One in three rural hospitals is at risk of closure. The hospital is now what the post office used to be — the last thing holding a community together.
If you’ve followed Intersect’s work, you know we’ve championed a “Hub and Spoke” approach to delivering healthcare — with academic medical centers and other large integrated health systems serving as the Hub (centers of excellence) and Spokes as the remote care delivery centers acting as “boots on the ground.”
Conceptually, this strategy makes a lot of sense for people living in rural and underserved communities who lack convenient access to specialty care. Many pundits see it as the path to the future. How do Hub organizations feel about it? It should appeal to them — additional revenue without new infrastructure investment.
The more pressing question is how the prospective Spokes feel. For many, their current financial crisis makes it difficult to think beyond the next payroll. It may be like the scenario described in Maslow’s hierarchy of needs, where someone worried about basic survival can’t focus on growth opportunities. For struggling rural hospitals contemplating a Hub partnership, the dynamic is similar.
The Scale of the Struggle
And the scale of that struggle is sobering. According to current CMS cost report analysis, 734 rural hospitals — roughly one in three of all rural facilities nationwide — are classified as at risk of closure due to severe financial problems, and 46% of rural hospitals are currently operating in the red. An estimated 323 facilities face immediate closure risk within two to three years. Many won’t survive without a fundamentally different operating model.
There are strong reasons to believe, however, that a Hub and Spoke model could be an answer for the financial woes currently plaguing hospitals in rural and underserved areas. Rather than referring patients with complex disease to centers of excellence — never to see them again — a collaborative relationship would enable continued revenue through the continuum of care.
The Patients Are the Biggest Winners
The biggest winners, however, would be the patients in those areas — and the communities themselves. Not every rural resident has the resources to travel for specialist care. Financial constraints and family responsibilities make that option impossible for many. The consequences of going without are real and measurable. Nationwide, cancer death rates in rural areas are 14% higher than in urban areas, and the disparity is getting worse. The 5-year cancer survival rate across all cancers is 8% lower in rural communities than in urban ones. The gap widens further for cancers caught at later stages — exactly the kind of cancers most likely to occur when screening and specialty access are limited. Bringing specialty care closer to home would extend to rural patients the favorable outcomes urban patients take for granted.
For the communities where access to local care is at risk, the stakes are profound. If they lose the hospital, the future is grim. The hospital is commonly the town’s largest employer, and those jobs disappear with it. New investment becomes improbable — employers won’t locate where workers can’t access care. Schools feel it too: teachers don’t want to live where there is no care.
A Hard Look Is Worth It
There is a strong case for Spokes to take a hard look at the Hub and Spoke model. Intersect is ready to talk. Our roots are in places like yours, if that is where you call home. Let’s move from struggling with basic necessities to self-actualization.
If you’re at a rural or community hospital weighing partnership options, I’d genuinely like to hear from you — what’s the biggest barrier you’re facing right now?
Let’s talk partnership
Intersect’s roots are in rural and underserved care. If your hospital is weighing its options, we’d like to hear from you.