Texas rural hospitals struggle; many vanish

Laura Garcia By Laura Garcia

Aug. 8, 2017 at 10:15 p.m.
Updated Aug. 9, 2017 at 6 a.m.

Two more rural hospitals, in the small towns of Crockett and Trinity, have shut down within the past few weeks.

This brings the number of Texas rural hospital closures to 18 since January 2013.

Dave Pearson, CEO of the Texas Organization of Rural and Community Hospitals, sent out an urgent release about the closures Monday.

Pearson said this crisis has left many rural communities without emergency and other care, has reached epidemic proportions and, unless the Texas Legislature and Congress take immediate steps, will only worsen.

The organization that represents 163 rural hospitals across Texas reported four closures were temporary, lasting only a few months, and three were replaced with a freestanding emergency or urgent care center.

But the care in those towns is now very limited, with 11 communities left with no emergency or hospital care.

One of those communities struggling is Wharton, which is an hour from Victoria on U.S. 59.

The Gulf Coast Medical Center shuttered its doors for good in November.

However, the hospital stopped serving ambulance patients in the area in March 2016.

Wharton Emergency Services Director John Kowalik said ambulances have been diverted to El Campo Memorial, but it has been tough without a hospital nearby.

He said El Campo can't handle every emergency case, so patients often end up in Rosenberg, Sugar Land or Richmond, which is 30-40 minutes away.

Kowalik said Wharton residents hope that a hospital system based in Richmond will enter into an agreement with the building's owner.

Joe Freudenberger, CEO of OakBend Medical Center, confirmed negotiations are underway and that he hopes to open the OakBend Wharton campus at that location by the end of the year.

OakBend still needs to raise half of its $2 million investment to pay for needed upgrades to hospital equipment, Freudenberger said.

As many as a third of the remaining rural hospitals in Texas are operating on a shoestring budget and struggle every day to stay open and serve their patients, Pearson wrote.

Pearson said many of these closures could have been avoided and are primarily the result of Medicare cuts by Congress in recent years totaling more than $50 million a year for Texas rural hospitals, coupled with underpayments in the Texas Medicaid program to rural hospitals approaching $60 million a year.

Don McBeath, director of government relations at TORCH, said leaving rural communities without immediate and reasonable access to emergency care has resulted in documented deaths because the local hospital was suddenly gone. "Congress must act very soon to renew some special rural hospital Medicare payment provisions that impact a number of our rural hospitals or their payments will decline even more, causing yet more closures," McBeath said. "Plus they need to address the series of cuts they have already inflicted on the rural hospitals over the past five years."

During the most recent regular session, the Texas Legislature directed the Texas Health and Human Services Commission, which manages the Texas Medicaid program, to look into the situation, but McBeath said it could be too little, too late.

Louis R. Willeke, chief executive officer of Refugio County Memorial Hospital, said Tuesday that all rural hospitals are concerned about future cuts that will have a negative impact on reimbursements from Medicare and Medicaid.

Willeke said they don't have control over that, but what they can control is to be very conservative in their spending and to look for sources of revenue from outside organizations.

"We have been very blessed to have received several grants through the years that help with the cost of medical equipment," he said. "We are also a Critical Access Hospital, which means our Medicare and Medicaid reimbursements are paid at cost."

Willeke said the hospital is lucky to have the support of many of its county residents and urges hospitals to be proactive with getting state and federal representatives to reconsider these cuts to reimbursements.

Kowalik, who lives in Wharton, said the closure has been difficult, and he hopes a hospital opens there soon.

"It's becoming very tough for small, privately run hospitals to stay afloat in this health care market right now," he said. "If they are not part of a large hospital chain or group, it makes it hard for them to survive."



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