Rural Hospitals in Illinois must be creative in order to stay afloat

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ALEDO AND PRINCETON, ILLINOIS (KWQC) - There's a shortage of healthcare providers across the country.

“We have been without a physician position being filled for about a year now and it only had three candidates two of which surfaced lately,” says Administrator of Genesis Medical Center Aledo Ted Rogalski.

And patients can feel the difference and it presents a challenge to hospital administrators.

“We see our patients leaving our communities and going elsewhere because our wait time for our two and physicians can be up to 8 weeks at a time so those patients will travel elsewhere to seek care,” says Rogalski.

The shortage of rural healthcare providers is about four times that in metropolitan areas.
But it does provide its benefits in terms of recruitment for rural areas.

Rural areas are “all known as health professional shortage areas which gives us access to grants to give loan forgiveness to people coming out of school,” says Rogalski.

And to help with manpower, rural facilities have had to get creative.

“Probably about five years ago we moved to a mix of 50/50 physician advance practitioner mix and that's helped a lot,” says Rogalski.

Hospitals in one Southern Illinois community decided to share resources according to the Illinois Critical Access Hospital Network (ICAHN).

“There's three hospitals in Southern Illinois in a county that share surgeons and rotate them so you have to be creative. Every day is a challenge,” says ICAHN Executive Director Pat Schou.

Balancing the budget is a struggle for most rural hospitals facilities.

“You just don’t have the expertise and the resources in a small standalone facility as you do in a large facility especially from a billing contracting standpoint in managing care,” says Rogalski.
After two years of significant losses, the hospital in Aledo which was once a stand-alone county hospital decided to partner with Genesis eight years ago.
Rogalski says after the partnership the hospital was able to turn its financials around in a year.

And partnering with larger health systems is a trend Rogalski says many rural hospitals are following.

He says the partnership has helped with negotiating contracts with healthcare providers

“The funding hasn't changed but what we've gotten more sophisticated on is collecting the money. It was difficult getting payments from medicare, Medicaid from commercial payers in a timely basis,” says Rogalski.

“It's a negotiation between the manage care company (insurance) and the local entity. If you're part of a larger organization you're going to have more power at the bargaining table than if you’re just a standalone where that managing care company might say this is all we're paying you, take it or we'll send our patients elsewhere,” Rogalski adds.

Medicade expansion has also played a role in helping rural hospitals in both Iowa and Illinois stay afloat.

“Before Medicaid expansion, there was no payment for those patients,” says Rogalski. Shou says although it’s less money, for hospitals receiving some money is better than none.

Some Illinois hospitals have tried to adapt the services they provide to help cover financial needs. Shou says some facilities have begun “diversifying” by adding services like “outpatient geriatric care,” but in that process, they have created some gaps.

“Over the course of time we worked on developing new payment programs for small rural hospitals because they primarily serve Medicare population, Medicade population. And we forgot about our OB/GYN services. Our moms that want to deliver locally and many of our hospitals discontinued OB/GYN services. When I started working in hospitals in 1990 out of 50 some hospitals there were 25 that provided OB/GYN services now there are six,” says Schou.

Shou says when it comes to rural healthcare facilities in Illinois it is “not just about paying bills in rural healthcare it's too expensive or not expensive it's about how do we keep that infrastructure in place.”

The 238 rural healthcare facilities in Illinois have an ever-changing game of maintaining balance. The most recent rural hospital closure was in 2016, and there haven’t been any since. Across the United States, 107 rural hospitals have closed the last nine years. The Illinois Critical Access Hospital Network says it doesn't know of any immediate closures, however, hospitals in rural Illinois still struggle. And that is why they say these facilities must remain vigilant.