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Home / US / A wave of rural hospital closings is testing communities in the US: shots

A wave of rural hospital closings is testing communities in the US: shots



Fort Scott, Kan., Fills on weekday afternoons when locals eat pizza, visit a coffee shop, or browse antique shops and bookstores. Like other rural communities, the business parks include empty shop windows.

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Fort Scott, Kan., Fills on weekday afternoons when locals eat pizza, visit a coffee shop, or browse antiques shops and bookstores. As in other rural communities, there are empty shop windows in the business parks.

Christopher Smith for Kaiser Health News

A light drizzle had begun on the gray December sky in front of the Christian community church when Reta Baker, president of the local hospital, went to a weekly morning coffee organized by Fort Scott, Kan's Chamber of Commerce.

The city administrator was there together with the franchisee of McDonald's, an owner of an insurance agency and the receptionist of the big car dealership. Baker, who grew up on a farm south of town, knew them all.

Nevertheless, she stopped in the door and held her chin up to look at the scene.

Just a few months earlier, Baker and the owner of the hospital, the St. Louis-based Mercy health care system, publicly announced that the 132-year-old hospital would be closed.

"Nobody spoke to me after the announcement," she said.

Baker, who says she spent "a lot of time" on delivering the news, carefully planned personal meetings with doctors and nurses in the last days of September. On October 1, she personally met with staff at Mercy Hospital in Fort Scott and then with key community leaders before sending communications to local newspapers and radio stations.

But for the 7,800 residents of Fort Scott, about 90 miles south of Kansas City, Kan., The closure of the hospital was a loss they had never thought possible.

"Babies will die," said long-time resident Darlene Doherty, who was collecting coffee. "This is a disaster."

The Sheriff of Bourbon County, Bill Martin, stopped on his way from the morning coffee and said the closure had "a dark side". And Dusty Drake, Christian Community's senior minister, said diplomatically that people had "many questions," adding that members of his community would lose their jobs.

Reta Baker, President of Mercy Hospital, Fort Scott, Kan. began in 1981 as a staff nurse and "has been here ever since." The hospital was closed at the end of 2018.

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Reta Baker, President of Mercy Hospital at Fort Scott, Kan., Started out in 1981 as a nurse and "has been here ever since." The hospital was closed at the end of 2018.

Christopher Smith for Kaiser Health News

But even though this city deals with the trauma of losing a beloved institution, the battle is rooted in deeper national issues: do small communities like Fort Scott even need a traditional hospital? And if not, how do you get the medical care you need?

The Sisters of Mercy opened the 10-Bed Frontier Hospital of Fort Scott in 1886 – a time when 48 km were traveled to the doctor and most medical treatments were unfathomable, so primitive that they could be distributed almost anywhere.

Now the drive on the four-lane highway north to Kansas City, Kan. or crossing the state border to Joplin, Mo. and back for a day trip, shopping and shopping includes stopping at a favorite restaurant. The larger hospitals there offer cutting-edge treatments and appliances.

And when patients get sick here, many just go elsewhere. From July 2017 to June 2018, an average of nine patients per day stayed in the more than 40 beds at Mercy Hospital Fort Scott. And these low occupancy rates are prevalent: Forty-five hospitals in Kansas report an average daily census of less than two patients.

] James Cosgrove, who led a study by the US Government Accountability Office on the closure of rural hospitals, said the nation needed to better understand what the closure meant to the health of people in rural America, where the disease burden – from diabetes to Cancer is often larger than in urban areas.

  Source: countyhealthrankings.org, the collaboration of County Health Rankings & Roadmaps of the Robert Wood Johnson Foundation and the Department of Health of the University of Wisconsin

Source: countyhealthrankings.org, the County Health Rankings & Roadmaps collaboration of the Robert Wood Johnson Foundation and the Population Health Institute of the University of Wisconsin

What happens if a 70-year-old grandfather slips on an icy sidewalk and decides whether to stay home or drive to the nearest emergency room 30 miles away? Where does the sheriff's deputy picking up an injured suspect take his medical clearance charge before he goes to jail? And how is a young mother treated whose child has fallen against the coffee table and now has a gaping head wound?

It also raises the question of how the hospital's business failure affects the city's economy In rural America, Fort Scott's hospital was a major source of well-paid jobs, attracting skilled workers to the community.

GAO plans to finalize a follow-up study on the consequences of closing down rural hospitals later this year. "We want to know more," said Cosgrove. The original report was requested in 2017 by Sen then. Claire McCaskill, D-Mo., And Rep. Tim Walz, D-Minn., And was replaced by Senator Gary Peters, D-Mich. Picked up.

At Fort Scott, the answers to these questions are painfully real-time. In late December, the Mercy system closed Fort Scott's hospital, but decided to keep the building open to lease parts for housing a building emergency room, ambulance, and other services. Mercy Fort Scott has joined a growing list of more than 100 rural hospitals that have closed nationwide since 2010, according to the University of North Carolina's Cecil G. Sheps Center for Health Services Research. How the city gets on is a window into what comes next.

