project on Hospital Costs, said. 'But I think given the magnitude of the cuts to Medicaid that are being considered, these are likely to have an impact on hospital finances, and could especially hit rural hospitals, given the financial challenges that those facilities tend to have.' Jobs in health care have been growing and are pathways into well-paying careers, and educators often promote the field to rural students to help address staffing shortages in rural areas. As employers, hospitals and medical offices are home to the pink-collar jobs of the new working class. In rural areas, they provide coveted desk jobs that don't require standing all day or lifting heavy equipment—unlike many other jobs available to non-college graduates in these areas, in industries such as retail, manufacturing, construction, and farming. Cutting Medicaid is just one of the many ways the Trump administration seems poised to betray the rural voters who have overwhelmingly supported him throughout his political career. From food assistance to disability programs, rural areas are much more likely to rely on government spending to keep people afloat, and that spending has knock-on effects throughout local economies. Medicaid spending is one of them, keeping health care available to rural patients while also supporting the local industries that supply that care. If that spending dries up, so may a lot of good jobs in places where they're hard to come by.
Newsweek
14-05-2025
- Health
- Newsweek
Map Shows Where Medicaid Cuts Could Close Hospitals
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. As congressional Republicans consider deep cuts to the Medicaid program, hundreds of rural hospitals already facing severe financial strain may be pushed to closure. With more than 300 rural hospitals identified as being at "immediate risk" of shutting down, reductions in Medicaid funding threaten to upend health care delivery in some of the nation's most vulnerable communities, according to the pro-Democratic organization Center for American Progress. Why It Matters More than 60 million Americans live in rural areas, according to the 2020 census, where hospitals serve as essential lifelines, not just for emergency and primary care, but also for obstetrics, mental health services and long-term treatment. Medicaid provides critical financial support for these institutions, often serving as the backbone of care in areas with thin profit margins and high rates of public insurance enrollment. Nearly one-third of the nation's rural hospitals are already in danger of closing due to sustained financial losses and low cash reserves, according to the Center for Healthcare Quality and Payment Reform, meaning Medicaid cuts would likely see these facilities shut down. What To Know The Center for Healthcare Quality and Payment Reform has identified over 300 rural hospitals at "immediate risk" of closure, as shown in the map above. The states that could see the highest number of closures include Kansas, Oklahoma and Alabama, all of which voted for President Donald Trump in the 2024 presidential election. Across all the states that expanded Medicaid enrollment, 190 rural inpatient hospitals are at "immediate risk of closure" already, meaning Medicaid cuts would likely see these facilities shut down as House Republicans seem poised to target the states that expanded Medicaid enrollment under the Affordable Care Act (ACA), also known as Obamacare. Almost one in three inpatient rural hospitals in Oklahoma and New York could close, and around one in four in Pennsylvania and Virginia. Residents of rural areas are also more likely than those in urban communities to rely on Medicaid or the Children's Health Insurance Program (CHIP) for their health insurance, according to the pro-Democratic organization Center for American Progress. Per the CAP, almost 40 percent of children in the small towns and rural areas of Virginia were covered by Medicaid and CHIP in 2023, while around 20 percent of adults younger than 65 were. The ACA expanded Medicaid eligibility to cover low-income adults up to 138 percent of the federal poverty level, which has been a lifeline for many rural institutions. However, the new budget resolution passed by Republicans has instructed the House Committee on Energy and Commerce to slash $880 billion in spending over the next decade, with Medicaid making up 93 percent of the committee's budget. Proposed changes include lowering the federal match rate for expansion enrollees and imposing work requirements. Democratic Representative Alexandria Ocasio-Cortez has spoken out about her concern that a number of rural hospitals in New York could close, where significant proportions of constituents rely on Medicaid coverage. What People Are Saying Craig Wilson, interim president and CEO for the Arkansas Center for Health Improvement (ACHI), a nonpartisan, independent health policy center based in Little Rock, Arkansas, told Newsweek: "There are already existing inflationary pressures on hospitals generally, but in a state where the healthcare providers in many of our rural counties and the residents they serve are heavily dependent on this safety net program, it would be difficult to absorb." He added: "Regardless of what the policy decisions are in Congress, there is a clear signal from the federal government that their goal is to shift more of the financial responsibility for the Medicaid program to the states. If states want to maintain the integrity of their Medicaid program and broader healthcare system and rural communities want to maintain access to services locally, they should recognize this shift and organize to respond." A notification on the website of New York Democratic Representative Alexandria Ocasio-Cortez says: "Next week, the House Energy & Commerce Committee will vote on a bill that cuts Medicaid. Republicans are setting out to cut $880 billion in healthcare from families across the United States." It adds: "If you are represented by a Republican, please call them now and leave a voicemail, or call first thing on Monday to get through to their office. Public pressure can work here. Many members are in close seats, and hearing from their constituents can make a difference." Representative Brett Guthrie of Kentucky, the GOP chairman of the Energy and Commerce Committee, said: "Savings like these allow us to use this bill to renew the Trump tax cuts and keep Republicans' promise to hardworking middle-class families." House Speaker Mike Johnson said: "Medicaid is intended, remember, as a safety net for young pregnant mothers and the elderly and disabled and vulnerable populations, not for young able-bodied men without dependents. Those are the kinds of people we're taking off the program." Eileen M. Sullivan-Marx, a professor at the New York University Rory Meyers College of Nursing, told Newsweek: "I had a rural primary care practice in eastern New Hampshire as a nurse practitioner in the 1980s. I saw first hand how local communities benefited from having rural hospitals. Not only were the rural hospitals part of the local economy and supportive to local nursing homes but they also provided a sound structure to local community governance and volunteer community services that we often see with business groups in communities. For example, charity fund raising and support of school activities go hand in hand with rural hospitals. Those employees and leaders at local rural hospitals are the same persons who hold communities together to support not only health but also community economic growth. Just think of Friday Night Football games, usually a medical professional (in New Hampshire it had to be a physician at the time) to cover the football and other impact high school games in case of injuries. The loss of the people who make us rural hospitals would have an effect an the entire community." What Happens Next The bill that would push forward cuts to the Medicaid program needs to win over nearly every Republican on the floor of the narrowly divided House. If it passes, it will then be considered in the Senate.
