WILLIAMSTON, N.C. \u2014 On a mid-August morning, Christopher Harrison stood in front of the shuttered Martin General Hospital recalling the day a year earlier when he snapped pictures as workers covered the facility\u2019s sign.<\/p>\n
\u201cYes, sir. It was a sad day,\u201d Harrison said of the financial collapse of the small rural hospital, where all four of his children were born.<\/p>\n
Quorum Health operated the 49-bed facility in this rural eastern North Carolina town of about 5,000 residents until it closed. The hospital had been losing money for some time. The county\u2019s population has slightly declined and is aging; it has experienced incremental economic downturns. Like many rural hospitals, those headwinds drove managers to discontinue labor and delivery services and halt intensive care during the past five years.<\/p>\n
Prospects for reopening seemed dim.<\/p>\n
But a new hospital designation by the Centers for Medicare & Medicaid Services that took effect last year offered hope. As of August, hospitals in 32 communities<\/a> around the country have converted to the rural emergency hospital designation<\/a> to prevent closure. The new program provides a federal financial boost for struggling hospitals that keep offering emergency and outpatient services but halt inpatient care.<\/p>\n The REH model \u201cis not designed to replace existing, well-functioning rural hospitals,\u201d said George Pink, a senior research fellow at the University of North Carolina\u2019s Cecil G. Sheps Center for Health Services Research<\/a>, which has documented 149 rural hospitals that have either closed or no longer provide inpatient care since 2010. \u201cIt really is targeted at small rural communities that are at imminent risk of a hospital closing.\u201d<\/p>\n The program hasn\u2019t yet been used to reopen a closed hospital.<\/p>\n With guidance from health consultants, Martin County officials asked federal regulators to explore the possibility of adopting the REH model and were ultimately given the go-ahead.<\/p>\n If successful, Martin County could become one of the first in the nation to convert<\/a> a shuttered hospital to this new model.<\/p>\n Ask members of a community that has lost its hospital what they miss most, Pink said, and it\u2019s almost invariably emergency services. Count Harrison among them, especially after a medical crisis nearly killed him.<\/p>\n Harrison, who lives in a smaller crossroads community a few miles south of Williamston, began experiencing leg pain in February. Under normal circumstances, Harrison said, he would have gone to his primary care doctor if his leg began to hurt. This time he couldn\u2019t, because the practice closed when the hospital folded months earlier.<\/p>\n Then, one morning he awoke to find his foot turning black. It took him 45 minutes to drive to the closest hospital, in the town of Washington. There, doctors found blood clots and he was flown by helicopter to East Carolina University Health Medical Center. A doctor there told him that he\u2019d probably had the blood clots for close to a year and that he was lucky to be alive. The medical team was able to save his foot from amputation.<\/p>\n Harrison, like many other community members, now had firsthand experience with the consequences of a shuttered hospital.<\/p>\n The state legislature\u2019s decision last year to expand Medicaid<\/a> has meant fewer North Carolinians are uninsured, which means fewer hospital bills go unpaid. But health care is evolving: Many procedures that once required inpatient care are now performed as outpatient services. Dawn Carter, the founder and a senior partner of Ascendient, a health care consulting firm working with the county, said the inpatient census at Martin General in its last few years ranged from five or six a day to a dozen.<\/p>\n \u201cSo you\u2019re talking about a lot of cost, a lot of infrastructure to support that,\u201d she said.<\/p>\n With no emergency care within a half-hour radius, Martin County administrators believe a rural emergency hospital would be a good fit and a viable option. REH status allows<\/a> a hospital to collect enhanced Medicare payments, an annual facility payment, and technical assistance.<\/p>\n Carter said the team will present to the state Department of Health and Human Services a set of drawings of the portion of the building they intend to use to see if it meets REH regulations.<\/p>\n \u201cI\u2019m hoping that process is happening in the next several weeks,\u201d she said, \u201cand that will give us a better idea of whether we have a handful of really quick and easy things to do or if it\u2019s going to take a little more effort to reopen.\u201d<\/p>\n Officials then will take proposals from companies interested in running the hospital.<\/p>\n Carter said the expectation is that, initially, the facility will be strictly the emergency room and imaging department, \u201cand then I think the question is, over time, where do you build beyond that?\u201d<\/p>\n And the rebuilding could prove a challenge from the start. Many former staff members have taken positions at nearby health care facilities or left the area. The effects of that exodus will be compounded by the widespread difficulty in recruiting health workers<\/a> to rural areas.<\/p>\n It\u2019s early yet, Pink said, to assess the success of the rural emergency hospital model. \u201cAll we have are armchair anecdotes.\u201d It seems to be working well in some communities, while others \u201care struggling a little to make it work.\u201d<\/p>\n Pink has a list of questions to assess how an emergency hospital is faring in the long run:<\/p>\n Is it at least breaking even? And if not, do administrators foresee a solution?<\/p>\n How is the community responding? If someone believes they have an issue that might require inpatient care, Pink suggested, perhaps they\u2019ll bypass the REH for a hospital that can admit them. And to what extent does bypassing their doors carry over to all services?<\/p>\n Are patients happy with the care they\u2019re receiving? Are the clinical outcomes good?<\/p>\n The rate of rural hospital closures rose through 2020, then dropped considerably in 2021. Congress had passed the CARES Act, and the Provider Relief Fund offered a financial lifeline, Pink said. That money has now been distributed, and the concern is that \u201cmany rural hospitals are returning to pre-covid financial stresses and unprofitability.\u201d<\/p>\n If the trend continues, he said, more rural hospitals may turn to the REH model.<\/p>\n Ben Eisner serves as Martin County\u2019s attorney and interim manager. He acknowledges that the health and well-being of this community require a lot more than a hospital. He cites, for example, a new nonprofit with a mission to address the social determinants of health<\/a>.<\/p>\n Advancing Community Health Together was created in response to the hospital closure. Composed of community members, its focus is addressing inadequate health care access and poor health outcomes as a consequence of generational poverty, said Vickey Manning, director of Martin-Tyrrell-Washington District Health.<\/p>\n \u201cWe can\u2019t address rural health care in a vacuum,\u201d Carter said. Her organization, Ascendient, is part of the Rural Healthcare Initiative<\/a>, a nonprofit commissioned by the North Carolina General Assembly to study sustainable models of health care for rural communities.<\/p>\n Like most of rural eastern North Carolina, Martin County is in transition, Eisner said. Diminishing family farms, less industry. \u201cAnd so the question becomes,\u201d he said, \u201c\u2018What happens for all these communities? What happens next?\u2019 And it\u2019s an answer that is not yet fully written.\u201d<\/p>\n Harrison, still relying on crutches to get around, recently drove 45 minutes north on U.S. 13 to the town of Ahoskie to have a doctor examine his foot. He said a hospital that offers basic emergency care isn\u2019t a perfect solution, but he\u2019ll have some peace of mind once the cover is peeled from that sign and his local hospital reopens.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n