At 11:59 p.m. on July 31, Haywood Park Community Hospital will cease inpatient admissions and emergency services. At the stroke of midnight, the Brownsville, Tenn. hospital will become an urgent care clinic, leaving the county’s rural residents to drive close to 30 minutes to hospitals in Covington, Ripley or Jackson.
According to a release from the hospital, operated by Community Health Systems, inpatient admissions had dropped from 1,300 in 2009 to less than 250 in 2013. Additionally, the Emergency Room had also seen a sharp decline with 15 or fewer patients per day over the past several months. The release went on to cite changes in guidelines for inpatient admissions and federal reimbursement cuts under the Affordable Care Act that have not been offset by Medicaid expansion in Tennessee as contributing factors to the hospital’s demise. In light of the new reality, Haywood Park CEO Joel Southern said maintaining a full-service hospital was simply not sustainable.
Although the latest to make a news splash, Haywood Park isn’t the only hospital that has closed in Tennessee or been reassigned as an outpatient clinic in recent months. Craig Becker, president of the Tennessee Hospital Association, noted Scott County in East Tennessee has only recently reopened (and without obstetric care) after being shuttered for several months and two others have closed in West Tennessee. Both Humboldt General Hospital and Gibson General Hospital both closed earlier this year, and yet another hospital in Upper East Tennessee is currently on life support.
A common theme among the recently departed inpatient facilities and the more than 50 others that have been deemed ‘in danger of closing’ is their rural location. “These rural areas are the most vulnerable,” Becker said, adding it was hard to envision how to adequately service these communities without hospitals.
Joellen Edwards, PhD, RN, FAAN, president of the Rural Health Association of Tennessee (RHAT), concurred, noting hospital closures have a ripple effect. “You lose your prenatal care. You lose your primary care because they just can’t make it when the hospital closes.”
Edwards, whose research focuses on rural populations, is a professor and associate dean at East Tennessee State University’s College of Nursing. Looking at a number of the threatened hospitals in the state, she said, “Some of these are critical access hospitals, which means there is not another hospital for a minimum of 30 miles – or it could be even further away ... and probably is.”
She continued, “In East Tennessee, if you live in our mountains, 30 miles is not an easy drive. Not having a hospital available in minutes … rather than an hour or more away … makes a difference literally to life and death.”
In addition to losing access to care, Becker said the economic impact of losing a hospital is a topic that has been glossed over. “These are often some of the best paying jobs in these communities,” he said.
Edwards pointed out hospitals are frequently the economic driver in rural towns and are sometimes one of the few jobs in the county that come with health benefits. Losing those jobs only exacerbates the problem of uninsured and under-insured rural populations.
“I can guarantee you Brownsville is hurting right now because of losing those jobs,” Becker said. He added CHS couldn’t be blamed for their decision to cease emergency and inpatient services … it’s simply an economic reality. “It certainly isn’t that the community doesn’t deserve to have a hospital. The reality is now you can’t afford to have one.”
Even in communities that don’t close hospitals, Becker said he anticipated seeing service lines that are not typically profitable … such as oncology and obstetrics … dropped. “Cutting services isn’t much of a strategy, but we’re going to see a lot of that,” he surmised.
He added lawmakers have, at times, accused the THA of ‘crying wolf’ as the association leaders have discussed the imminent danger to numerous hospitals in the state. “This is the kind of thing we’ve been predicting,” Becker said of the recent closures, adding he wasn’t happy to be proven right.
The current closures, however, are feared to be the tip of the iceberg. Fueling the concern is that the federal funding cuts, such as DSH payments, are back loaded. Becker said Tennessee hospitals face $1 billion in cuts in the year 2019 alone. “Even with (Medicaid) expansion, it’s going to be difficult,” he said of the financial stressors hospitals face. “But without expansion, we’ll lose even more hospitals and definitely see more services cut.”
He added, “One-third of the hospitals in the state are losing money. I see other hospitals on the border … on the brink.”
The Tennessee Plan proposed by Gov. Bill Haslam as an alternative to the Medicaid expansion program rolled out by the federal government, which has been accepted by 26 states plus the District of Columbia so far, is still stalled … although not yet dead. During the 108th General Assembly, however, state lawmakers added another hurdle to getting funding to Tennessee hospitals by passing a bill requiring Haslam to obtain legislative approval before accepting any expansion dollars.
Becker, who called himself an eternal optimist, said he still believes the Tennessee Plan could pass. Unfortunately, he said it might take having more hospitals close to drive the message home. “Maybe there is going to be some pressure on some of these rural legislators when they realize they are losing part of the social fabric of their communities,” he said.
From RHAT’s standpoint, Edwards said, “We have a stance that uninsured people in Tennessee should have an opportunity to be covered just like in Maryland where they chose to expand Medicaid.”
Although she said the association doesn’t take a political stance as to which expansion plan is implemented, Edwards concluded, “We in the Rural Health Association do want to see a reasonable expansion of services to people in this state … it’s what they deserve.”
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