Rural Health Care Crisis Impacts Scotland County Hospital

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By Mike Scott

“Rural health care is collapsing across the nation,” said Dr. Randy Tobler, CEO of Scotland County Hospital.

Scotland County Hospital is one of 35 Critical Access Hospitals in Missouri. The designation was created in 1997 in response to over 400 rural hospital closures in the 1980s and early 1990s.

According to the Rural Health Information Hub website, “The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, CAHs receive certain benefits, such as cost-based reimbursement for Medicare services.”

Those services are reimbursed at 65-70 percent of their cost, said Tobler. Compounding the issue is that they are only paid 30-35 percent of their reimbursement as monthly cash flow, with the balance owed paid at the end of the year.

“We have to make up the rest through commercially insured patients,” he said.

“Over 50 percent of rural hospitals are at risk,” Tobler said, citing information from the National Rural Health Association.

Metro hospitals are in better financial shape, largely because they have more commercially insured patients.

“The safety net has been pulled out from under us,” Tobler said.

“Payers tell us to do more with less, but we’ve already been doing that,” he added.

Other health care centers, such as urgent care clinics and stand-alone medical facilities, operate under a very different cost structure. For example, they do not need to be open or maintain the capacity to treat patients 24 hours a day, seven days a week.

“They are killing us, and I don’t know how we’re going to cope with that,” Tobler said.

Making the situation even worse for rural hospitals are skyrocketing expenses.

“We have been held to extraordinary increases in health care costs,” Tobler explained.

“Medical supplies have skyrocketed, and we’ve had to pay up to $200 per hour for traveling nurse service,” he added.

“Reimbursements are not keeping up,” he said.

Tobler said that he has spoken with Senators Blunt and Hawley, and with Congressman Graves, about reimbursements, but due to the divide in Washington, it’s unlike to be solved soon.

“Very little is on the horizon being done about it,” he said.

Like every business, labor costs have increased sharply in the past two years.

“We have to be competitive in the labor market.” Tobler said. “We have nearby places that are offering $10,000 dollar signing bonuses for nurses. We’ve got great people, and a lot of them could find jobs for a lot more, but they stay because they love the community.”

On Tuesday, June 28, the hospital will hold it’s monthly board meeting, which is open to the public.

“We’re going to be very open that we’re struggling financially,” Tobler said. “We don’t want to suffer the same fate as the Care Center.”

A special meeting was held earlier in June to review the hospitals service lines.

“We review all the service lines (service areas provided by the hospital) from a mission and a financial standpoint. We look at how many and which ones we can sustain. It’s a very difficult analysis,” he said.

“We will not do anything that we cannot do well, and we will not sacrifice safety,” he stressed.

Tobler didn’t expect any major decisions to be made at Tuesday’s meeting, but that contingency plans would be considered.

Tobler also explained that Scotland County Hospital’s management agreement with Blessing Health System ended January 1, and that the hospital’s relationship with Blessing remains strong.

Tobler has also expressed to the board his interest in a creating a plan of succession.

“It’s something every business should have in place,” he said.

“I’ve been CEO for seven years, and it’s time to groom a successor. The idea is to hire a new COO (Chief Operating Officer), and get them familiar with our situation and managing a Critical Access Hospital,” Tobler said. The departure of the hospital’s chief nurse and Dr. Davis earlier this year have delayed plans to find a successor to Tobler.