“Be sure you put your feet in the right place, then stand firm.” – Abraham Lincoln
While snow continues to fall in northern Michigan, spring is officially here, and for many, that means our weekend travel plans shift from skiing and snowmobiling to camping, hiking and boating. Rural Michigan is an amazing travel destination for many, but it also is home year-round to 20% of our state’s population, and access to affordable, high-quality healthcare remains absolutely crucial. Rural hospitals are an integral part of the local fabric of their communities, treating the ill and improving the health and well-being of their residents. They work extremely hard to make sure they’re able to provide the best quality of care, while operating on a budget with slim to nonexistent margins. In a small town, there is nowhere to hide when the hospital is experiencing challenges of any kind. This is especially true when the hospital is the largest employer in the community and a vital economic engine, which is very often the case in rural Michigan.
I recently had the opportunity to attend the annual American Hospital Association (AHA) Rural Health Care Leadership Conference, along with a number of MHA senior staff and Michigan rural healthcare leaders, including Tina Freese Decker, CEO of Corewell Health and current chair of the AHA Board of Trustees; Julie Yaroch, DO, CEO of ProMedica Charles and Virginia Hickman Hospital and current chair of the MHA Board of Trustees; and JJ Hodshire, CEO of Hillsdale Hospital, current MHA Board member and host of the Rural Health Today podcast. We focused on the latest rural health challenges and innovations, as well as our shared federal advocacy priorities. Key topics included rural obstetrical care, cybersecurity, long-term care transformation and strategic partnerships.
According to the latest U.S. census and other demographic resources, rural Americans are notably older, sicker and poorer than their urban and suburban counterparts. While rural areas currently cover 97% of the nation’s land, they are home to only 19.3% of the total population. Demographers believe that we are moving toward a future state in which an even higher concentration of the population will be in non-rural settings – and that in the next five years, more than 40% of Michigan counties will have more than a quarter of their population older than 65, with nearly all of those counties being rural. As we have learned – especially during the COVID pandemic – traditional volume-based healthcare reimbursement methods do not adequately address the fixed costs inherent in healthcare delivery, a reality that is exacerbated for rural hospitals with smaller patient volumes and more constricted resources and economies of scale.
Although Medicaid expansion (a major accomplishment resulting from MHA advocacy) improved the viability of rural hospitals – a fact that is borne out when benchmarking Michigan to non-expansion states – that funding is currently in severe jeopardy given the current state of play in Washington, D.C., as discussed at length in last month’s CEO Report. In addition, the 340B program is another critically important part of the rural healthcare ecosystem, as the cost savings from the program are used by healthcare providers to offer critically important services to everyone in their respective communities, regardless of their socioeconomic status. The MHA continues to advocate at the state and federal level, in the legislative arena and in the courts, to protect and defend the 340B program.
With guidance from the MHA Council on Small or Rural Hospitals, currently chaired by Peter Marinoff, CEO of Munson Healthcare Southern Region (see Peter’s recent insights on rural healthcare), and staffed by Lauren LaPine, MHA senior director of Legislative and Public Policy, the MHA is also advocating for continuation of the rural access pool and obstetrical stabilization fund in the state budget, and promoting good public policy with respect to critical access hospitals, rural emergency hospitals and a host of other key issues.
Our rural healthcare leaders continue to prove they are exceptional at delivering extraordinary value, despite challenging circumstances. I know from first-hand experience that our rural hospitals provide high quality care and deserve to be fully supported. And we absolutely must support them, as the fragility of the current environment is real: there have been some 151 rural hospitals that have closed across the country since 2010 due to financial variables that make it extremely difficult to maintain hospital facilities in rural areas.
Now more than ever, we need to think about our rural hospitals, stand firm and do all we can to protect these vital institutions.
As always, I welcome your thoughts.
U.S. Rep. Jack Bergman (R-MI) recently co-sponsored HR. 538, the Critical Access Hospital Relief Act of 2025, which would remove the 96-hour physician certification requirement for inpatient services at critical access hospitals.
