GLENWOOD If you want to watch a rural community die, kill its hospital.
After the Lower Oconee Community Hospital shut down in June 2014, other mainstays of the community followed. The bank and the pharmacy in the small town of Glenwood shuttered. Then the only grocery store in all of Wheeler County closed in the middle of August this year.
On Glenwood’s main street, building after building is now for sale, closing, falling apart or infested with weeds growing through the foundation’s cracks.
Candler County is struggling to make sure its hospital, which is about 45 miles east of Wheeler County, doesn’t go the same way as Glenwood’s. Among rural hospitals, the Georgia Department of Community Health ranks Candler County’s facility as the second-most financially in need. The state’s new rural hospital tax credit program encourages businesses and individuals to donate to these facilities through a 90 percent tax write-off.
“You don’t know what’s going to happen in the next five months,” Candler County Commission Chairman Glyn Thrift said last month. “Today’s a good day. We have enough money to make payroll today.”
Since 2010, 82 rural hospitals have closed nationwide. As many as 700 more are at risk of closing within the next 10 years, according to Alan Morgan, the CEO of the National Rural Health Association, a nonprofit professional organization that lobbies on rural health issues.
“The Southeast of the U.S. is where things are going horribly wrong. You’ve got higher levels of obesity, diabetes, hypertension you pick up any health disparity or measure and it’s there,” Morgan said. “And again this is where now we are shutting down rural hospitals.”
One in five adults in the South report having poor health. Fifteen percent of non-elderly residents are uninsured, according to the Kaiser Family Foundation, and that’s 5 percent higher than the rest of the country. The South also has the largest cluster of states that have not expanded Medicaid under the Affordable Care Act: Alabama, Florida, Georgia, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Virginia.
“Those most in need of health services have the fewest options available, and we are closing rural hospitals,” Morgan said. “From a policy standpoint, we are going in the wrong direction.”
Georgia is “ground zero” for rural hospital closures, he said.
Bad decisions in Metter
In Metter, a series of bad decisions especially the installation of a faulty IT system combined with the usual factors squeezing rural hospitals have left the Candler County Hospital with about $6 million in accounts payable and an additional $4 million debt that the county incurred on its behalf, according to hospital CEO Dave Flanders. The facility, located in Metter, owes another $1.8 million in additional notes and liabilities. The hospital has been unable to make debt payments to the county, forcing the local government to increase property taxes and borrow money in January and February to cover its own bills.
But Flanders and Larry Hadden, who sells insurance in Metter and serves as chairman of the Candler County Hospital Authority, both think the hospital is going to make it.
“Will it be easy? Absolutely not. We’ll probably rely on support from the county,” Hadden said.
Candler County, population 11,000, has dug deep to keep its second-largest employer afloat.
“We’re all in this together. It’s one thing to look at the financial numbers,” Hadden said. “It’s another thing to look at saving someone’s life.”
The loss of a rural hospital goes beyond even vital medical care. It represents a loss of identity, a loss of community.
“There’s a psychological impact where people are tied to their hospital and feel comfort with it here,’’ said Doug Eaves, the Candler County administrator. “They’re emotionally committed to it. It’s something they’ve always had.”
“I understand things are changing, but try to have a thriving community without a hospital,” said Carvy Snell, publisher of the Metter Advertiser, a 104-year-old local paper.
Metter’s main street is already showing economic cracks. While it looks bustling compared to Glenwood’s, some shops are closed or empty.
The county got a financial boost when Linzer Products Corporation opened up a paint manufacturing and distribution center in Metter last year, creating 200 jobs. It would be a lot harder to attract that kind of new business without a hospital, Snell said.
Flanders pointed toward cost-cutting measures implemented by the management company ER Hospitals including better negotiation on insurance payments and streamlining of administrative services across the company’s health care operations as critical to the Candler facility’s survival. The hospital’s robust volume of 130 to 135 surgeries a month and its profitable “swing beds” which can be used for patients requiring either acute care or skilled nursing care are helping it break even on operating revenue, according to Flanders.
But he has no answer for the long-term debt, and if the hospital were to close, Candler County would still be on the hook for the money.
“We’ve got to go down swinging,” said Thrift, the county commission chairman.
Rural hospitals are in danger across the country, their closures both a symptom of economic trouble in small-town America and a catalyst for further decline.
Six rural hospitals in the state have closed their doors since the beginning of 2013. Two of those have been reopened as modified medical facilities, but no longer function as full-fledged hospitals. And more than half of the state’s remaining rural hospitals are vulnerable to closure, according to a 2016 report on rural hospital strength by iVantage Health Analytics for the National Rural Health Association.
Many states like Georgia didn’t expand Medicaid. So rural areas in those states have been hit by the cuts without getting the full coverage boost offered by Obamacare.
Expanding Medicaid would have meant greater access to insurance for low-income people and more reimbursement for hospitals, thus helping their bottom lines. But Georgia’s political leadership has refused to expand the program, citing the costs for the state.
However, community leaders in Wheeler and Candler counties said there is no doubt that a Medicaid expansion could have helped. “The reality is from a hospital management standpoint, the non-expansion of Medicaid has hurt all rural county hospitals,” said Eaves, the Candler County administrator.
There are nearly 700 other rural hospitals in danger of closing across the country and thus hundreds of rural communities that need to find a solution.