Many of Georgia’s hospitals are in critical condition. That is the message delivered by speaker after speaker at the Senate Health and Human Services Committee hearing at the Georgia Capitol on August 22, 2016.
Our rural hospitals are struggling. Forty-one percent of them are working with a negative operating budget, and that number is expected to climb past 50 percent in the next few years. In the past couple of years, five rural hospitals have closed in Georgia and others have scaled back services, leaving patients in the communities they serve to have to travel farther for medical care. Cash-strapped community hospitals are unable to purchase the newest technology or update their aging buildings, so many people in those communities choose to drive to hospitals in bigger markets under the impression that newer stuff means better care. A few hospitals have so little cash on hand that they have struggled to meet payroll at times.
Georgia ranks 4th in the nation in the number of uninsured patients, aggravating hospitals’ already precarious financial situations. Medicaid recipients make up a large share of rural patients, and with Medicaid paying 20 cents on the dollar for services, you see a sizable chunk cut from local hospital revenues. Add in the underinsured, which often show up in the bad debt column, and you have a toxic fiscal environment for our rural hospitals.
Solutions are hard to come by. Georgia’s Hub and Spoke model for community care with regional hospitals and community service providers is showing promise. Resistance to change is a big challenge, however, and more needs to be done to coordinate between service providers and communicate the value of receiving care in the local market to those in the community. Many patients are managing multiple chronic conditions, and some require help beyond their medical issues. This type of intensive case management is best handled at the local level.
The Rural Hospital Stabilization Committee is one organization that is studying the challenges facing our rural hospitals and will be reporting back to the Health and Human Services Committee throughout their pilot process. Their goals are to help local hospitals increase market share while reducing Medicare readmissions, which come with a penalty, as well has improving access to primary care and reducing non-emergency care in the communities they serve. They have many tools in their toolbox and expect to make some inroads in the pilot communities.
The Georgia Chamber of Commerce has convened a health care access task force who will be reporting their findings as well.
In the meantime, rural hospitals will continue to do their best to meet the needs of their communities with the limited resources they have, and we will all continue to hope that they can hang on until state leaders can shape policies to fix what ails them.
Karla Jacobs is a member of the Georgia Commission on Women. She lives in Marietta with her husband, two kids, a dog, and some fish.