News & Analysis

Reconfiguring Rural Healthcare Access

Portrait of Dawn Carter

Dawn Carter

An orange sunset lights up a country road and a nearby water tower – a metaphor for the coming darkness in rural healthcare||

"Since 2010, 120 rural hospitals have closed across the United States." We hear statistics like that a lot – so often, in fact, that the big numbers start to lose their impact. But in a story last week from my local news station, WRAL, the reporter went on to list by name seven of the rural hospitals that have shut down in North Carolina, where I've lived for 30+ years.

Franklin Medical Center, Yadkin Valley Community Hospital, Sandhills Regional Medical Center – these are places I knew, places that had treated my friends or employed members of my network. For me, seeing the names listed one by one had a greater impact than the big, top-line number.

It's just another reminder of a crisis in rural healthcare access that's picking up speed and intensity all across the country. (Last year, in fact, saw a record number of hospital closures.) Because Ascendient’s home office is in North Carolina, a state with more than 2 million rural residents, this is an issue that we've worked on for many years, and we'll have a big announcement soon regarding a brand new effort to address the rural healthcare crisis.

[Update: Ascedient was one of five firms involved in launching the Rural Healthcare Initiative, a nonprofit collaborate focused on sustainable healthcare delivery in rural communities.]

As a North Carolinian, this is personal to me, but as a consultant, I try to stay objective at the same time. It's not possible or even desirable to have a full-service hospital in every rural community, because the costs are simply too high to justify the benefits. Urban or rural, the average American will require hospital admission fewer than 10 times over the course of their life, while they will visit a primary care physician about 120 times. That’s why “Save our hospital” efforts might be misguided: The loss of inpatient services may be an emotional blow, but the most-utilized healthcare services – physician care, urgent care, emergency care – can often be delivered without a costly hospital tower.

Priorities Are Key to Rural Healthcare Access

Rather than saving hospitals, per se, the goal should be maximizing access to the most-needed services with the greatest impact. In rural areas with sparse populations, that often means taking a regional approach to ensure that healthcare supply, demand, and resources are properly balanced.

Even with reams of data and the most sophisticated models, that can be easier said than done. Rural hospitals are a lot like high schools – local institutions that generate intense loyalty and strong emotions based on generations of experience. Pride, politics, and tradition can get in the way of good decision-making, and it can take years to find a solution that works in the real world.

It's worth the effort, though. Ascendient recently completed a multi-year engagement in a rural area where several hospitals found themselves in desperate financial straits. At the end of the day, we managed to reimagine the landscape so that more people than ever can live closer to the healthcare they need most – including a brand-new hospital and state-of-the-art technology that the region never had before. The full case study, entitled "Steering Two Competing Health Systems Toward a Population Health Center," is available here.