CLEVELAND, Ohio - Rural hospitals across Ohio face a crisis in care and funding. Many feared that proposed cuts to health care funding in Washington would have pushed them to cut vital services, or go out of business entirely. But even with repeal and replace seemingly out of the equation, they still worry about their future in an increasingly difficult industry.
"The underlying problem is still there. It's just the fix they were working on didn't address the underlying problem and made things worse," said Alan Morgan, CEO of National Rural Health Association (NRHA). "Hopefully, the debate has shifted off of cutting Medicaid to how do we make the system better."
Forty-one percent of all rural hospitals in the nation, including 13 Ohio facilities, operate at a loss. Expensive services like obstetrics are among the first to be cut. Already, some women in Ohio must drive more than 100 miles to deliver their babies.
Union Hospital in Dover, for instance, cut 30 jobs last year, saving $3 million. It had been economizing for years. But that wasn't enough. In May, the hospital entered into an agreement with the Cleveland Clinic, announcing plans to become part of the Clinic's healthcare system by 2018.
"You're constantly challenged with finding ways to be more and more cost effective. Eventually, you start running into negative margins," said Bruce James, president and CEO of Union Hospital. "We wanted an organization that would help build up rural healthcare."
Nationally, 80 rural hospitals have closed since 2010, according to The Chartis Center for Rural Health. Another 273 are at risk.
Unless something changes for the better, the country is on pace to lose a quarter of its rural hospitals in the next decade, Morgan said. And that means rural residents, who statistically are older and sicker, could see even greater barriers to healthcare access.
"It is a tough time for rural hospitals out there right now. We are in the middle of a rural healthcare closure crisis," Morgan said.
The American Hospital Association estimates hospitals receive 90 cents per dollar spent on Medicaid and 88 cents per dollar of Medicare. Hospitals with greater shares of Medicaid and Medicare patients have to find ways to make up the difference, despite rising costs of supplies, prescriptions and providing care.
"Somehow, some way, those resources need to be found to support those needs," said Jason Justus, CFO of Pomerene Hospital in Millersburg.
In Ohio, rural hospitals fare a bit better than those in other parts of the country because of the Medicaid expansion under Obamacare that provided insurance to an extra 700,000 people.
That meant they could see primary care doctors instead of using expensive emergency room care. And it meant that when they did need hospitalization, they were covered by Medicaid. Before the Medicaid expansion in Ohio in 2014, Wooster Community Hospital had to write off $400,000 a month in charity care. Today, that number is about $30,000 per month.
While not all of that change can be directly tied to the Medicaid expansion, a significant portion of the drop in unreimbursed charity care was, according to Scott Boyes, Wooster's chief financial officer.