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Senate panel led by Wyden focuses on rural hospital finances, closures • Oregon Capital Chronicle
Rural hospitals and clinics across the U.S., including in Oregon, are facing economic hardship as they struggle to meet the medical needs of people living in remote regions with limited care choices.
Last August, Saint Alphonsus Medical Center in Baker City cited financial problems in closing its birth center in eastern Oregon. It was the only maternity hospital in a municipality with almost 17 thousand inhabitants and had served the region for 100 years. The measure forced pregnant women to travel an additional 72 kilometers to the Grande Ronde Hospital in La Grande, a treacherous, if not impossible, journey during the winter.
Rural hospitals are often the only medical care outposts in many communities, offering a range of essential services such as baby deliveries, emergency medical care and surgeries.
However, more than half of rural hospitals in the US operate in the red. At the same time, large healthcare companies are gobbling up small hospitals that have been operating for decades. This can place much of the decision-making power over what services to offer – or discontinue – in the hands of executives who live far away and who are focused on the bottom line rather than the needs of these communities.
On Thursday, the Senate Finance Committee, led by U.S. Sen. Ron Wyden, D-Oregon, heard from hospital leaders and healthcare experts, with the goal of finding policy solutions and ideas to help rural hospitals continue to maintain the financial base necessary to remain open.
In his remarks, Wyden said he is concerned about the outlook for rural hospitals. Between 2011 and 2021, one in four rural hospitals nationwide stopped providing obstetrics services, Wyden said.
“What happened in St. Alphonsus in Baker City is a classic example of what is happening in rural communities across the country,” Wyden said. “These Americans deserve better.”
Wyden said the country needs a “fresh approach” that provides extra financial support to small hospitals — but only on the condition that “the big hospital chains don’t take the money and run.”
Wyden and other speakers said the issue is complex and will require a multifaceted approach. One on the list: better and adequate Medicaid and Medicare reimbursements for rural hospitals, support for telehealth services, and incentives that encourage new doctors and other medical professionals to work in rural communities that often struggle to attract staff.
Eastern Oregon Perspective
Jeremy Davis, president and CEO of Grande Ronde Hospital in La Grande, spoke to senators about the challenges of running a 25-bed independent hospital in rural Oregon. The hospital and its 19 outpatient clinics are 260 miles east of Portland.
Davis said hospitals face a variety of challenges, including rising expenses, labor shortages and stagnant revenues. Technology, crucial to medical care, also increases costs. Hospitals have also faced higher insurance costs since 2019 to protect them in the event of a cyberattack, he said.
“Rural hospital administrators like myself have an interconnected list of concerns that keep us up at night, including safety and labor shortages, financial stability and, most recently, cybersecurity concerns,” Davis said. “And the next emergency, whether natural, public health or man-made, is always just around the corner.”
When Baker City Hospital’s birthing center closed, La Grand Hospital saw a 65 percent increase in patients from the surrounding area, he said, adding that they hired more staff.
“While we were prepared and committed to meeting this need, decisions like this are a constant juggling act between limited financial resources and balancing our larger workforce and the service needs of our community,” he said.
Davis said he recently heard a report of a pregnant woman on her way to the hospital from Baker County who gave birth during a stop along a canyon before arriving at the La Grande hospital.
“Luckily it was this time of year rather than December or November,” he said.
St. Alphonsus Medical Center in Baker City. The hospital closed its birth center in 2023. (Provided by Trinity Health)
Other rural hospitals are closing entirely.
Since 2010, more than 170 rural hospitals have closed nationwide, said Michael Topchik, executive director of the Chartis Center for Rural Health, a Chicago-based company that focuses on accessible and affordable health care solutions.
Topchik told senators that more than 400 hospitals across the country are vulnerable to closure as they are pressured by rising costs and low reimbursements.
“This is a national threat that will send shockwaves through communities if left unchecked,” he said. “When rural hospitals close, access to care becomes more difficult and jobs in those communities – hospital jobs and related roles – disappear.”
The bleak outlook has led previously independent rural hospitals to affiliate with large companies in an attempt to reduce costs, but that is not a panacea, he said.
La Grande hospital remains an independent hospital in Oregon, while Baker City hospital, which downsized its birthing center, is affiliated with Saint Alphonsus Health System, which is part of the nonprofit Trinity Health. Trinity Health, a national Catholic health system, is headquartered in Michigan.
In general, Wyden said a concern is that executives outside the hospital community make decisions that impact people.
“Many of the shots are being fired thousands of miles away,” Wyden said.
Other states
Officials in other states have pointed to similar challenges in preserving services – and the need for more workers.
In Wisconsin, about 13 birth centers have closed in the past 11 years, said Lori Rodefeld, director of graduate medical education at the Wisconsin Collaborative for Rural Graduate Medical Education. The program is part of the Wisconsin Rural Health Cooperative.
One challenge for rural health care providers is finding people to replace them, she said.
“It’s hard to be a doctor for someone who provides services to a community,” she said. “I know how difficult it can be. If you want to take a vacation, who will cover who will deliver your babies for you?
But Rodefeld said progress can come with programs that train and encourage new doctors to work in rural areas.
U.S. Sen. John Barrasso, R-Wyoming, said the University of Wyoming’s medical school participates in a partnership that has campuses in Washington, Wyoming, Alaska, Montana and Idaho.
“What we have found is that providing students with rural experience and providing residents with rural experience helps them recognize early in their career the benefits of working in rural clinics and hospitals,” he said.
At the same time, challenges like Oregon’s are also present in Wyoming.
In Wyoming, five of that state’s 23 counties have lost maternity services entirely, seven have limited access to care and only 11 counties have adequate access to services, said Barrasso, who had a 24-year career as an orthopedic surgeon.
Every county in Wyoming is geographically larger than the state of Delaware, he said. If the entire state of Delaware lost all its maternity services, he said, “it would be on the front page of every newspaper.”
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