Its hospital gone, one town asks what's next

'People are sad. People are shocked.'

Residents of one Kansas town have been fighting to save their hospital—but they just lost.

Over the weekend, Mercy Hospital Independence closed, and residents are wondering what it means for the future of their community, Mitch Smith and Abby Goodnough report for the New York Times.

According to University of North Carolina researchers, Mercy is the 58th rural hospital to close since 2010. And the trend has only accelerated in recent years, with more midsize than critical access hospitals closing their doors.

Rural hospitals like Mercy are facing the perfect storm: rural populations are falling; their patients are getting older and sicker; regulatory expenses are increasing; and reimbursement rates are declining.

WSJ: Rural hospitals under more pressure than ever

The residents of Independence still have two hospitals within a 30 minutes' drive, but some worry it won't be the same as having one around the corner. Mercy Health System, which owned Mercy Independence, says another health system has tentatively agreed to open an urgent care center to provide outpatients services, but it won't have an ED or inpatient services.

Mercy's ED handled about 8,000 cases a year, about 250 of which were medical emergencies, officials say.

Some doubt that all hospital closures hurt patients' health. A study recently published in Health Affairs found hospital closures had no effect on local hospitalization and mortality rates.

Ashish Jha, a health policy professor at Harvard University and co-author of the study, says traveling further to another hospital was "an inconvenience" but didn't seem to affect outcomes, "even for really time-sensitive conditions."

Role in the community

But for the residents of Independence, Mercy was more than a hospital that provided medical care—it was a hub of the community that provided jobs and economic stability. Micky Webb, the city manager, says companies that consider moving to Independence like to know if there is a hospital in town. Some residents even say that with the hospital gone, older relatives are rethinking their plans to move to the city.

The hospital had been in the town since 1910, and for some the closing is a personal loss. "My children's children will not be born in Mercy—like I was, like my kids were," says state Sen. Jeff King (R). "That is a new fact of life that we are addressing in the best way we can."

"People are sad. People are shocked," says Annrené Brau, a former hospital administrator. "No one thought we would ever come to this."

Reversing the trend

King and other lawmakers hope to push through some form of Medicaid expansion in the state to help other hospitals like Mercy stay viable, although Gov. Sam Brownback (R) has been staunchly opposed to the idea.

Officials say expanding Medicaid would have infused Mercy with $1.6 million more revenue annually, although Mercy officials say the hospital's long-term survival was about more than Medicaid expansion.

Maggie Elehwany, the National Rural Health Association's chief lobbyist, agrees that saving rural hospitals is about more than just expanding Medicaid. "If it were just one silver bullet, it would have been easier to attack it legislatively and figure it out," she explains. "It's really death by a thousand different knives" (Smith/Goodnough, New York Times, 10/8).

Schuylkill Health: Bouncing back from the brink of closure

With only 17 days cash on hand, this community hospital was nearing insolvency; but by quickly implementing margin improvement strategies, and improving the surrounding culture, they are now on the path to success.

GET THE STORY

On the Weekly Briefing: What happens when hospitals fail?

Listen to the new episode of the Weekly Briefing, as Dan Diamond, Rivka Friedman, and Rob Lazerow debate why some U.S. hospitals like Mercy are shuttering—and whether others are getting "too big to fail."

And subscribe to the Weekly Briefing on iTunes so you'll immediately get a brand-new episode every week. Subscribers are calling it "fascinating and fun," and "disturbingly good." According to one well-known health care expect, "it's excellent. I get smarter listening to it."



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