What is happening in Albert Lea and Austin is playing out across our state and nation: Rural hospitals and the systems that operate them are under increasing pressure to streamline in order to keep pace with state and national goals of reducing costs, improving outcomes and moving more care from inpatient to outpatient settings. They’re also wrestling with a shrinking number of patients admitted for hospital stays, health care workforce shortages and low reimbursement rates.

The results here and elsewhere are the transformation of traditional full-service inpatient hospitals to outpatient-focused treatment, consolidation of services and (increasingly) the closing of small rural hospitals. Across the country 80 rural hospitals have closed since 2010 and a study by the National Rural Health Association shows another 673 — one-third of America’s rural hospitals — are “vulnerable or at risk of closing.” In Minnesota, two rural hospitals have closed since 2010, and many of the state’s remaining 78 federally-designated Critical Access Hospitals are under increasing pressure.

The numbers tell the tale. When two rural hospitals in relatively close proximity to each other have an average of fewer than 20 patients per day, it is difficult to sustain both. It is to Mayo Clinic Health System’s credit they have committed to keeping open both hospitals in Albert Lea and Austin, even as they gradually consolidate some services over several years. Maintaining a presence in each community is important to residents of both.

Make no mistake, modifying or downsizing rural hospitals is not only an economic exercise but carries significant human consequences for local residents. Rural hospitals are literally the life blood of the communities they serve — their largest employers and health care centers — representing tremendous economic and quality of life impacts. Making needed shifts is not the fault of any single health system, but the reality of changes in rural demographics, economics and health care policies.

National trends are also driving many necessary changes in how we deliver health care. A greater emphasis on keeping people healthy and focusing resources on outcomes more than procedures are important to improving the quality and cost-effectiveness of health care everywhere. The shift in emphasis from inpatient to more outpatient care has been growing for decades.

However, these changes cannot come at the expense of timely access to critical care in rural areas. On average, rural residents are older, less healthy, less wealthy and more isolated than urban residents, making them more vulnerable to such changes.

The threat to so many of America’s rural hospitals and communities is the reason NRHA, the Minnesota Rural Health Association and rural health advocates across America are pushing for federal legislation that would strengthen funding for our rural hospitals (Save Rural Hospitals Act, H.R. 2957). If Congress doesn’t act to stop the bleeding and prevent further rural hospital closures, an estimated 11.7 million patients across America will lose direct access to care while local economies suffer.

Steve Gottwalt

executive director

Minnesota Rural Health Association