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Tom Crawford: Prognosis is grim for Georgia's rural hospitals
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If you operate or work for a hospital located in one of Georgia’s rural communities, you should be very afraid. There’s a strong possibility your hospital will be closing down soon because of financial problems.

For hospitals across the state, the prognosis is very disheartening.

Eight rural facilities have gone out of business since 2001. In the past two years, these four institutions have shut down: Lower Oconee Community Hospital in Wheeler County, Charlton County Hospital, Stewart Webster Hospital and Calhoun County Hospital.

It’s true that hospitals in more populous areas, such as St. Francis in Columbus, are also having financial problems, but the situation is especially acute in thinly populated rural Georgia.

The picture only looks darker as time goes on. A special committee appointed by Gov. Nathan Deal last year to examine the situation at rural hospitals released a report warning that 15 of these facilities “are considered financially fragile, with six operating on a day-to-day basis.”

The problem is the same everywhere: many patients can’t afford health insurance and come to the emergency room to get medical treatment, leaving the hospitals with huge unpaid bills for what is called “uncompensated care.”

The crushing burden of this charity care makes it difficult to generate the cash flow needed to pay a hospital’s daily expenses. Eventually, the institution reaches the point where it just can’t go on.

One thing that could help would be an expansion of Medicaid coverage under the provisions of the federal Affordable Care Act. That decision would bring the state more than $3 billion in federal funds each year and provide more than 400,000 uninsured residents with health care coverage.

Under this Medicaid expansion, a higher percentage of the patients at rural hospitals would have coverage that could pay at least part of their bill. The cash flow crunch would be eased for these hospitals, which would have a fighting chance of staying open.

Deal, however, does not like the ACA and has refused to accept the federal money for Medicaid expansion. He signed a bill last year that shifts the decision on Medicaid expansion to the legislature, whose Republican members dislike the ACA even more than Deal does.

The state spurned more than $3 billion in federal funds last year and will pass up a similar amount this year that would have flowed to rural hospitals desperately struggling to stay alive.

The special committee that Deal appointed to help rural hospitals didn’t discuss the possibility of Medicaid expansion at its meetings and made no mention of the available federal funding in its final report.

Instead, the committee recommended the development of a “hub and spoke” network of medical facilities that serve rural areas.

The four proposed “hubs” in this system would be Union General Hospital in Blairsville, Appling Healthcare System in Baxley, Crisp Regional Hospital in Cordele and Emanuel Regional Medical Center in Swainsboro.

These hospitals would coordinate the treatment provided to patients who interact with the “spokes” in the proposed network: smaller critical access hospitals, ambulances with telemedicine capabilities, school clinics, federally qualified health centers, public health departments and local physicians.

Legislators have already allocated $3 million in the state budget to provide the computer equipment, software, program development and necessary training at the four “hub” hospitals.

“The goal of the ‘hub and spoke’ model is to best use existing and new technology to ensure that patients are being treated in the most appropriate setting, thus relieving some of the cost pressures on the smallest rural hospitals’ emergency departments,” the report said.

The proposal is not a bad idea and it may result in more efficient treatment of patients outside urban areas. However, it won’t come close to solving the money problems that are forcing rural hospitals out of business. It is rather like using a Band-Aid to treat a cancerous tumor that’s eating away at your vital organs.

A lot of money would be available to our rural hospitals if state officials would agree to accept federal funds for Medicaid expansion. It probably wouldn’t save all of them, but it could keep some of them going.

By not taking the money, our elected leaders are signing the death warrants for many of these hospitals.

Tom Crawford is editor of The Georgia Report.

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