Rural Hospital Woes

Steps being taken to remain viable in small towns

By Becky Gillette


Rural hospitals are on life support. They are struggling with declining government reimbursement rates, too many uninsured patients, and increasing costs for providing care and for regulatory compliance. “It is a terrible time for rural hospitals and it is getting progressively worse,” says  Mendal Kemp, director of the Mississippi Hospital Association Center for Rural Health. “What is going to happen is we are going to have to rethink our current system. There are all kinds of pressures on hospitals these days, and it seems to be increasing every day. These small rural hospitals with 50-100 beds or less, it is very difficult for them to make it by themselves. About half of them have already partnered up to share resources with a larger hospital. That is trend not just in Mississippi, but nationwide.” Other strategies include diversification of services providing primary care and outpatient surgery services. A major drain on hospitals is patients who go to the emergency room for primary care rather than a true emergency. Primary care clinics provide healthcare at much lower cost. Some Delta hospitals are helping their viability by being involved in a “swing bed” program where patients can stay in the same hospital while transitioning from acute to long-term care. “A lot of people get through the acute stage, are not ready to go home, but don’t want to go to a nursing home,” Kemp says. “So this swing bed program really meets that need. They stay 20 to 30 days and then are usually ready to go home.” Telemedicine is also important for rural hospitals. Some rural Delta hospitals have emergency rooms staffed by nurse practitioners who are connected to emergency doctors at the University of Mississippi Medical Center.  “It has upgraded the emergency room care tremendously,” Kemp says. “For example, they have a telestroke program that saves lives. We are in the stroke belt. There is a drug that can get rid of blood clots quickly, but it has to be administered within two to three hours of the stroke. It is really exciting to see this kind of technology improving care. Then the patient stays at that hospital near their home instead of being shipped off to Jackson. It is win-win for everybody, especially the patient.” Rendering the right care at the right time in the right place is a challenge.  “Despite scarce resources, rural hospitals are meeting this challenge improving the health of rural citizens,” he says.  One Delta hospital doing a good job adapting to the current environment, Kemp says, is the Tallahatchie General Hospital in Charleston. Administrator Jim Blackwood says it isn’t any one thing alone, but a number of strategies that fit together. “For us, revitalization started with a renewed emphasis on customer satisfaction and personal attention to our patients,” Blackwood says. “Then we were able to do some things to update our facilities for a new direction that emphasized what critical access hospitals are intended to do: primary health care. Doing swing bed is a niche area for us. We were able to posture ourselves to be able to offer this by doing things like revamping to provide physical therapy, occupation therapy and speech therapy seven days a week.” Tallahatchie General is also being proactive putting in infrastructure to improve public health by building a new, 20,000-square-foot wellness center. “It is much cheaper to treat diseases on a preventative basis,” Blackwood says. “We are trying to prevent the train wreck that these diseases cause later on. We want to help Tallahatchie County develop a culture of wellness to put a dent in chronic illnesses like diabetes and heart disease.”