Practice Management News

Rural Hospital Closures Boost Mortality Rates by Nearly 6%

New research shows that patients are more likely to die following a rural hospital closure, whereas urban closures had no measurable impact on mortality.

Rural hospital closures and mortality rates

Source: Thinkstock

By Jacqueline LaPointe

- Rural hospital closures increased mortality by about 5.9 percent overall, while urban hospital closures had no measurable impact on mortality, according to a recently published National Bureau of Economic Research working paper.

The paper clears up questions about the impact hospital closures have on patient outcomes, researchers from the University of Washington said regarding their study of 92 hospital closures in California from 1995 to 2011 and their impact on adjusted inpatient mortality for time-sensitive conditions, including sepsis, stroke, asthma/chronic obstructive pulmonary disease (COPD), and acute myocardial infarction (AMI).

“With the rise in hospital closures, and especially with increasing rates of rural closures, lack of studies on the impact of closures on patient outcomes and the lack of consensus across existing studies pose barriers to policy implementation,” they wrote in the paper. “This paper attempts to reduce the aforementioned gaps and reconcile differences across prior studies.”

Their study of hospital closures in California examined the impact of closures on Medicare and non-Medicare patients, and is the first paper to analyze the impact on patient mortality following the closure of hospitals in California, a state with a high number of hospital closures, they explained.

The study revealed significant differences between patient outcomes following an urban and rural hospital closure.

Like many other studies, researchers found no measurable impact on mortality when they did not differentiate between urban and rural hospital closures. However, when comparing the impact by type of hospital, they found that patients are more likely to die following a rural hospital closure.

The impact on mortality rates also varied by condition. Rural hospital closures increased mortality for sepsis patients by 9.0 percent, while urban closures boosted mortality for AMI patients by 4.1 percent. Urban hospital closures also decreased mortality for asthma/COPD patients by 6.3 percent, researchers reported.

“[T]hese results demonstrate the extent to which negative effects of rural closures are masked when no distinction is made between treatment groups. As such, these results offer a crucial potential explanation for the lack of consensus among scholars regarding the impact of hospital (and ED) closures: rural hospital closures have a differential impact on patient mortality than urban closures,” they stated in the paper.

How rural hospital closures impact patient outcomes is a conversation at the tip of the healthcare industry’s tongue. Since January 2010, 113 rural hospitals have closed their doors permanently, according to research from the North Carolina Rural health Research Program.

More rural hospitals are also on their way to closing. Consulting firm Navigant recently reported that one in five rural hospitals is on the verge of closing based on the organization’s total operating margins, cash on hand days, and debt-to-capitalization ratios. The at-risk hospitals represent 21,500 staffed beds and 707,000 annual discharges.

Recent economic downturns and job losses are putting rural hospitals in crisis mode, researchers from the University of Washington explained. Outmigration and shrinking populations are leaving behind patients who are older, sicker, and more reliant on Medicare and Medicaid, which significantly underpay hospitals.

Aging facilities, outdated payment models, greater competition, and strategic decision by corporate owners or operations are also contributing to rural hospital closures, they added.

Patient access to care suffers when a rural hospital closes its doors for good, and consequently, patient outcomes can deteriorate. Research like theirs should have a significant impact on policies that aim to address access to care following a hospital closure, the authors stated.

“Overburdening of the health care system post-closure and rural closures are particularly concerning, they wrote in the paper. “While policy instruments that tackle root causes for closures and macroeconomic effects of rural closures appear less straightforward, there seems to be a clear need to ensure emergency transportation post-closures, especially for vulnerable populations, and to identify strategies that help surrounding hospitals manage increased and potentially differential health care demands post-closures.”