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'Rural hospitals are drowning': Exploring disparities in rural Tennessee healthcare access

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Since 2010, more hospitals have closed in Tennessee than almost any other state, disproportionately impacting rural communities. That's according to a 2021 report by the Tennessee Health Care Campaign, called "The Ambulance is Our Emergency Room."

Access to healthcare in rural areas was a topic mentioned in Governor Bill Lee's State of the State Address earlier this week.

"We need qualified, dedicated physicians and staff in rural areas," Gov. Lee said during his speech Monday night.

Judy Roitman, Executive Director of the Tennessee Health Care Campaign (THCC), tells us people who live in rural areas often have the greatest healthcare needs, but the least access.

On Wednesday, we learned more about why this is, how it impacts rural communities, and what some say needs to be done.

"Well, rural areas tend to have an older and sicker population. And they're more dependent on Medicare and Medicaid, or TennCare," said Roitman. "They tend to have more chronic disease, more diabetes, more obesity."

Dunlap resident Ryan Jordan might not fit that mold, but he did have to visit the ER a couple years back.

"I did break my arm two years ago, and it was nice to have an emergency room there for that," he said, referring to Erlanger's free standing emergency department in Dunlap.

But Jordan couldn’t find everything he needed locally.

"It just sucked that the follow up visits had to be all the way out in Chattanooga," he said. "We can use a hospital here because I mean, we have an emergency room. But when people need a certain kind of care, they don't really have it there."

According to 2020 data from the Sycamore Institute, which we obtained from the Tennessee Health Care Campaign's report on rural hospital closures, Sequatchie County is one of four counties in our Tennessee viewing area with no hospital. But there is a free-standing emergency department to help meet the needs of local residents, which is more than Meigs and Polk County have.

"The immediate emergency can be taken care of in the county, and then there's a relationship with, in this case Erlanger, to send more complex needs into Chattanooga," said Roitman, the director of THCC, about the emergency department in Sequatchie County.

If this center didn’t exist in Dunlap, nearby resident Emerald Boyd says she isn’t sure where she’d go in an emergency.

"Oh gosh, either all the way to Jasper or all the way to Chattanooga," she said.

The THCC report says over one fourth of the state's rural counties have no hospital, while one fifth have no emergency room services.

"These rural hospitals are drowning under the weight of uncompensated care," said Roitman.

She says many people in rural areas have no insurance.

"They go in an emergency to the hospital, the hospital’s required to treat them, and there's no money to pay for it," said Roitman. "The fact that Tennessee is one of 12 states in the nation that has not expanded Medicaid to cover low income adults is a real problem for our rural hospitals."

THCC's report indicates that since 2010, "Tennessee has had the second highest number of hospital closures in the nation."

Those closures create an obvious problem for people who are sick and in need of care, but it can also take a toll for other reasons, including job loss.

"In a lot of places the rural hospital is the largest employer in the county, those are really good jobs," Roitman said, also noting that it can have a negative impact on real estate value. "People love to move to our beautiful rural counties. But if they're retirees, they might think twice about moving to an area that doesn't have a hospital."

She says hospital closures can affect business development in rural communities.

"It's very hard to get a company to want to move to an area that doesn't have the infrastructure," said Roitman.

Plus, she says it can have an impact beyond the immediate community, since many rural areas are big vacation destinations, attracting people from out of town.

"For someone to be canoeing down the Ocoee and not have an ambulance, not have an emergency room to deal with whatever crisis might happen there, that's a problem too, for people visiting from out of town," noted Roitman.

Looking ahead, she says one of the big solutions is in the hands of the state.

"We would like to see the state of Tennessee expand the the TennCare program to cover uninsured, low income adults who are currently locked out of any access to health care," Roitman said, explaining that this would help hospitals get reimbursed for more of the care they're providing.

In his proposed $52.6 billion budget, Governor Lee is calling for $82 million to reimburse public hospitals for uncompensated care, primarily in rural areas. The budget also sets aside over $18 million to attract 150 new primary care residents for rural Tennessee.

"I want to applaud Governor Lee for his initiative in allocating $18.6 million toward primary care providers in rural areas. I think that's terrific," said Roitman. "But as I said, the obvious solution to the funding crisis is to deal with the Medicaid problem. And he did not do that."

Roitman acknowledges that realistically, not every rural community can sustain a full-service hospital. That's why she says the state and local communities need to explore more '21st century solutions.'

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"Maybe a freestanding emergency room, maybe more telehealth with specialists," she said. "Making more use of advanced practice nurses, nurse practitioners in rural areas."

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