Rural Midwest communities losing their hospitals have few health care options | KCUR

Half a dozen Gouldian finches greet patients with their chirps from a cage in the waiting room of the Boone Health Primary Care Clinic in Mexico, Missouri. The birds belong to Dr. Peggy Barjenbruch, who along with Dr. Michael Quinlan, has served the Mexican community for decades.

That looked like it might end last fall when the hospital they were affiliated with, Audrain Community Hospital, suddenly closed.

Audrain Community Hospital has been a community fixture since its founding in the 1980s, but in September it joined a growing list of rural hospital closings. More than 130 rural hospitals in the US have closed in the last decade. Dozens of those closings occurred in the Midwest, including 10 in Missouri, amid pressure from shrinking populations and lower reimbursement for care due to uninsured patients.

In many rural towns, local hospitals are community attachments. When they close, the entire community feels the ripples and access to critical health care is compromised. For Barjenbruch and Quinlan, the closure brought uncertainty.

“We always thought we were old enough to go on,” Quinlan said.

Quinlan, originally from Mexico, grew up with the hospital at the heart of the Mexican community. It closed shortly after the change of ownership for the second time in two years. Noble Health Corporation, based in Kansas City, Missouri, had acquired the hospital in 2021.

Sebastian Martinez Valdivia

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KBIA

After growing internal turmoil at the company, Noble sold the hospital to Texas-based Platinum Team Management, which closed the facility. Quinlan said toward the end, staff were working without pay to continue serving the community.

In the wake of the closure, the Audrain County Health Department had to step in, setting up a hotline to answer patient questions, said CEO Craig Brace.

“We had a nurse dedicated to looking at these questions and finding answers and making them available,” Brace said.

But some of these questions did not have easy answers. The closing of the local hospital means the closest option for urgent care and other inpatient services is 40 miles away, in Columbia.

Quinlan said this left his patients in a difficult position.

“You'll hear some mornings that, 'Oh, I had chest pains at 2 in the morning and I was waiting to see if I could see you guys,'” he said. “… We don't want to risk it.”

Patients have also postponed important appointments such as cancer screenings, Quinlan said, maintaining hope that the hospital will reopen.

There is no sign that this will happen anytime soon, but other providers have moved on. MU Health has opened two clinics in Mexico in the summer, including an urgent care center. And Boone Health acquired Quinlan's hospital outpatientclinic in October.

Boone Health CEO Troy Greer saw benefits from the move for both his health system and the community.

Sebastian Martinez Valdivia

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KBIA

“It allows Boone to continue to grow in those areas to serve their needs, but also [creates] a more convenient place for those people to use Boone services,” Greer said.

But taking action to manage the hospital is not something Boone or any other institution can do, according to Greer.

An option for urgent care that has multiplied in other states it is the freestanding ER — an emergency department not affiliated with a hospital. Freestanding ERs can often provide faster care than traditional ERs, but they can also be accompanied by higher price tags.

While much of the independent ER wave has come to suburban areas, it may be an option for rural towns as well, said Dr. Cedric Dark, assistant professor of emergency medicine at Baylor College of Medicine in Houston studying independent ERs.

“When we talk about closing rural hospitals, I think you should at least be able to keep the ER open as a freestanding ER because people in those communities still need access to urgent care,” Dark said.

Regulations many states, including Missouri, effectively ban independent EPs. According to the Missouri Hospital Association, the state does not recognize or license independent ERs.

That means communities like Mexico have to find other ways to keep their hospitals open, either through private investors or individual investors.

Quinlan and Brace were optimistic about a potential investor who had expressed interest in reopening the hospital. But, according to Quinlan, Platinum recently sold the property to another buyer.

Instead, Quinlan said the newly enacted federal rural emergency hospital designation it's an estimate. This will allow the hospital to reopen its emergency department and provide outpatient care.

However, Quinlan said there are also plans to open a micro-hospital at a different location — offering emergency services and some inpatient care — if Audrain Community does not reopen.

This story comes from a collaboration between KBIA, Side Effects Public Media, based on WFYIand the Midwest Newsroom — an investigative journalism partnership that includes IPRKCUR 89.3, New Nebraska Public Media, Public Radio St. Louisand NPR.