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The ACA helped rural hospitals. It did NOT hurt them.
Quote:
Originally Posted by rbohm
so you seem to be blaming trump for these hospitals closing since 2010? did it ever occur to you that the 21,000+ pages of new regulations created by obamacare just might be the cause of this?
Incorrect - the ACA helped rural hospitals.
The causes of rural hospital closings are multiple. What follows are the SIX identified by Kaiser in excerpt form - read the lengthy report for all the details:
Quote:
Key Findings
What factors contribute to rural hospital closures?
Rural areas face challenging demographic, social, and economic pressures. Respondents in all three communities pointed to similar economic and demographic trends that contributed to the closures. They cited high poverty and uninsured rates in rural communities, high rates of Medicare and Medicaid coverage, and declining populations. In each community, poverty rates were higher than state and national averages and median incomes were lower, and the population was shrinking.
Privately insured patients often went elsewhere for care, hurting the local hospital’s revenue base and contributing to perceived low quality of the local hospital. In all three case studies, respondents reported that, prior to the hospital closure, community residents with private insurance or other resources typically travelled to bigger, newer hospital systems outside the community
Rural hospitals built in neighboring communities under Hill-Burton now compete for limited patients, federal dollars, and health care resources. All three case study hospitals were located in close proximity to larger hospitals in nearby communities.
Corporate business decisions, rather than assessments of local needs or planning, drove the hospital closures. In all three sites, the large health systems that owned and managed the hospitals made the decision to close them based not on community needs, but on corporate business considerations that favored other hospitals in their system over the ones they closed.
Changes in Medicare and Medicaid payment over the past few years have had an adverse effect on rural hospitals. Decreases in Medicare reimbursement rates have exacerbated financial pressure on already struggling rural hospitals, especially those with an older patient population. In recent years, Medicare cuts arising from budget sequestration and other federal policies14 have led to lower reimbursement rates overall, while specific provisions of the ACA, such as the Readmissions Reduction Program, under which CMS reduces PPS payments to inpatient hospitals with high readmission rates, have also resulted in lower Medicare reimbursements for many hospitals.15
Rural hospitals have not adapted to new models of payment and service delivery that emphasize preventive and primary care provided in outpatient settings. Increasingly, Medicare, Medicaid, and large private payers are implementing payment and delivery system reforms that move “from volume to value” and shift investment away from inpatient care and toward preventive and primary care and greater access to care in outpatient settings.
The causes of rural hospital closings are multiple. What follows are the SIX identified by Kaiser in excerpt form - read the lengthy report for all the details:The real issues are poverty, demographics, competition, corporate decisions, budget sequestration, and failure to adapt.
Also, states which had not expanded Medicaid under the ACA, were more apt to experience rural hospital closings.
if obamacare did indeed help rural hospitals, then why have they been closing since 2010 when obamacare was signed into law?
Did you read the report in linked OP?
From above article:
"In states expanding Medicaid, rural hospitals saw a greater increase in Medicaid revenue than urban hospitals did. City-based facilities save a higher percentage than rural hospitals with the reduction in uncompensated care, though that change “did not translate into improved operating margins for urban hospitals,” the study notes.
How much these differences matter, though, remains up in the air.
“There is a disparity in the impact of Medicaid expansion, and probably the [law] overall,” said Brystana Kaufman, a doctoral candidate at the university’s department of health policy and management and the study’s first author. “There needs to be more exploration into why we’re seeing this.”
One likely factor: Rural hospitals serve more low-income people — who weren’t eligible for insurance before, but who got covered after the health law took effect. And rural hospitals are historically more likely to operate at a loss than are urban ones. So the chance to see increased revenue is greater than in a city-based hospital."
That being said rural hospitals in general always have had tough times. The fact they are just that; located in rural areas means they do not see the same sort of populations as large urban or even suburban healthcare facilities. Of the population demographics they do see fiscal health is largely dependent upon the wealth (or lack thereof) of the area served. If you are running a small hospital in a dirt poor Podunk, USA town where 90% of local area residents are working poor to indigent you are essentially in the business of providing near 100% charity/uncompensated care.
Best rural hospitals can hope for under such situations is that as much of said local population is covered by Medicaid and or other schemes that will at least allow the hospital to recoup some percentage (even if small) of the bills patients cannot pay.
Rural hospitals have a host of issues including attracting and retaining staff especially doctors and nurses. Local young people often aren't interested in staying and move away. Those from "outside" the area often cannot be lured for love nor money to move to a rural area.
"In states expanding Medicaid, rural hospitals saw a greater increase in Medicaid revenue than urban hospitals did. City-based facilities save a higher percentage than rural hospitals with the reduction in uncompensated care, though that change “did not translate into improved operating margins for urban hospitals,” the study notes.
How much these differences matter, though, remains up in the air.
“There is a disparity in the impact of Medicaid expansion, and probably the [law] overall,” said Brystana Kaufman, a doctoral candidate at the university’s department of health policy and management and the study’s first author. “There needs to be more exploration into why we’re seeing this.”
One likely factor: Rural hospitals serve more low-income people — who weren’t eligible for insurance before, but who got covered after the health law took effect. And rural hospitals are historically more likely to operate at a loss than are urban ones. So the chance to see increased revenue is greater than in a city-based hospital."
That being said rural hospitals in general always have had tough times. The fact they are just that; located in rural areas means they do not see the same sort of populations as large urban or even suburban healthcare facilities. Of the population demographics they do see fiscal health is largely dependent upon the wealth (or lack thereof) of the area served. If you are running a small hospital in a dirt poor Podunk, USA town where 90% of local area residents are working poor to indigent you are essentially in the business of providing near 100% charity/uncompensated care.
Best rural hospitals can hope for under such situations is that as much of said local population is covered by Medicaid and or other schemes that will at least allow the hospital to recoup some percentage (even if small) of the bills patients cannot pay.
Rural hospitals have a host of issues including attracting and retaining staff especially doctors and nurses. Local young people often aren't interested in staying and move away. Those from "outside" the area often cannot be lured for love nor money to move to a rural area.
As more and more hospitals are built in urban cities, it seems like where Trump won in rural America many, many hospitals have closed the doors since 2010.
Since, there is very high Medicaid/Medicare usage in states that voted Trump. I wonder what happens when all these cuts go through.
More rural hospitals are built? Obamacare moved money from the middle class to the poor. If you work in a non-urban area, you were paying for new hospitals and hospital expansions in urban areas while watching your local hospital close.
Obamacare has been a disaster for the middle class.
That's ridiculous. They vote against their self interest to support people who couldn't care less about them because they are depicted in a manner they don't like ?
Are you saying Obama (through Obamacare) punished these rural areas for not voting for him?
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The ACA helped rural hospitals. It did NOT hurt them.
