Map courtesy NC Hospital Association

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Seven rural North Carolina hospitals receive national recognition for excellence.

By Taylor Sisk

These are trying times for the state’s rural hospitals. Like their counterparts across the nation, they’re facing reduced reimbursements; aging, declining populations; and difficulties recruiting health care professionals.

But the news isn’t all bad.

On Monday, iVantage Health Analytics released its annual list of the nation’s Top 100 Critical Access Hospitals and Top 100 Rural & Community Hospitals. North Carolina was recognized with three hospitals on the critical access list and four in the rural and community category.

iVantage provides analytics and decision-support tools to health care providers. In compiling its Top 100 lists, it weighs more than 70 performance measures, including quality, outcomes, patient satisfaction, safety and cost.

The critical access hospitals honored are all in the western region of the state: Angel Medical Center in Franklin, Ashe Memorial Hospital in Jefferson and Transylvania Regional Hospital in Brevard.

Map courtesy NC Hospital Association

The four rural and community hospitals selected are Carteret General Hospital in Morehead City and Sentara Albemarle Medical Center in Elizabeth City, both on the coast; Johnston Health in the Piedmont town of Clayton; and Northern Hospital of Surry County in Mount Airy, 45 minutes northwest of Winston-Salem.

North Carolina’s rural hospitals routinely ascend to “Best Of” status in national polls. But Jeff Spade, executive vice president of the North Carolina Hospital Association’s NC Center for Rural Health Innovation and Performance, cautioned in an interview with North Carolina Health News earlier this year that it’s not something that should be taken for granted.

Support from the federal and state governments is critical, Spade said. The payoff is neighbors caring for one another.

‘Time bomb’

The Top 100 ratings come three months after the release of iVantage’s “2016 Rural Relevance: Vulnerability to Value” report, which found 673 of 2,078 rural hospitals across the country are “vulnerable or at risk for closure.”

Of those 673, two-thirds are critical access hospitals. CAHs are hospitals with fewer than 25 beds and more than 35 miles from the next nearest hospital. They’re required to provide around-the-clock emergency care services.

Cathy Landis is CEO and chief nursing officer of Transylvania Regional, selected a Top 100 Critical Access Hospital by iVantage Health Analytics. Photo credit: Taylor Sisk

There are 1,284 CAHs in the country. North Carolina has only 21 – three of which made that Top 100 list.

But CAHs are under particular duress.

Just prior to the release of the “Rural Relevance” report, federal Department of Health and Human Services Sec. Sylvia Burwell announced a plan calling for 85 percent of all hospital Medicare reimbursements to be tied to performance by 2016, and 90 percent by 2018.

Medicare is typically these hospitals’ largest payer, and CAHs now receive cost-based reimbursement from the program. That means CAHs receive payment based on 99 percent of allowable costs, whereas non-CAH hospitals are reimbursed based on a fixed rate – often lower than their costs – as determined by the federal Centers for Medicare and Medicaid Services.

iVantage’s “Rural Relevance” report called the shift to the value-based payment model a “financial time bomb” for these hospitals.

In the neighborhood

Spade believes the state’s critical access hospitals can compete in this value-based world. Health care costs are generally lower in rural areas, he pointed out, in part because of generally lower overhead. And small hospitals, he said, are well capable of delivering in quality of service and patient satisfaction.

“They can deliver in the new world of health care, the value that’s being sought,” Spade said, “but they won’t get there if they’re not resourced for it – and that would be a shame.”

When you work in a critical access hospital, he said, “you’re working and living with your neighbors, friends and colleagues.” The federal and state government should therefore provide resources “to ensure the value rural North Carolina [communities] can bring to their local low-income populations.”

These communities can succeed, Spade said, through the transformation to a focus on population health based on keeping people out of the hospital. But, he said, they’ll need assistance with, for example, implementing health IT and other support systems, and with recruiting health care professionals.

“It can be done, but we’ve got to be wise about it,” Spade said. “We’ve got to think about it and we’ve got to resource it.”

See you in church

Cathy Landis, CEO and chief nursing officer of Transylvania Regional, one of the three North Carolina critical access hospitals selected to this year’s Top 100, echoed Spade’s observation about the importance of a hospital to a small, rural community.

This year’s honor is nothing new for Transylvania Regional: The hospital has made it into iVantage’s Top 20 for three consecutive years, and Landis said the foundation of its success “is absolutely the passion and community commitment.”

One of the hospital’s orthopedic surgeons once told her that it was really quite simple: If he’s going to operate on your hip and then see you two weeks later in church, he’d darned well better feel a total commitment.

“It’s a heightened commitment, I think,” Landis said, “just because you’re treating your neighbor.”

[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]

Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...