If only for a few days, the recent historic snowstorm pushed to the back of our minds the fact that we are still in the midst of a pandemic. The snow has now melted away and our mobility has returned, but we are faced with the realization that covid-19 is still very present in our communities.
I remain confident that covid-19 will melt away, albeit not as swiftly and completely as snow on Southern soil. When it does, though, the myriad of health and health-care challenges faced by Arkansans--many of which were highlighted and exacerbated by covid-19--will remain, and stalled efforts to address those challenges will need renewed energy.
One of our remaining challenges is the continued risk of hospital closures in rural areas of the state. After Arkansas experienced its first rural hospital closure of the decade in early 2019--compared to nearly 50 rural hospital closures in surrounding states over the same period--I documented on these pages the significant threat to our rural hospitals and highlighted a report from consulting firm Navigant that listed Arkansas among the states with the highest percentages of rural hospitals at high risk of closing.
During the public health emergency, hospitals, including those in rural areas, have seen an infusion of covid-19 relief funds. While those funds have equipped rural hospitals with better capacity to respond to the pandemic, they were not intended to provide, nor have they provided, rural hospitals with the ability to address longstanding issues placing them at risk of closure.
Rural hospitals are still struggling with aging facilities, work-force recruitment challenges, and out-migration of younger populations from rural areas, leaving rural hospitals to care for fewer patients, who are older and sicker. Indeed, a report by the Center for Healthcare Quality and Payment Reform in January found that 16 rural hospitals in Arkansas were at immediate risk of closing.
That's one third of our state's rural hospitals.
Fortunately, some long-awaited help might be on the way. Tucked into the Consolidated Appropriations Act passed by Congress in late 2020 was the Rural Emergency Acute Care Hospital (REACH) Act, which creates a new provider type through the federal Medicare program. Rural acute-care hospitals with 50 or fewer beds, including critical-access hospitals--of which there are 28 in Arkansas--can seek designation as this new provider type, a rural emergency hospital.
A rural emergency hospital designation would allow facilities to discontinue offering inpatient services, which require intense staffing and have higher overhead costs compared to other services. Approximately a half-dozen Arkansas hospitals have an average daily census of fewer than five patients. Consequently, a substantial number of rural hospitals in Arkansas are likely to welcome the flexibility offered by this new designation and potential benefit to turn their attention to offering much-needed outpatient, urgent, and emergent services in rural communities.
It's certainly promising, but there are still some loose ends that need to be tied. First, the designation is not available through Medicare until 2023, so states should extend a lifeline to rural hospitals on the verge of closure before then.
Second, Congress limited the availability of the Medicare designation to hospitals in states that also establish a rural emergency hospital designation. In anticipation of continued financial pressure on rural hospitals and this new opportunity, policymakers in Arkansas should act by directing the state Department of Health to establish the designation and require Medicaid and private insurers to recognize the designation as a reimbursable provider type.
Third, hospitals planning to convert to rural emergency hospitals should ensure that robust emergency and non-emergency transportation services are available to get residents to appropriate sites for care.
Finally, seeking care in an emergency is one thing, but how likely is it that rural residents will seek needed preventive care and disease management when those services aren't available within an hour's drive? Consequently, greater investment in rural primary care is crucial to improving quality of care and health outcomes while also reducing unnecessary emergency department visits.
As we do all we can through precautions and vaccinations to hasten the end of the covid-19 pandemic, we must acknowledge the fragility of our rural health-care system. When we emerge from the pandemic--and we will--we should emerge with a purpose and take advantage of new opportunities to redesign our hospitals to optimize both their responsiveness to local needs and their financial stability. Let's not allow them to melt away.
Craig Wilson, J.D., M.P.A., is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock.