Forward Rabun Gap Analysis: Healthcare

According to the NCSL, nearly 140 rural hospitals closed between 2010 and 2021, primarily due to financial reasons. In 2020, twenty rural hospitals closed, becoming what the University of North Carolina and N.C. Rural Health Research Program has noted as the “worst” year for closures since they began tracking in 2005. To make matters worse, as of January 2021, they reported over 800 rural hospitals across 47 states were in danger of closure, and attributes the COVID-19 pandemic as a factor that worsened the situation due to lost revenue resulting from deferred or canceled services, additional costs for personal protective equipment, and other necessary supplies. 

The NCSL reports state policymakers have options to support these hospitals and safeguard them from closure, including the following:

• Providing grants and funding opportunities to hospitals that are struggling. For example, the state of Georgia’s Rural Hospital Stabilization Grant Program allocates state funding to rural hospitals designated by the legislature each year. This creates a plan for sustainability by using a “hub and spoke” model of care to help relieve financial pressure on such facilities while providing patients with care in appropriate settings.
  
  Stephens County Hospital (SCH) in Toccoa, GA was awarded $300,000 in Phase 5 of the program. The hospital was overwhelmed with non-emergency visits to its Emergency Department (ED) and had previously set up a Community Paramedicine (CP) program to address the issue. Part of this funding was to enhance the services the program provides, which include services such as in-home clinical services such as individualized chronic illness and management education, assistance for home medical equipment and medication, and enhanced information to help patients understand the appropriate use of emergency services.
  
  CP discovered transportation is a major issue for their patients, with this factor often being the reason patients were readmitted to the floor or emergency services were overutilized. SCH and local transportation providers are working toward an agreement to determine how to help transport patients to and from medical appointments, pharmacies, and other related services. 
  
  Funding from the grant was also designated for addressing patient behavioral health needs, as the hospital often sees as many as 4 to 6 patients per day needing behavioral health care in the ED. The funding was used to ensure the seclusion room in the ED met required patient care and safety standards, as well as form an agreement with Coastal Harbor, which assesses involuntarily admitted behavioral health patients via telemedicine and improves the timing of placement as well as assists with patient transportation to reduce extended hold times.
  
  Another portion of the funding was designated to improve patient satisfaction. SCH teamed up with Survey Solutions with the goal of surveying ED patients in real-time and addressing their needs in order to be more present and involved as the ED is often viewed as the front door of the hospital. 
  
  
• Adopt Medicaid expansion to not only help keep rural hospitals “financially solvent.”
   
• Consider alternative payment models. For instance, the Pennsylvania Rural Health Model transitioned participating facilities from fee-for-service to global budget payments where participating payers provide the facilities with a fixed payment to cover all inpatient and hospital-based outpatient services. The program began in 2019 with five rural hospitals and five payers participating in the first performance year. In January 2020, eight more hospitals joined along with Aetna as a new commercial payer. Five hospitals joined in 2021, bringing the total to eighteen participating rural hospitals and six payers. The program’s 2020 annual report revealed over 848,000 lives were impacted by this model, which also provided 11,000 jobs.