Researchers say regional approach, partnerships key to developing healthcare alternatives for communities.
Texas communities facing a rural hospital closure should not solely concentrate on whether or not to close a hospital, but instead focus on the available health resources in the surrounding area. That’s one of the findings of a new report by the Texas A&M Rural and Community Health Institute (RCHI) that examined rural hospital closures and looks at new solutions for rural healthcare concerns. The Episcopal Health Foundation (EHF) sponsored the report.

The report found that options like expanding telemedicine, converting a former hospital into a freestanding emergency room, or establishing new rural health clinics are some of the many successful healthcare alternatives available to communities at risk of losing a traditional rural hospital. “We still have an American concept that every town should have a hospital,” said Nancy Dickey, MD, RCHI’s executive director, president emeritus of the Texas A&M Health Science Center and co–author of the report. “But the growing reality is that it’s not cost effective. The good news is there’s a menu of alternatives that can help optimize healthcare for a rural community, not shut down healthcare in that community.”

Rural Texans are more likely to be uninsured, have lower incomes, and higher rates of death from heart disease and stroke.

Researchers found the health gap between urban and rural areas is widening and the number of physicians working in rural areas continues to fall. They point to statistics showing that 158 counties in Texas (with a combined population of 1.9 million) do not have a general surgeon and 147 counties (1.8 million people) don’t have an obstetrician/gynecologist. In 35 Texas counties, there is no physician at all.

The report also found that since 2010, more than 15 percent of the rural hospitals that have closed across the U.S. are in Texas.

“Policy makers, elected officials and communities themselves need to better understand the health challenges facing rural areas,” said Elena Marks, EHF’s president and CEO. “This report shows that the question to ask isn’t only whether to close or not close a rural hospital. It stresses the importance of regional partnerships and collaborations that can help develop a system of accessible health services that meet the unique needs of each community.”

In the report, researchers examined rural hospital closures across the country and interviewed former leaders of shuttered hospitals. While the report found that most rural hospitals in Texas closed due to financial difficulties and lack of patient volume, it also found that there are often available healthcare delivery resources within a radius of 20 to 30 miles from the closed facility.

“It’s not about miles, it’s about minutes,” Dickey said. “We need to have a policy discussion at the state and national level to determine what is an acceptable timeframe to reach care. Geography confirms that every community is a little different.”

Researchers suggest communities facing a hospital closure first ask community members where they currently go for healthcare services. Then, leaders can use that information to create a tool to help at–risk hospitals search for alternatives and develop area partnerships that create an inventory of resources without duplicating care.

“There are opportunities for these communities to reframe the health conversation and go beyond ‘Why are they closing my hospital?’” Dickey said. “There are a variety of solutions and if large hospital systems and rural hospitals can work together, they can find patient–centered answers for at–risk communities.”