1. Rural Health Care Past, Present and Future

2. 1946  The Hospital Survey and Construction Act (aka Hill-Burton Act)  Designed to provide federal grants and guaranteed loans to imprve the physical plant of the nations hospital system.  The states were to achieve 4.5 inpatient beds per 1000 people. (2.0 in Colorado today)

3. Rural Hospital Role in the United States  Rural hospitals account for about one- third of the nations Hospitals  Rural hospitals account for about 12 percent of national hospital spending  Rural Hospitals are often the largest or second largest employers in the towns where they are located.

4. Survival in the 80’s and 90’s  From 1980 through 1998, there was an 11.8% decrease in community general hospitals.  In the late 90’s new policy was developed to help these hospitals generate adequate income for survival.  Critical Access Hospitals and Rural Health Clinics with enhanced Medicare reimbursement.

5. It’s 2015 and the world is changing  For Critical Access Hospitals and Rural Health Center, they lose money on every Medicare and Medicaid patient that goes through their door (50-75% if their patients).  50 rural hospitals have closed since 2010.  35% are operating at a loss.  It has been estimated that over 280 are vulnerable to closure.

6. What does the Future look like?  Continue aging population, so need will grow.  New models of care  Value based payment models and an uncertainty of how rural facilities fit in the model.