These findings suggest that profound changes are underway for rural hospitals in Tennessee. If nearly half of the potential patient base is driving past the door to get the same services farther from home—for whatever reason—that challenges financial viability. Hospitals that don't attempt to understand that migration and that don't adapt to that migration will shutter.
"These hospitals are going to find themselves forced to either go it alone or sell to a for-profit or somebody like that who knows how to do it, because the reality is a lot of these places are not financially viable," Coulter says.
Maybe it's time for rural hospitals to wave the white flag for elective procedures and instead focus on services that take advantage of their proximity to patients: Trauma and chronic care.
"Trauma is 'every minute counts,' but there are diseases like myocardial infarction and pneumonia where minutes really do count as well," Coulter says.
"It has also been shown that the most appropriate and best intervention for myocardial infarction is on-the-spot angioplasty and not the clot busters that for so long we thought were the equivalent. In other words, if you don't have a cardiac cath lab, you aren't serving the people in your community. If anything, you may be just slowing them down from getting where they need to go."