CEO Thoughts

Submitted By Tony Keene, MBA

Chief Executive Officer – SCMH

What is the future of rural healthcare?  That is a question that is being hotly debated in many political circles these days.  For many of us that live in rural areas, access to quality healthcare that is close to home can have a profound impact on our lives.  In decades past, rural healthcare was the lifeblood of many communities.  Local doctors lived and practiced in small towns and were an integral part of their communities.  Even in small counties there was at least one hospital, often located in the county seat and it was a major employer for the region.  While small compared to their urban counterparts, these communities and their hospitals thrived.  Unfortunately, over the last 30 years the gap between urban and rural communities and hospitals has increased at an alarming, and some might say, irreversible rate.

According to a recent article in Bloomberg’s, at least 30 hospitals across the US filed for bankruptcy protection in 2019.  Another article in Becker’s Hospital Review stated that more than 15 hospitals closed their doors permanently in 2019.  There has already been another hospital closure in Missouri this year with the announcement of Pinnacle Regional Hospital in Boonville closing on January 15th.  This closure marks the 7th hospital closure in Missouri since 2015.  The communities facing these financial struggles and closures will be deeply impacted for years to come due to the loss of jobs, the loss of local access to healthcare, and the economic impact to the communities at large due to the inevitable loss of a substantial tax base.

For Sullivan County Memorial Hospital, our well-being as a healthcare provider depends on many factors that are out of our control.  A good portion of our patient base utilize some form of government payor for their health insurance.  A recent calculation by the American Medical Association estimated that payments from Medicare and Medicaid lagged costs by $76.6 billion in 2018.  What that means is that often the cost to provide the service is higher than the reimbursement received for the service.  As a wise person once told me…you can’t buy $5 watermelons and sell them for $2; that is not a sustainable business model.    

A report issued by the Missouri Hospital Association discusses many of the alarming disparities between rural Missouri and urban Missouri.  Higher rates of smoking, higher rates of obesity, lower educational achievements, higher rates of heart disease and cancer deaths, and an overall lower life expectancy are characteristics of the rural experience in Missouri.  In generations past, the answer to many of these issues was a robust primary care network in the rural communities with doctors working with patients to better manage these chronic diseases and socio-economic issues.  The MHA study also found that primary care physicians in rural areas are increasingly more difficult to find.  According to the study, there are 55.9 primary care physicians for every 100,000 rural residents in Missouri; that compares to 139 per 100,000 urban residents.  Further compounding the issue is that nearly 61% of primary care physicians in rural areas are over age 50, with almost 9% over age 70.  PCP’s under the age of 40 are moving to the urban areas in vast numbers where they can enjoy a more positive work/life balance compared to their rural peers.   

As I look at the future of Sullivan County Memorial Hospital and healthcare in our area, I see a future of continued struggle, but one of optimism as well.  The easy answer to how do we ensure continued access to healthcare in our community is simple…support your local healthcare providers.  We have high quality practitioners and support staff at all levels here in Sullivan County and we continue to pursue additional providers to fill needed vacancies.  Do we have everything you can find in Columbia or St. Louis or Kansas City?  No, but what we do have, we do very well and what we don’t have, we will work hard to get you stabilized long enough to get you where you need to be.  

As we look ahead to the challenges in front of us, we will hold to our original mission…to meet the healthcare needs of our community by providing quality health services designed to restore and cultivate good health.  Sullivan County Memorial Hospital is YOUR community hospital.  We are here when you need us.