"We were naive"

Over time, the Mercy Hospital in Fort Scott became so much a part of the community that parents could rely on. The hospital ambulance stood by Guard the high school football matches on Friday night.

The hospital appeared to be everywhere and actively promoted community health initiatives by working with the school district to reduce child obesity rates, as well as with local employers on diabetes prevention and healthy eating programs – earned, but often no financial resources for the hospital.

"You can not assume that your hospital is as committed to your community as you are," said Dave Martin, manager of Fort Scott City. "We were naive."

The Mercy Hospital at Fort Scott, Kan., Blew in December in honor of former President George H.W. Bush, who died on November 30th.

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Mercy Hospital at Fort Scott, Kan., Blew in December in honor of former President George H.W. Bush, who died on November 30th.

Christopher Smith for Kaiser Health News

When Mercy decided to build a new hospital in 2002, residents raised $ 1 million for the construction. Another $ 1 million was donated by the residents to the hospital's hospital fund upgrade and hospital equipment replacement hospital.

"No one donated to Mercy just because it was Mercy's," said Bill Brittain, a former city and county commissioner. The idea was to build a hospital for Fort Scott, the county seat of Bourbon Country.

Today, however, Mercy is a major health conglomerate with more than 40 acute and specialty hospitals and 900 medical practices and outpatient facilities. Fort Scott's hospital is the second hospital in Kansas that Mercy has closed.

The steady decline in patient numbers, rising expenses and inadequate hospital reimbursement have "created an untenable situation for the ministry," said Tom Mathews, Mercy's vice president of finance in southwest Missouri and Kansas.

Visitors to the Mercy Hospital at Fort Scott passed a tall white cross as they descended a winding driveway before arriving at the front door. Sisters of Mercy Nuns founded the hospital in 1886 and the newest building, built in 2002, honors this Roman Catholic faith.

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But Fort Scott is a place that needs medical care: every fourth child in Bourbon County lives in poverty. Here, people die much younger than in the rest of the state. According to the Kansas Health Institute and the Robert Wood Johnson Foundation, birth rates for adolescent teens, adult smoking, unemployment and violent crime in Bourbon County are above the national average.

Ten percent of Bourbon County's more than 14,000 residents, approximately half of whom live in Fort Scott, are not covered by health insurance. Kansas is one of 14 states that did not extend Medicaid under the Affordable Care Act, and while many factors are contributing to the closure of rural hospitals, the GAO report found that states that have expanded Medicaid have fewer.

The GAO report also noted that rural residents generally have lower household incomes than their counterparts in larger cities and are more likely to suffer from chronic conditions such as high blood pressure, diabetes, or obesity, which affect their daily activities.

The premature birth rate of the district is also higher than the nationwide 9.9%, a figure Dr. Ing. Katrina Burke, a local family doctor who also gives birth to babies, is worried. "Some of my patients do not have a car," she said, "or they have a car, and their husband or friend works in the car." Dr. Gianfranco Pezzino, Senior Fellow at the Kansas Health Institute, said: "Although the health needs are high, it's not clear how you pay for them."

The & # 39; very baffling & # 39; development of health care

Reta Baker described the farm she grew up south of the city as "a little bit of space in the street." She applied to the Mercy School of Nursing in 1974 , left her after her marriage and returned to take up a position as a nurse in the hospital in 1981. She has been "here since," 37 years – the last decade as a hospital president.

It was "very amazing" to see herself Baker said: "Patients stayed in the hospital for weeks after the operation and said," They come in and have their gallbladder out and go the same day Home. "

This changed the payment and reimbursement practices of government agencies and health insurers, as well as the evaluation of procedures rather than the time spent in hospital. According to the GAO report, rural hospitals across the country are struggling with this formula.

Dr. Katrina Burke inspected Randall Phillips during an examination at Mercy Hospital, Fort Scott, Kan., In December. "Up in the city, many doctors do not do everything the way we do," Burke said about the variety of patients she sees as a family doctor who also gives birth to babies.

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Dr. Katrina Burke inspected Randall Phillips during an examination at Mercy Hospital, Fort Scott, Kan., In December. "Up in the city, many doctors do not do everything the way we do," Burke said about the variety of patients she sees as a family doctor and who also gives birth to babies.

Christopher Smith for Kaiser Health News

The Federal Government acknowledged the challenge and set up some programs to ensure survival for hospitals serving poorer populations. Through a program called 340B, some hospitals are getting discounted prices on expensive medicines.

Rural hospitals that qualified as "critical" due to their remote location received higher payments for some longer stays. Around 3,000 hospitals nationwide receive "disproportionate participation payments" to account for the fact that their patients are generally poorly insured or uninsured.

