The (Fort Wayne) Journal Gazette
State officials have recognized Angola’s Cameron Memorial Community Hospital and a physician with Parkview Health for their commitment to rural communities, which are suffering through a health care crisis.
Dr. Eric Reichenbach, a family medicine physician at the Parkview Wabash Health Clinic in North Manchester, won the Outstanding Rural Health Provider Award. Cameron Memorial won the Quality Improvement and Critical Access Hero awards. The two received the commendations through the Indiana Department of Health and State Office of Rural Health Critical Access Hospital Award program.
Unfortunately, such health oases are rare in rural America. Since 2015, nine rural Indiana hospitals have closed including four since 2022. IU Health Blackford is the latest to close its doors in October.
“One of the challenges for rural communities is the ability to recruit and retain health care providers, especially obstetricians,” said Laura Kracher, vice president of public affairs and communication for the Indiana Hospital Association. “In Indiana, 87% of rural residents live in areas with a primary care shortage.”
The U.S. Department of Health and Human Services lists Noble, DeKalb, Whitley, Huntington and Adams counties as health professional shortage areas.
In looking at data from the federal Rural Health Information Hub, the counties that collar Fort Wayne and Allen County have a shortage of physicians per 10,000 people. For example, Allen County has 28.7 physicians per 10,000 residents. Huntington is at 13.3, while Adams is at 5.3 doctors per 10,000. Both counties have about 36,000 residents, showing the disparity isn’t about county size.
The numbers are even more stark when looking at the availability of nurse practitioners and physician’s assistants in those counties. NPs and PAs are graduate-level trained and licensed professionals who can provide primary care.
According to National Rural Health Association data, 25% of Indiana’s 55 rural hospitals have “negative operating margins,” 13 have pulled back service and seven hospitals considered closing. The association did not mention facilities by name.
Meanwhile, the health disparities between rural and urban areas are pronounced and startling, with the people in the former being older and more prone to chronic conditions such as lower respiratory disease, heart disease, stroke and cancer. Rural men and women will live about three years fewer than their urban counterparts.
Cancer care, mental health and dialysis are the most difficult services to access for rural Hoosiers.
Indiana Hospital Association’s Kracher points to low Medicaid reimbursement as a significant challenge for hospitals, particularly in rural areas where more than half of annual births are covered by Medicaid. In Indiana, hospitals are experiencing significant financial losses due to inflation and rising costs, she said.
Medicaid expansion — Indiana was the first red state to expand in 2015 — improved the financial performance of hospitals and other providers particularly for rural and small hospitals, according to the Kaiser Family Foundation survey of research released in June.
But the amount paid by Medicaid has not changed in 30 years to keep up with costs, Kracher said.
According to an outside analysis the Indiana Hospital Association commissioned surveying inpatient operating base rates, the standard amount of Medicaid reimbursement paid in Indiana is $3,524. Kentucky and Michigan, which have compiled complex methodologies that include legislatively approved base rate increases, paid average amounts of $5,796 and $4,996, respectively. Ohio’s base rate is just over $5,000.
“Policy solutions are needed to raise Medicaid reimbursement for hospitals now so that we don’t erode access to vital health care services or see our rural and urban safety hospitals close,” Karcher said. “Policymakers in neighboring states like Kentucky and Illinois have successfully enacted policies to raise their reimbursement levels just in the last year. Without immediate financial support, Medicaid shortfalls will only exacerbate the emerging trends of service reductions and facility closures across the state.”
Indiana can’t hold itself as inclusive and equitable if we’re telling 1 million rural Hoosiers that the choice for living in the country is to submit to a growing health care desert.
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