Maternal, Surgical Care Eliminated After Rural Hospital Mergers

Are rural hospitals trading obstetric and surgical care in exchange for financial stability? According to a new study published in Health Affairs, those services lines and others may be at stake following rural hospital mergers.

Access to obstetric and surgical inpatient services significantly declined among rural hospitals that underwent a merger, reported researchers from IBM Watson Health and the Center for Financing, Access, and Cost Trends at the Agency for Healthcare Research and Quality (AHRQ) in the study.

For maternal/neonatal services, the percentage of mergers rural hospitals offering the service line declined from about 75 percent in the premerger period to 61 percent in the post-merger period. Meanwhile, the percentage did not change among rural hospitals that remained independent.

Similarly, the percentage of hospitals providing surgical services decreased by 5 percentage points more for merged than for comparison hospitals from the pre period to one year after a merger.

Additionally, the number of mental/substance use disorder-related stays decreased or remained stable at merged hospitals and within their catchment areas, while that number increased for independent rural hospitals and their catchment areas. The finding indicates that communities with merged rural hospitals may have experienced decreased access to behavioral services, researchers said.

No or limited access to these services at rural hospitals is a problem for patients. People living in rural areas tend to be poorer, have more health conditions, and have greater unmet health needs compared to people living in urban or suburban communities. Additionally, rural residents generally rely on local hospitals to access even routine care because of severe physician shortages.

Moreover, the opioid crisis has hit rural areas particularly hard, creating a pressing need for behavioral health and mental/substance use disorder services.

Rural hospitals, however, have faced their own challenges. More than 180 rural hospitals have closed since January 2005, with the majority happening after 2010, the latest data from UNC’s Cecil G. Sheps Center for Health Services Research shows. That number is likely as the risk of rural hospital closures increased during the COVID-19 pandemic, the Center for Healthcare Quality and Payment Reform (CHQPR) recently reported.

Rural hospital mergers have been a lifeline for many facilities. Data cited in the Health Affairs study showed that 11 percent of rural hospitals underwent a merger between 2005 and 2016. Since then, the trend of hospitals mergers has increased.

“Mergers might be a strategy to keep rural hospitals afloat in precarious financial times, but the trade-off may be a hospital that is less responsive to community needs,” the study’s lead author Rachel Mosher Henke of IBM Watson Health, said in a statement.

Henke et al. advised payers to move away from fee-for-service payments to “provide more stability in cash flow, such as global payments.” The more stable revenue source could help reduce the risk of future rural hospital mergers or closures and ensure rural hospitals can continue to provide the services their communities need.