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Fulton Medical Center closing just one indicator of rural hospital struggles


JEFFERSON CITY, Mo. – Questions continue to rise as Callaway County officials scramble to find a way to keep the doors open at the Fulton Medical Center after the owner, NueHealth, announced this week that the facility will close no later than Sept. 22.

“While we are deeply disappointed by NueHealth’s decision to close the Fulton Medical Center by Sept. 22, the city of Fulton, the Callaway County Commission and the Callaway Chamber of Commerce have already intensified our efforts to identify both short- and long-term solutions that could prevent an interruption in health services and determine a sustainable health care model for the future,” Fulton city, county and chamber officials said in a joint statement. “The loss of 158 jobs and the impact that would have on families is paramount in our thoughts and actions. We are committed to finding a way to preserve the level of health care our residents have come to expect.”

The planned shutdown came as a surprise to many, but not as a complete shock, as the previous week saw University of Missouri Health Care back out from their investment in the facility, saying the facility was unsustainable and losing money.

MU Health Care had owned a 35 percent minority interest in the Fulton Medical Center, investing about $1.6 million in it. MU was to operate the hospital, per the deal in 2014. According to MU Health Care, their operating agreement provides them the opportunity to sell their interest back to FMC.

Their decision to pull out of Fulton comes as the UM System faces decreases in state funding and revenue declines from lower enrollment numbers, which forced a series of budget cuts.

NueHealth says that their decision to close the Fulton hospital was based on a number of different factors, including low patient volumes, unsustainable finances, extensive repairs and upkeep, an inability to expand and provide additional revenues, as well as an inability to provide a new care delivery model due to the certificate of need application denial by the Missouri Health Facilities Review Committee. The loss of a partner in MU Health Care was just another contributing factor in the decision to close.

The closing of hospitals isn’t a new issue, however. According to a state-by-state breakdown of rural hospital put together by the North Carolina Rural Health Research Program, 81 rural hospitals have closed in the U.S. since 2010, and Fulton Medical Center would become number 82. Three other hospitals have closed in Missouri within the last three years.

“We’ve had a couple close in the last couple of years,” Dave Dillon, vice president of public and media relations for the Missouri Hospital Association, said. “Each one has its own specific challenges, and how they work with those challenges has some bearing on whether they survive or thrive. Each hospital is different, so it’s hard to compare.”

But another factor may have also played a role: Missouri’s decision not to expand Medicaid. With the hospital not receiving enough money and attempting to shore up their finances through Medicaid funds, the writing was on the wall. Dillon says it’s fair to say that the lack of Medicaid expansion played a role in each closing hospital.

For years, lawmakers ignored the calls of former Gov. Jay Nixon, asking to expand Medicaid in the Show-Me State. Missouri’s current Medicaid program, compared to other states, could be described as the bare minimum. But any hopes of addressing or changing Medicaid in Missouri all hinges on what the federal government does with the Affordable Care Act. Some, however, will argue that a company basing revenue on funds from a federal program to make ends meet is not a fiscally solvent business plan.

But those types of facilities are facing more challenges each day, most typically involving money.

“Finding ways to make the numbers all add up over time, especially over time, it’s very difficult,” Dillon said. “And if you look at the uncompensated care costs at rural hospitals, that would be a potential offset. We’d be receiving payments for a lot of people who come in as uninsured in the system. Statewide, hospitals provided $1.2 billion in uncompensated care in 2015, and that’s a pretty big chunk of change.”

In addition to trying to remain fiscally sound, there’s currently a demand for physicians to operate in those facilities, so much so that the University of Missouri-Kansas City recently opened a new school in Joplin in hopes of training more doctors to build a stronger rural network. Finding people who want to live and work in those communities, and can make a living doing so takes some work.

Another potential issue people face in this sort of issue is access to rural hospitals. With no hospital in Fulton, it means that the closest facilities for folks to use would be in either Jefferson City or Columbia. And while the distance can be a problem, Dillon also notes that not every medical need requires a trip to emergency rooms and that a facility in a rural area could just as easily address broken bones, lacerations, etc.

In the long run, Dillon says, the inability to overturn or fully repeal the Affordable Care Act means that hospitals and Missouri’s government will have to take a long, hard look at what should be done to maximize the benefits of the system as it is.

But as long as the questions about health care continue nationwide, then questions about the sustainability of rural health care options may persist.