Texas rural hospitals facing closures want a piece of the $50B in federal funding up for grabs

States will receive funding based on applications they submit in early November.

As Texas develops its application for a new rural health funding program, rural hospital leaders say the priority should be financial stabilization for their facilities.

The recent sweeping tax and spending plan includes a $50 billion appropriation for the Rural Health Transformation program. States will receive funding based on applications they submit in early November.

During an hours-long public hearing Monday to discuss the program, several hospital leaders raised concerns that without direct funding, the state may experience more rural hospital closures.

Erin Clevenger, CEO of Memorial Medical Center in Port Lavaca, southeast of Victoria, said her hospital is high on the list of Texas hospitals at risk of closure.

“Every day is a battle to make sure we don’t become one of those statistics,” Clevenger said.

In the last decade, Texas has lost 14 rural hospitals. Of the 156 rural hospitals currently in the state, about 70% have lost services, and more than half are at risk of closing, according to a report from the Center for Healthcare Quality and Payment Reform.

Memorial Medical Center is in the southern part of the state, but it provides critical services that benefit people across Texas – even patients in Dallas.

“When even large urban hospitals could not take on more patients, we opened a COVID care unit and accepted their transfers, even flying patients in from Houston and Dallas,” Clevenger said.

Memorial Medical Center is a critical access hospital – a designation that rural hospitals can receive to reduce the financial vulnerability and keep essential services in rural communities. In order to receive the designation, Memorial Medical Center had to be more than 35 miles away from another hospital.

The Rural Health Transformation Program is meant to focus on transformation and innovation, but Clevenger said the best way to support rural hospitals is through direct financial support for the first few years of the program.

“Without it, all the planning in the world will not matter because there will be no hospital left to transform,” she said.

Rural hospitals face challenges that can be harder to address than in urban areas, including lack of access to transportation, internet and broadband.

Jon Gill, CEO of Pampa Regional Medical Center in the panhandle, said Texas has made efforts to support rural health care, how those investments are made can lead to them being less effective.

A large academic hospital in the panhandle received $1 million to provide maternal care in Pampa, but Gill said the organization didn’t engage the local hospital to see what it was doing with maternal care.

“During this time, it was discovered that they weren’t going to be able to provide the care unless it was something along the lines of cancer care for maternal care,” Gill said. “That would affect maybe one patient every three months where we didn’t have basic maternal care being provided in this area.”

Gill said rural hospitals involve and benefit from academic and larger hospital systems, but if rural hospitals aren’t present and supported the community won’t continue to receive care.

Leaders of larger health systems advocated for the state to invest in telehealth programs or further research and data collection, but rural hospital leaders raised concerns about if those programs would be accessible.

Kurt Sunderman is CEO of Rice Medical Center, a 25-bed critical access hospital in Eagle Lake, west of Houston. He said many larger health systems don’t work with rural hospitals because “they don’t have to,” which can push rural hospitals out.

“Programs like Telestroke and other telehealth services for major systems have become so unaffordable that they price rural hospitals out of participation altogether,” he said. “Rural hospitals know what we need. We know how to stretch a dollar and when funds are put in our hands. They are spent conservatively and on the most critical needs of our patients.”

Sunderman said rural hospitals are able to collaborate and innovate with rural providers, hospitals and patients in mind.

The Texas Organization of Rural and Community Hospitals, or TORCH, has its own telehealth program, which Rice Medical Center participates in. Sunderman said while rural hospitals can effectively work together to directly address concerns, when distributing funding, it doesn’t end up going to rural hospitals.

“Instead, urban, suburban, and university systems capture those dollars, and much of that funding disappears into overhead research or projects that never touch a rural patient,” Sunderman said.

The federal funding is significant for rural communities. Other policy changes in the tax and spending plan — including cuts to Medicaid, Medicare and Affordable Care Act coverage – are expected to significantly increase the uninsured rate both in the state and nationally.

Sunderman said if larger systems receive access to funding from the Rural Health Transformation program, the state needs to implement long-term cost controls and accountability measures.

“We’re not asking for special treatment,” Sunderman said, “only for the resources originally intended for rural transformation.”

Source: Abigail Ruhman, KERA News

Photo Credit: A surgical suite in Eastland on March 10, 2019. Gary Rhodes for The Texas Tribune

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