CBS News
24-04-2025
- Health
- CBS News
Some Colorado lawmakers craft plan to provide millions to providers that serve under, uninsured
Rural healthcare in Colorado is on life support. The Colorado Hospital Association says half of the state's rural hospitals are operating in the red, and two behavioral health facilities and two obstetrics programs in rural Colorado recently announced they're shutting their doors. A new study by the Center for Healthcare Quality and Payment Reform finds that 10 rural hospitals here are so cash-strapped, they're in danger of closing. Located on the western edge of the San Luis Valley, Rio Grande Hospital serves one of Colorado's poorest communities. A total of 70% of its patients are on Medicare and Medicaid, meaning the hospital loses money on seven in ten patients who walk through its doors. CBS "We have to be sustainable, and it's been tough the last few years," says CEO Arlene Harms. The hospital and its four primary care clinics have been operating in the red for years. With just eight providers at the hospital to serve 10,000 patients, Harms says, staff members wear many hats, "If somebody is needed in the ER, several of us go back there and several are in the executive staff... so we all do a lot to make it work but we all love what we do." It goes beyond caring for the sick. Employees raised money for a Community Wellness Center last year that includes exercise equipment, a meditation room, and a greenhouse. But it's the health of the hospital that keeps Harms up at night, "I often times feel forgotten just because we're so far away from the metro (area)." As the financial health of rural providers worsens, state lawmakers are stepping in. "We have legislators on both sides of the aisle saying, 'Look, we're going to do something about this. We hear you loud and clear,'" says Senator Kyle Mullica, an emergency room nurse from Adams County. He's sponsoring a bill to provide at least $60 million over the next three years for primary care and behavioral health providers that are considered "safety net providers" because they serve a large number of uninsured and underinsured. The money will come from interest on the state's Unclaimed Property Trust Fund. The Rio Grande Hospital Wellness Center Rio Grande Hospital Mullica says he's also secured close to $40 million from philanthropists and is hoping for some matching federal dollars, bringing the total to over $100 million. Mullica's co-sponsor is Senator Barb Kirkmeyer, who's a Republican. The bill passed its first two committees unanimously. "We're hearing from those providers saying this is what we need. We don't need it in a year, we don't need this in two years, we need this now. Not doing something is not an option," said Mullica. Rio Grande Hospital clinics are among those in danger of closing. Like many rural hospitals, it is one of the top employers in its community, so the local economy also depends on its survival. Under the bill, an enterprise will disperse the money based on how many low-income patients a provider serves. Harms says the funding is a lifeline for those who serve the state's most vulnerable lives, "This bill gives me hope for all of us in the rural health care market." Rio Grande Hospital was just named one of the top critical care hospitals in the country.
Yahoo
04-04-2025
- Health
- Yahoo
Past president of Alabama Rural Health Association weighs in on rural hospital closures
BIRMINGHAM, Ala. (WIAT) — 27 rural hospitals are at risk of closing in the state of Alabama, that's according to Center for Healthcare Quality and Payment Reform. Seven rural hospitals in the state have closed since 2011, according to the Alabama Hospital Association. On Thursday, CBS 42 News stopped by the 2025 Alabama Rural Health Conference in Hoover to talk with the past president of the Alabama Rural Health Association about how we got here. 'A lot of it just boils down to funding,' noted Ferrell Turner, who is also the CEO of Physicians Care in Clarke County. 'What I mean by that is in some cases funding from if they are say a governmental hospital, so they be owned by the county or the city or somebody like that, and they may get some funding that way, but it's primarily the re-imbursement.' Ferrell said re-imbursement rates in Alabama are among the lowest in the country. They get compensated either by the patient, an insurance company, or Medicare or Medicaid. John Green to speak at Alys Stephens Center in June 'It's rather difficult to operate hospitals if you're not getting paid for what you do,' he added. Having your hospital close down isn't necessarily a bad thing, according to Dr. Nick Gillespie who practices in Moulton, Alabama. He said Lawrence Medical Center closed it's doors several weeks ago. 'With the improvement in healthcare, the improvement in medication, the way it's going we just don't have that need anymore.' Dr. Gillespie said what they do need in Moulton, however, is emergency services and a good diagnostic center. He remarked that he's not speaking for every hospital everywhere. State Representative Ron Bolton was awarded 'Rural Health Legislator of the Year' at the Alabama Rural Health Conference on Thursday. He said the closing of the Pickens County Hospital in March of 2020 has had an impact on his constituents. 'Right now we're having to move people to our other hospitals in Tuscaloosa and Columbus, but we're doing everything that we can to try and get that hospital back open.' Bolton said they hope to be able to qualify for a federal program for a rural emergency hospital at some point. To make that happen though, a bill would need to pass that would allow applicants that were operational through March of 2020 to be considered. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
