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At a gathering of the Tennessee Farm Bureau in Franklin, Tenn., Republican Senate nominee Rep. Marsha Blackburn, talked about things she would aim to reduce, such as EPA regulations, and things she would aim to build up, such as broadband internet.
Blackburn said fast internet was important for education, and health care.
"Hospitals are closing in rural America because they don't have access to high-speed internet," she said Aug. 8.
We decided to see if lack of broadband was as pivotal to rural hospitals as Blackburn said.
Nationwide, 87 rural hospitals have closed or stopped providing in-patient care since 2010.
The leading reasons these hospitals close include: 1. They serve older, poorer, and sicker communities where higher percentages of patients are covered through public insurance programs; 2. They have too few patients to support the size of the facility; 3. Medicaid and Medicare reimbursements often don’t cover their costs.
Access to high-speed internet would help, but researchers were unable to identify a hospital that closed due to lack of access.
The Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill tracks rural hospital closures. The center’s director and senior researcher told the Senate Finance Committee in May that the causes are complicated, but they did see some patterns.
"Most closures and abandoned rural hospitals are in the South – 60 percent – where poverty rates are higher and people are generally less healthy and less likely to have health insurance, private or public," they said.
They said in 2016, the average urban hospital had double the profit margin of the typical rural facility, about 5 percent compared to a bit over 2 percent. A profit margin that slender put hospitals at risk.
Their testimony made no mention of high-speed internet.
Shep Center research associate Kristie Thompson told us that "we have not identified broadband or any other single cause for the rural hospital closures."
It’s not that broadband access wouldn’t help. It would.
"Without it, a hospital can’t perform to its potential," said Maggie Elehwany, vice president for policy at the National Rural Health Association. "High-speed internet is definitely a factor in keeping a hospital in good condition. But you can’t say that the lack of it forced a hospital to close."
The trade group NTCA-Rural Broadband Association estimated that telemedicine through better broadband could boost the bottom line of the average rural hospital in Tennessee by about $150,000 a year. That is a relatively modest amount.
We looked at the eight rural hospitals that have closed in Tennessee since 2010. No press release or news article mentioned the lack of high-speed internet as a driving factor. More common was a declining demand or advances in treatment that left the centers unable to compete. And some reports mentioned federal Medicaid and Medicare payments.
Elehwany told us a major issue is a slide in government reimbursements. She said after a wave of rural hospitals shut their doors in the 1980s and 1990s, Congress designated these facilities as critical access hospitals, or other types of rural facilities, and paid them more generously under Medicare. Some states used that designation to boost Medicaid payments as well.
"Now, there’s been an erosion of payments to rural hospitals," Elehwany said. "Sequestration was particularly damaging."
In an article in the Journal of Health Affairs, public health researchers at the University of Colorado reported that the Affordable Care Act appeared to play a role in rural hospital closure rates.
States that expanded Medicaid saw the number of hospitals closing decrease drop steadily after 2014, while states that didn’t saw their closures first decline, and then rise. Overall, researchers said that Medicaid expansion was good for the hospitals’ bottom line. Tennessee did not expand Medicaid.
Shep Center researchers said it is an open question whether Medicaid expansion alone lies behind these trends, but they noted that the disproportionate share of closures in the South overlaps with the states that were least likely to expand Medicaid.
Abbi Sigler, spokeswoman for the Blackburn campaign told us that lack of access limits hospitals' ability to provide care. "
If we don’t improve high speed internet access to rural hospital providers, they will continue to close at alarming rates," Sigler said.
She gave no example of a hospital that closed because it didn't have high-speed internet.
Blackburn said that rural hospitals are closing because they don’t have access to high-speed internet. We could find no research to back that up.
The country’s leading center for tracking rural hospital closures said it did not know of a case where lack of broadband caused a hospital to close. A broadband trade group estimated that better internet would help the typical rural hospital in Tennessee by about $150,000 a year.
Researchers say that other factors play a much larger role, including a patient base that tends to need more care and has less ability to pay for it.
We rate this claim False.
The Tennessean, What Marsha Blackburn and Phil Bredesen told Tennessee farmers as they campaign for the US Senate, Aug. 9, 2018
University of North Carolina Sheps Center for Health Services Research, 87 Rural Hospital Closures: January 2010 – Present, accessed Aug. 13, 2018
University of North Carolina Sheps Center for Health Services Research, Testimony on rural hospital closures before the U.S. Senate Finance Committee, May 24, 2018
National Rural Health Association,Rebuild Rural: The Importance of Health Care in Infrastructure, Feb. 20, 2018
Journal of Health Affairs, Understanding The Relationship Between Medicaid Expansions And Hospital Closures, January 2018
Copper Basin Medical Center, Closure statement, Oct. 1, 2017
Jackson Sun, McNairy Regional Hospital to close in May, March 18, 2016
Manchester Times, United Regional, Medical Center set to merge hospitals July 1, June 24, 2015
WRCB, Parkridge West shuts down medical services except ER, March 26, 2015
The Tennessean, Rural hospital in Brownsville set to close, April 29, 2014
WBBJ, Trenton Hospital to Convert to Outpatient Clinic, May 28, 2013
Daily Post-Athenian, Changes for Starr Regional Medical Center, March 24, 2014
NTCA-Rural Broadband Association, Anticipating economic returns of rural telehealth, March 2017
National Rural Health Association, New report indicates 1 in 3 rural hospitals at risk, Feb. 2, 2016
Interview, Maggie Elehwany, government affairs and policy vice president, National Rural Health Association, Aug. 13, 2018
Email interview, Kristie Thompson, research associate, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Aug. 13, 2018
Email interview, Abbi Sigler, spokeswoman, Blackburn for Senate, Aug. 14, 2018
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