What to do about Tennessee’s rural hospital closure crisis | Opinion

Barbara Clinton and Randall Rice
Guest Columnists
  • Barbara Clinton and Randall Rice are members of the Tennessee Health Care Campaign board.

Correction: Starr Regional Medical Center-Etowah is open. This guest column originally incorrectly listed it among rural hospital closures in Tennessee. The authors relied on a Becker’s Hospital CFO report that was released in 2018.

Tennessee has fewer than 60 rural hospitals left, and we’ll lose another one in Celina next month.

There are no doctors in the emergency room at Lauderdale Community Hospital; they weren’t being paid.

In 2014, hospitals closed in Humboldt, Trenton and Brownsville. The next year, we lost Methodist Fayette in Somerville, Parkridge West in Jasper and United Regional in Manchester. 

Losses in 2016 included McNairy in Selmer. Copper Basin Medical Center in Copperhill closed in 2017 and last year McKenzie Regional closed along with Physicians Regional in Knoxville and Lakeway Regional in Morristown. 

Others are hanging by a thread, as is the health of thousands of Tennesseans facing life-threatening situations simply because of where they live. 

More:The hospital is dead. Welcome to Ducktown

The state has let citizens down

Mayor of Ducktown Mayor Doug Collins stands in the doorway of a room wehre hosptial beds have been stored inside town's shuttered hospital in Ducktown, Tennessee on Dec. 5, 2018. Copper Basin Medical Center closed 15 months ago due to mounting debt.

When hospitals close, businesses suffer and job creation slows or stops. The 34 employees at Hancock County hospital earned $1.7 million the year before it closed. 

School budgets decline and schools offer fewer courses and teams. Restaurants close.  Realtors notice that their customers want houses near health facilities. 

Based on the Tennessee Health Care Campaign’s listening sessions in counties with closed or threatened hospitals, Tennesseans are beginning to suspect that state government has let them down.

They say that hospitals are closing because the legislature refused to expand TennCare, so fewer Tennesseans have health insurance.  Rural people see the effect first because they are older and sicker. 

They’ve heard about a Medicare billing scheme that’s hit Tennessee and other states, allowing larger reimbursements for lab tests billed from a rural county, no matter where the testing was done. Billing companies purchase rural hospitals not to run them, but so they can bill from a rural facility.  The building deteriorates, staff and vendors go unpaid, and the hospital eventually closes.

They recognize that the health business model depends on payments from the well insured helping cover the costs of the less well insured. But this model breaks down in rural counties where there are high proportions of uninsured or poorly insured people.

Tennessee leaders need to step up for rural residents

Rhonda Kisselburg, 51, comforts her granddaughter, Makayla, 9, who was not feeling well. Kisselburg's husband, Kent Kisselburg, 47, sells fruits and vegetables at a his stand in Ducktown on Dec. 4, 2018.

Tennesseans don’t expect state government to build a shiny new hospital in every county. But they expect the kind of serious problem solving they’ve heard about in other states, where expanding Medicaid is being reconsidered, where the bipartisan "Save Rural Hospitals Act" that provides financial and regulatory relief to rural hospitals is being supported, and where creative ideas like small stabilization units, where rural patients can be cared for while awaiting transport to urban hospitals, are being explored. 

Gov. Bill Lee vowed to protect Tennessee’s rural areas. It’s time to step it up, before more facilities shut down. Find a way to accept federal help to expand Medicaid. 

Then shake loose the money needed so rural Tennesseans who’ve had strokes, heart attacks and serious accidents can be cared for while waiting for the ambulance. 

Get serious about the billing scams and Medicare fraud that appear to be killing hospitals and people. And advocate for realistic oversight of rural hospitals given their smaller staffs and caseloads.

Barbara Clinton and Randall Rice are members of the Tennessee Health Care Campaign board. Rice is an advocate for healthcare access issues and is a retired Grand Lodge Representative for the International Association of Machinists and Aerospace Workers. Clinton serves on several non-profit boards and is the former director of Vanderbilt's Center for Health Services.