COLUMBUS (AP) -- Rural hospitals across Ohio face financial straits worse than their urban counterparts as expenses rise and health care reimbursements decline.
A January snapshot by iVantage Health Analytics found hospitals in the state's metropolitan counties were running slightly in the black, while those in non-metro counties -- often the largest employers -- showed narrow losses, The Columbus Dispatch reported Sunday.
Four years ago, struggling hospitals in Washington Court House and Logan closed their maternity units. More recently, hospitals in Chillicothe and Zanesville saw their bond ratings downgraded. Hospital workers in Gallipolis face possible layoffs later this year, while OhioHealth announced this week it will close its inpatient hospital in Nelsonville before 2015.
The hospital's 24-hour emergency department will remain open until the completion of a new outpatient center, which will house urgent-care services.
"I hate to see us lose the 24-hour emergency room. If someone is injured here locally ... it's certainly more convenient to go a mile or two than go 14 or 15 miles to Logan or Athens," Nelsonville city manager Mark Hall told the newspaper. The city's population is about 5,400. "There was a certain amount of pride that a city of our size was able to hang on as long as we did to the facility."
At issue are the unsustainably high costs of the U.S. health care system, which have been coupled by decreased federal government reimbursements.
Brock Slabach, senior vice president of the National Rural Health Association, said the challenges at rural hospitals are in some ways unique because they have trouble recruiting health care professionals while serving a population that's often older and poorer.
"We live on a thinner margin to begin with because we're not bolstered by a larger population of commercial payers," said Scott Cantley, CEO of Memorial Health System in Marietta, which has employed half a dozen consultants to help it become leaner.
Rural hospitals can no longer be all things for all people, their leaders say, as evidenced by the fact that 23 Ohio counties no longer have a hospital that delivers babies.
The federal Affordable Care Act has begun to address the costs of the uninsured and could also cut into charity-care costs, the newspaper reported -- particularly in states such as Ohio that have expanded Medicaid. For many hospitals, including those in rural areas, the Medicaid expansion will help make ends meet in light of other cuts in government health care payments.
But Slabach said private carriers that sell insurance through the act's new government-run marketplaces often limit plan participants to narrow networks of providers that often exclude small hospitals.