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2017-08-24

Texas rural hospital closure crisis heats up

By Dave Pearson and Dan McBeath

The Texas rural hospital closure epidemic continues with 2 more rural hospitals locking their doors in the last few weeks. The hospital in Trinity, Texas, ceased operations on Aug. 1, and the hospital in Crockett, Texas, shut down on July 1, leaving those communities without immediate access to emergency and other hospital care.
Dave Pearson, CEO of the Texas Organization of Rural & Community Hospitals (TORCH), says the 2 recent rural hospital closures bring the total number that have closed since January 2013 to 18. According to Pearson “this closure crisis, which has left many rural communities without emergency and other care, has clearly reach epidemic proportions and unless the Texas Legislature and Congress take immediate steps, it will only worsen.”
TORCH, which represents the 163 rural hospitals across Texas, notes that of the 18 hospital closures in the last four and a half years, 4 were temporary lasting only a few months and 3 were replaced with a freestanding emergency or urgent care center. But the care in those towns is now very limited. Eleven (11) communities still have no emergency or hospital care.
Pearson adds “as many as a third of the remaining rural hospitals in Texas are operating on a shoestring and struggle every day to stay open and serve their patients.” He also says “the real tragedy is many of these closures could have been avoided and are primarily the result of Medicare cuts by Congress in recent years totaling more than $50 million a year for Texas rural hospitals, coupled with underpayments in the Texas Medicaid program to rural hospitals approaching $60 million a year.”
TORCH Director of Government Relations Don McBeath states “Congress and the Texas Legislature have apparently not fully realized the magnitude of the crisis despite our efforts to educate them about the situation. They need to take quick and strong action to put the brakes on the closure slide.” He adds “we are leaving more and more rural communities without immediate and reasonable access to emergency care which has resulted in documented deaths because the local hospital was suddenly gone.”
Besides leaving holes in the state’s safety-net of trauma and other care, the closures are having a devastating economic impact on Texas. David Byrom is the CEO of Coryell Hospital in Gatesville and is also the current chairman of the TORCH association board. He points out “these closures are bad for the Texas economy. Rural hospitals cover 85 percent of the state’s geography and serve 15 percent of the population. They help keep healthy the workforce that supplies the state’s and much of the nation’s food, fuel and fiber.” Byrom goes on to say “each Texas rural hospital, on average, employs 173 people and has an annual payroll of $23 million. Statewide, that is more than 22,000 good paying jobs and expenditures of
$3.7 billion year. The combined economic impact of the 163 Texas rural hospitals is more than $18 billion year.”
TORCH CEO Pearson adds “these rural hospitals are an economic driver for rural Texas but the closures can also be a death blow to a rural community. Most of the employees and their families will move elsewhere in pursuit of a hospital job. Local businesses suffer and the rural schools suffer, losing money from the state because of declining students. And, the chances of future economic development are lessened without a local hospital. Most rural communities never recover from a hospital closure.”
McBeath, in his role as the association’s primary contact with state and federal lawmakers, says the downward spiral of Texas rural hospitals can be stopped, but that it will take immediate action from elected lawmakers. “Congress must act very soon to renew some special rural hospital Medicare payment provisions that impact a number of our rural hospitals or their payments will decline even more, causing yet more closures. Plus they need to address the series of cuts they have already inflicted on the rural hospitals over the past five years” says McBeath. “And, the Texas Legislature and the state Medicaid program need to take immediate steps to address the massive underpayments to the hospitals.” In the most recent regular session, the Texas Legislature did direct the Texas Health and Human Services Commission, who manages the Texas Medicaid program, to look into the situation, but, McBeath says “it could be too little, too late. With a two year study window, followed by who knows how much time to react to the findings, we could see dozens more of Texas’ rural hospitals vanish.”
Association board chairman Byrom says of the situation “the citizens of our rural communities fortunate enough to still have a rural hospital need to know this is happening around them and call their elected state and federal representatives and tell them to take action now to stem the tide of Texas’ rural hospital closures. The two closures in the last month, bringing the total to eighteen (18) in the last four and a half years, could be the tip of the iceberg.”