HLM: Why are rural hospitals struggling even more than their urban and suburban counterparts?
Lewis: Rural hospitals do not have the population to support specialty services. Larger hospitals have in some cases very large sums of money entirely as a result of specialty services they provide including cardiology and orthopedics and oncology. In small rural hospitals it is a rarity to see a surgeon. It takes eight family practitioners to support one surgeon. It takes about 5,000 people to support a family practitioner. So you have to have 40,000 to support a surgeon. Well, that is just not there.
HLM: What needs to be done to keep rural hospitals viable?
Lewis: Somewhere along the line, a decision will be made that we will either try to address rural America or we will just let it go to Hell. Right now it is in the process of going to Hell because the payers don't have any sensitivity to save the rural segment.
It is easier for them to cut rates to rural hospitals because they have less ability to negotiate because they don't have the volumes. Until such time as policy makers mandate that insurance companies reconsider the rural part of the nation we are going to have a situation in Georgia and nationally where the people who live in rural communities are going to be very old and on Medicare, or they are going to be unemployed and uninsured or on Medicaid and it is going to be a tremendous financial burden on all the states.
HLM: Is there any good news out there for rural providers?
Lewis: If you look at what is coming out of Washington, there was a recent proposal to do away with critical access hospital designation. That is the vehicle that has kept those hospitals going and somebody wants to eliminate that! The only good news is those people in rural healthcare have the passion to help people and help them survive. The American spirit does live on.