OSF: A quarter of rural hospitals still at risk

The Peru hospital has been reopened, but OSF HealthCare warned Tuesday tough times remain for rural hospitals.

At a town hall in Ottawa, A.J. Querciagrossa, CEO of OSF’s western region, said the popular perception is rural health care was squeezed by the novel coronavirus, but in fact trends were spotted years before anybody heard of COVID-19.

Those problems continue, and more than 400 hospitals are in danger of closing.

“We’ve seen that firsthand in the last year,” Querciagrossa said, alluding to the closure of the Peru and Spring Valley hospitals. The latter remains closed and while OSF has no plans to acquire it.

“We don’t have an interest in the Spring Valley hospital,” he said – OSF’s plans would not be altered if another network acquired it.

None of which has stopped OSF from planning a new hospital for Ottawa with a targeted opening of late 2027. The hospital is expected to will feature 12 medical-surgical beds and a 26-bed inpatient behavioral health unit.

OSF’s investment will be more than $120 million. OSF pledges to discuss with Ottawa officials how to repurpose the existing hospital, as the very design will lend to outpatient services where older facilities were designed for inpatient.

“No one in our region will have this type of campus in our community,” Querciagrossa said. “Ottawa might look different ... but will have more services in the future.”

However, the problems that led to the closure of local hospitals have not disappeared. These include rising health care costs and lower payments received from commercial insurance plans. Rural hospitals have smaller, more diffuse populations which means smaller patient volumes. Rural patients tend to be older, sicker and poorer than in urban areas.

All of that has cut into profitability for hospitals and health networks who were further squeezed by their aging facilities.

“It’s really expensive to upgrade old buildings or build new buildings,” Querciagrossa said.

Throw in a critical shortage of healthcare workers, and more hospitals have been closed than opened since 2011. For those hospitals that have survived, critical services have been cut led by obstetrics: 55 of rural hospitals in the United States do not offer labor and delivery, and for 10 states it’s 66%.

How dire is the situation for rural hospitals? It varies by state.

Hospitals in the mid-Atlantic and New England regions are at a comparatively reduced risk of closure. Fewer than 10% of hospitals in Maryland, Delaware, New Jersey and most of New England (except Massachusetts) are in danger of closing. At the other end are Florida, Tennessee and Nebraska, where 41% or more of rural hospitals are at risk.

Illinois is nearer to the middle, as is Missouri. For those two states, 21% to 25% of rural hospitals are at risk of being closed.

The good news is the trends have been slow enough in coming that OSF has had time to foresee their arrival and to adapt.

One shift has been from inpatient to outpatient. Upwards of 95% of services are provided on an outpatient basis (depending on where in OSF’s service area) while just 34% of beds are occupied.

“We’re not saying we don’t need inpatient services – you do need inpatient services – but it’s less than 20% of the services you need,” said Dawn Trompeter, president of OSF St. Elizabeth and St. Paul (Mendota) medical centers. “And when you do need it, you will have it.”

OSF has responded not only by modifying their facilities but by using virtual care and telehealth – even in the intensive care unit – to limit wait times and facilitate outpatient services. The total investment in the Interstate 80 corridor is a projected $180 million.

During the question-and-answer period, there were individuals who questioned the shuffling of between Peru and Ottawa. Querciagrossa and Trompeter said the goal was to keep services available regionally – no more than 30 miles drive for any city – and pushed back against any suggestion there would be staffing cuts.

“We need them all,” both replied.

Trompeter said she foresees a day when virtual nurses will handle admissions, leaving actual nurses with the freedom to “take more time with the patients.” Similarly, OSF established a dial-in service exclusively for expectant mothers.

Artificial intelligence has a burgeoning role at many levels of patient care – including in the patient’s home – not least because of the shortage of caregivers at all levels.

“We cannot continue to do healthcare the way we’ve been doing it,” she said.