Fort Scott participated in the 340B Discount Drug Program and disproportionate share payments. But though Baker tried, he could not gain critical access status.

When Medicare's reimbursement dropped by 2% due to seizure under the 2011 Budget Control Act, this proved traumatic as the federal insurer was a major source of revenue and the best payer for many rural hospitals.

In 2013, when the federal government began sanctioning most hospitals for returning to many patients within 30 days, hospitals like Fort Scott lost thousands of dollars in one year. It contributed to Fort Scott's "financial fall," Baker said.

Baker did her best to get things right. In order to reduce the number of rebound shots, patients would receive a call from the doctor's office within 72 hours of their hospitalization to schedule a consultation within two weeks. "We worked very, very hard," Baker said. Five years ago, the number of patients returning to Fort Scott's hospital was 21%. In 2018 it was 5.5%.

Meanwhile, patients also chose Ascension Via Christi in Pittsburg, Kan. Because they offered cardiology and orthopedic services, Baker said. Patients also frequently drove 90 miles north to the Kansas City area for specialty treatment and the Children's Hospital.

An empty operating room in the closed Fort Scott Hospital of Mercy.

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An empty operating room at Mercy's closed Fort Scott Hospital.

Christopher Smith for Kaiser Health News

"Anyone undergoing major surgery, an intestinal resection, or a mastectomy wants to go where people do it all the time," Baker said. Mercy's Fort Scott Hospital had no cardiologists and only two surgeons performing less complicated procedures such as repairing a hernia or removing an appendage.

Last year, only 13% of people in Bourbon County and surrounding areas opted for a hospitalization stay at Fort Scott, according to the industry, which were shared by Baker.

One weekend in December, there were no patients in hospital beds, Baker said. "I look at the report every day," she said. "It jumps between zero and seven." The hospital employed 500 to 600 people a decade ago, but when the closure was announced, fewer than 300 were left.

This logic – and the financial need – for the closure did not accord with the residents, and the executives of Mercy knew it. They knew they would close Fort Scott in June, but waited until October to tell the staff and the city. City Manager Martin responded by quickly putting together a health task force on the day of the announcement in October, insisting that sending the right message about the closure was "crucial."

Fort Scott, Kan., City Manager Dave Martin stands in the middle of the city's historic main street. "We really thought we had a relationship," says Martin, who is angry at Mercy's decision to close the hospital.

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Fort Scott, Kan., City Manager Dave Martin stands in the middle of the city's historic main street. "We really thought we had a relationship," says Martin, annoyed at Mercy's decision to close the hospital.

Christopher Smith for Kaiser Health News

Relations between Mercy and the city became so strained that civil servants needed lawyers just to talk to Mercy. Overall, Fort Scott had spent more than $ 7,500 by the end of 2018, according to the city, for legal fees for the Mercy Closure Project.

Will Fort Scott perish without mercy?

When Darlene Doherty graduated from Fort Scott High School in 1962, there were two things to do in the city: "Work at Mercy or work at Western Insurance." The insurance company was sold in the 1980s, and the employer disappeared along with nearly a thousand jobs.

Despite the community's slow population decline, Martin and other community leaders have kept Fort Scott alive. There's the new Smallville CrossFit studio that Martin visits; a new microbrewery; two new gas stations; a Sleep Inn Hotel, a center for assisted living; and a Dairy Queen franchise. And the McDonald's, which opened in 2012, has just completed the renovation.

Peerless Architectural Windows and Doors, the city's largest employer, which has around 400 jobs, has bought another 25 acres and plans to expand. There are state funds pledged to develop local highways, and Fort Scott has applied for government grants to upgrade its airport.

Baker and some of the doctors at Mercy hospital staff have been trying to ensure the survival of basic health services.

Baker found buyers for the hospital hospice, home health services, and primary care clinics so they could continue to operate.

Burke, the family doctor, was a member of the Community Health Center in southeastern Kansas, a Nationwide Qualified Nonprofit Association that takes care of four health clinics run by Mercy Fort Scott. She has to deliver babies in Pittsburg, almost 30 miles (48 km) away, on a mostly two-lane highway that is under construction to widen them.

Unused hospital equipment is stored for shipment to other hospitals in the Mercy healthcare system.

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Unused hospital equipment is kept for shipment to other hospitals in Mercy's healthcare system.

Christopher Smith for Kaiser Health News

Burke said that her practice is full and she wants her patients to be cared for: "If we do not, who will do it?" County and city.

And last but not least, Baker negotiated a two-year contract with the Ascension Via Christi Hospital in Pittsburg for the operation of Fort Scott Hospital's emergency room, which was closed for two weeks in February, reopening under new management.

But Baker knows that this, too, can only be a patch. If no buyer is found, the facility will be closed until 2021.

Kaiser Health News is a non-profit news service that deals with health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.


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