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.
Still, the future of the Affordable Care Act and its Medicaid expansion is
up in the air, with Republicans pushing another repeal bill in the U.S.
Senate. With that uncertainty in mind, political leaders in Georgia are in a
David Ralston, the speaker of the Georgia House and a Republican from rural
Blue Ridge, said the state “did the financially prudent thing when we
decided not to expand Medicaid.”
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.
It’s inexcusable that Washington is leaving rural hospitals to founder,
“At the federal level, they’re just watching it burn. It’s beyond
frustrating,” he said. “At some point I hope rural communities recognize
this and hold people accountable for it.”
“Patients aren’t going to go away if new health care [legislation] comes out
with severe cuts to Medicaid,” Flanders said. “Patients will still show up
in the ER, and it’s up to us to figure out how to pay for it.”
Jimmy Lewis, who heads HomeTown Health, an association of rural hospitals in
Georgia, said there’s a magic number when it comes to sustaining
a rural hospital without extra government support
: a potential
patient population of 40,000 people.
You need that many people to sustain surgery services, which in turn
help keep the hospital profitable, Lewis said. Without a population that
large, hospitals need substantial county assistance, a high level of
diversification in health services or the backing of a regional hospital
In Cook County, about 100 miles southwest of Glenwood with a population
of just 17,000, another version of this story is playing out.
The hospital authority that operates Tift Regional Medical Center, based
in nearby Tift County, acquired Cook County’s hospital in July 2012. The
Cook Medical Center, located in Adel, is now getting a new facility to
replace the one built in the 1940s. Construction is expected to be
completed in the summer of 2019.
There’s just one catch: The new facility won’t have an emergency room.
Cook Medical Center had seen unpaid charges in its ER balloon from $5.6
million in 2012 to $8.5 million in 2016. Hospital CEO Michael Purvis,
who started at the facility as an X-ray technician two decades ago, said
95 percent of patients who visited the ER were “non-emergent” ― meaning
they could have been treated in a clinical setting. And the ER saw an
average of only about 0.4 patients between midnight and 7 a.m.
The costs of keeping the emergency room open, combined with general
upkeep for the deteriorating building, were unsustainable. The hospital
had a net loss of $2.6 million in 2016. So earlier this year, the
hospital decided to shut down its ER, steering patients to a nearby
community clinic that it operates.
Purvis, meanwhile, had pulled together a stakeholders group that
included the Cook County commissioners, officials from the city of Adel,
the Adel Industrial Development Authority and the Cook County Economic
Development Authority to talk through their options.
In the spring of this year, they presented the county with a choice:
They could build a new facility with convenient care and primary
care clinics, a surgical center, a geriatric psychiatric center, an
attached nursing home, inpatient and outpatient services, and no ER
for about $35 million. Or they could close the hospital all
“We needed to figure out a new way to serve our rural community, or
else you don’t have a viable shot,” Purvis said.
Under the plan for a new hospital, Cook County would be on the hook
for $5 million, the city of Adel for $4 million, and the Adel
Industrial Development Authority and the Cook County Economic
Development Authority for $600,000 each. The remaining costs of at
least $25 million would be covered by the Hospital Authority of Tift
When the Cook County Board of Commissioners took up the plan this
March, Purvis wasn’t sure what was going to happen. The
commissioners had been upfront about their unease with an expensive
new building plan, which they feared could require raising taxes and
create political blowback. But a no vote meant the hospital would
More than 200 people came to the monthly
, which usually attracts only about 10 residents. The
community was not going to let the hospital go without a fight. They
presented a petition signed by 697 people lobbying to keep it alive.
One resident held up a sign that read “No Hospital - Dead City,”
according to the Adel News Tribune. The event was also streamed live
on the newspaper’s Facebook page, where more than 400 people watched
The commissioners’ vote was unanimous: The hospital project would go
“We felt like as leaders we had to band together to save 250 jobs
and the industry in the area,” said Adel Mayor Buddy Duke, one of
many who spoke at the meeting.
The project aims to save those jobs and create 50 more when it’s
completed in the summer of 2019.
When asked, Purvis said he didn’t know of any patients who were
harmed by the closure of the ER earlier this year. Most of the
major trauma cases were already traveling the 30-plus minutes to
Tift Regional or a hospital in Valdosta, he said.
People in Cook County aren’t particularly excited about losing
the ER, but they’re happy there’s still a hospital at all, said
Maria Hardman, general manager of the Adel News Tribune.
“We didn’t want it shuttered with trees growing up through it,”
said Brent Dixon, chairman of the Adel Industrial Development
Still, 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.
Thrift, the Candler County commissioner, acknowledges that the
future of rural health care probably lies in prioritizing
regionalized medicine with larger, newer facilities that draw
patients from several counties ― much like what’s happening in
“Only way we’re going to survive in rural Georgia is we’ve got
to learn where the county line doesn’t end anymore,” he said.
Some health care experts say the rural future lies in standalone
emergency rooms, perhaps with a few beds on standby for
follow-up care. Shifting people with less urgent conditions to
convenient care clinics, instead of relying on expensive ER
visits, can cut down costs. Telehealth
will serve some needs
, although broadband service in
Georgia’s rural areas has a long way to go.
The total number of full-fledged hospital beds should also be
reduced, some experts say. And
some community hospitals may survive
by investing in new
facilities and equipment to better compete for patients and cut
down on maintenance costs.
One way or another, the size and scope of care at many rural
hospitals has to be reduced to beat the bottom line pressures.
“Health care looks different every day, it’s ever evolving, and
new delivery looks different,’’ said Dixon, the chairman of
Adel’s development authority. “Eventually you realize you can’t
do business the same way you’re always doing business, so you
either stop doing business or change.”
Infographics created by HuffPost’s Alissa Scheller.