File photo Rush Foundation Hospital in Meridian 

A national report states that one in five hospitals nationwide is at “high risk of closing,” naming Rush Foundation Hospital in Meridian and Laird Hospital in Union as two at-risk hospitals in Mississippi.

Navigant, a consulting firm, conducted a study of more than 2,000 hospitals, comparing their financial viability to recently closed hospitals in search of red flags.

Alabama and Mississippi ranked first and second, respectively, for percentage of rural hospitals at high financial risk, analyzing each hospital’s profits, debt and days of cash on hand.

In both states, roughly half of rural hospitals fell under high financial risk with 21 hospitals in Alabama and 31 hospitals in Mississippi.

Rush Health Systems, which oversees both Rush Foundation Hospital and Laird Hospital, declined an interview with The Meridian Star, releasing instead a statement from Larkin Kennedy, the president and CEO of the company.

“We do not believe the Navigant report is complete in its analysis. All Mississippi hospitals have been negatively impacted due to the recent Medicare and Medicaid reimbursement cuts. Rush Health Systems has been providing quality care to our patients in East Mississippi and West Alabama since 1915, and we look forward to continuing this tradition in the future,” Kennedy said in the statement.

Dave Mosley, who co-authored the study with Daniel DeBehnke, said they studied recently closed hospitals for clues of financial risk, evaluating hospitals still open for that same risk.

“We’re just saying, ‘Hey, if you’re the county (hospital) commissioner or a hospital board member look at the hospital in your community and do a double check.’ If you’re a legislator, for goodness sakes, let’s not have you be surprised that all the sudden your hospital has triggered bond covenants or is set to close,” Mosley said. “Let’s be proactive to the degree possible so that we can thwart the negative consequences that are not just negative for the hospitals but they’re negative for the communities that they serve.”

The report calls for legislative action, such as the bipartisan Rural Emergency Acute Care Hospital (REACH) Act that would allow hospitals to resize and stabilize as a “Rural Emergency Hospital” without needing to maintain excess inpatient beds and shifting that focus to transporting patients to larger hospitals.

“While rural hospital struggles have been documented for years, our analysis shines a new light on a crisis that must be addressed,” the report states. “Local, state and federal politicians, as well as health system administrators, need to act.”

Another recommendation from the report suggests that smaller hospitals partner with academic health systems to reduce costs and promote telehealth.

The Mississippi Hospital Association lobbies on behalf of hospitals across the state and has frequently pushed the state to address decreased reimbursements to hospitals, which have hurt hospitals who provide care in low-income areas.

“Navigant’s report reflects the concerns that MHA has been trying to impress upon our state leaders for the last several years – that is, the situation for our hospitals, particularly for our rural hospitals, is critical,” Richard Roberson, the vice president for Advocacy for MHA, said in a statement. 

Specifically, for Mississippi healthcare providers, MHA has advocated for the expansion of the Affordable Care Act, known popularly as Obamacare. A 2017 report from the U.S. Census Bureau said Mississippi’s 12 percent uninsured rate was higher than the national average, at 8.7 percent.

Roberson’s statement continued: “In addition, Mississippi’s leaders have chosen not to offset these Medicare cuts and the crushing amount of un-reimbursed care, by expanding insurance coverage as allowed under the Affordable Care Act. Health care costs for hospitals have continued to rise. Skilled medical labor, the ballooning costs of electronic records, advances in medicine and medical technology and equipment and the need to address infrastructure in facilities have all increased costs. It doesn’t take a rocket scientist to figure out that when your costs keep increasing and your revenues decrease, it’s going to create financial difficulties.”

Mosley noted that the number of states with more than a quarter of hospitals at high financial risk included hospitals that had voted to expand Medicaid, such as Alaska, Arkansas and Michigan. (Fourth-place Maine, with 8 rural hospitals at risk, or 40 percent of the state’s total hospitals, voted to expand Medicaid in 2018.)

Roberson, in an interview, stressed the importance of rural hospitals when it comes to providing healthcare, especially Laird Hospital, which the MHA named its 2018 Outstanding Small Rural Hospital of Mississippi.

“Particularly when there are emergency situations or even when you want a family member cared for closer at home, it’s better,” Roberson said. 

Without Laird, Union patients would have to travel to Meridian or Jackson, as highlighted in the MHA award video. 

“We have to deal with life-threatening injuries and illnesses. We make a huge impact in this area, especially in stabilizing people with life-threatening illnesses or injuries,” Walt Willis, the medical director overseeing Laird Hospital’s Emergency Department, said in the video. “We also, as far as with severe trauma patients, we serve as a safe place for helicopter rendezvous for the terribly injured patients that need to be transfered to trauma centers.”

In June 2017, Rush Health Systems ended a security contract with three critical care access hospitals, including Laird, and cut back its workforce by 4 percent, or 112 positions, of approximately 2,800 positions. 

In a 2017 statement, Rush Health Systems said the workforce reduction followed a decrease in Medicare and Medicaid payments. 

Roberson emphasized the economic impact of hospitals, especially in rural areas where they might be the biggest employer.

“Being able to attract other businesses to the community, they look at healthcare,” Roberson said. “They’re all very important reasons to keep our hospitals viable.”