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Hospital closures have little impact on health, study finds. Unless you're in rural Missouri

Connie Chapman, who worked at the Sac-Osage Hospital in Osceola, Mo.,for 40 years, looks over a nearly empty room in the hospital.
Todd Feeback|Heartland Health Monitor
Connie Chapman, who worked at the Sac-Osage Hospital in Osceola, Mo.,for 40 years, looks over a nearly empty room in the hospital.

Chris Smiley spent most of Tuesday moving the last of the boxes out of Sac Osage Hospital in rural Osceola, MO. In the months after the small town’s only hospital closed for good, the facility’s CEO has been selling off supplies and making arrangements to transition her patients’ care to other places. The building itself is set to be demolished.

“We arranged to have another facility take over our clinic,” Smiley said. “There will be ambulance service in the community. There’s a heli-pad that will be maintained by the ambulance bay.”

Still, the economic and emotional hit of losing the only hospital and the largest employer in the western Missouri town is palpable. During public meetings, Smiley and her staff found themselves reassuring residents that everything is going to be OK.

“It’s a scary thing when your hospital goes away,” Smiley said. 

The studies tell a different story

But maybe hospital closures aren’t as bad as they seem. A Harvard University study analyzed 195 hospital closures nationwide and Medicare patient data. It concluded that there were no significant differences in hospitalization rates or mortality for communities that had recently lost a local hospital. Communities were defined as Health Service Areas, a federal designation for geographic areas that are relatively self-contained for hospital care. 

“What we’ve shown in this study is that Medicare patients, for the most part, had other options. They went to places that were perhaps doing better in terms of their finances and potentially provided better care,” said Dr. Karen Joynt, the report’s lead author, and a cardiologist at Brigham and Women’s Hospital in Boston.

The research included only Medicare beneficiaries and closures that occurred between 2003 and 2011, before the majority of the Affordable Care Act changes had been implemented. Analysts reviewed patient data for hospitalizations for heart attacks, strokes and trauma.

Joynt cautions that the findings do not apply to every hospital closure. Most of the closures during the review period occurred in urban or suburban areas, where residents had easy access to other hospitals. Averaged together, the effects felt by rural hospital closures may not show up. Devastating accidents, such as the Texas toddler who died in 2013 when she choked on a grape and was taken to a recently-closed emergency room, would also be lost in the data.

“I do think it’s important in communities with a closure, to understand what happens to the most vulnerable, and we did not do that in this study,” Joynt said.

The data did show that patients in communities that experienced a closure were more likely to be eligible for Medicaid, have multiple chronic conditions, or be a racial minority. 

The report appeared in the May issue of Health Affairs.

Where hospital closures occur

Hospital closures have been a rallying cry for advocates hoping to convince Missouri’s legislature to expand Medicaid through the Affordable Care Act. Missouri Hospital Association spokesperson Dave Dillon said he doesn't agree with the report's conclusions, and believes that only using Medicare patient data missed the effects of closures on uninsured patients, or on people with other forms of insurance. 

"This is going to sound callous, but the study doesn’t control for deaths that occurred outside a hospital as a result of that closure," Dillon said, pointing to a St. Louis study of patient mortality data that linked worsened outcomes to longer travel times for care. 

"If you look at why hospitals are important, it’s not just exclusively for health, it’s also the health of a community economically," Dillon said. 

A map of U.S. hospital closures between 2003 and 2011, from the report's Appendix. 195 hospitals closed during that period.
Credit Health Affairs
A map of U.S. hospital closures between 2003 and 2011, from the report's Appendix. 195 hospitals closed during that period.

The Health Affairs analysis included three Missouri hospitals that closed or stopped offering inpatient care between 2003 and 2011:

  • 2005: Crossroads Regional Medical Center, Wentzville. (This hospital became SSM St. Joseph Health Center)
  • 2006: Baptist-Lutheran Medical Center, Kansas City.
  • 2007: Medical Center of Independence, Independence. (This hospital was replaced by a successor)

The report also noted the 2011 closure of Kenneth Hall Regional Hospital in East St. Louis.
Since 2011, Missouri providers, including the Missouri Rehabilitation Center in Mount Vernon and the Cottonwood Residential Treatment Center in Cape Girardeau, have closed their doors. Some small hospitals have been bought out by larger health providers, including Mineral Area Regional Hospital in Farmington, which was acquired by BJC HealthCare. But the most recent closure of a Missouri hospital was Sac Osage Hospital in Osceola. 

A changing healthcare landscape

Osceola residents have had a few months to adjust to Sac Osage Hospital’s closure, which became official in September. CEO Chris Smiley said the 43-bed facility became financially unsustainable. By the time Sac Osage closed, Smiley said, 85 percent of the patients were uninsured or were on Medicare or Medicaid, which reimburses hospitals at a lower rate than private insurance.  

“The last two years were really bad. The most recent year, we had a $2 million loss on the hospital,” Smiley said. “You can’t continue to do that and not make a decision that there needs to be a different way to provide care.”

Smiley said that loss would have been unavoidable, even with Medicaid expansion in Missouri. She attributes some of the hospital’s decline to a loss of patients overall, many of whom had begun to seek care by driving more than an hour away to Kansas City and Springfield. She added that a developer has stepped forward with plans to demolish the hospital and build an outpatient medical center.

“I think it may turn out to be a really good thing for the community down the road. But people have to hang on for another year or so,” Smiley said.

For more health news, follow Bouscaren on Twitter: @durrieB