Roxanne Cotter, vice president of the La Grange Area Chamber of Commerce, said it was a shock when St. Mark’s Medical Center in La Grange, Texas, announced last month that it would become a Rural Emergency Hospital.

“It took all of us by surprise,” she said.

A type 2 diabetic, Cotter said she’s been to the hospital four times in the past year for overnight stays to treat her diabetes. Now, she said, she’ll have to travel to hospitals in other communities, some 20 or more miles away, for the same treatment.

Hospital officials said the move to become a Rural Emergency Hospital, or REH, wasn’t a decision the board took lightly, but one that kept the hospital from closing. Area residents said the move adds even more barriers to healthcare for the 25,000 residents in Fayette County, Texas, where La Grange is located.

In January, the federal government instituted the REH designation – one that provides higher compensation rates from the Centers for Medicare and Medicaid Services – as a way to help rural hospitals stay afloat in the midst of financial stresses. Studies indicate that of the nearly 2,200 rural hospitals across the country, as many as one in five is in danger of closing.

But the new designation comes at a cost. REHs must provide emergency services 24/7, and cannot provide in-patient services.

As part of the switch, St. Mark’s will no longer be performing inpatient services, surgical services, orthopedic clinics, skilled rehab care, ambulatory care or speech therapy. However, the hospital would still provide many outpatient services like cardiovascular imaging and x-ray services; lab work; nuclear medicine; occupational and physical therapy; respiratory therapy and wound care.

Cotter said her concern wasn’t with herself, but with others accessing care. While the change will mean she may have to travel to a nearby hospital for treatment, that’s something she is able to do.

“What’s even more of a concern for us is that there are a lot of elderly in our community,” she said. “We need that hospital for people who may not have access to transportation to get to other hospitals.”

Karen Killian, a former surgical nurse for the hospital, said the switch left many people scrambling to reschedule surgical procedures.

“We had cases scheduled every day,” she said. “That last week, the orthopedic surgeon had several surgeries scheduled. Those patients were given the option to follow their doctor and have the surgeries done at another hospital.”

Her concern is the residents in the nursing homes throughout Fayette County.

“We had some patients who came from the nursing homes here. Some of them have no family to help them,” she said. “If their neighbors have to drive them all the way to another hospital, will that affect their care? How will they get home?”

But Kent Babcock, a retired nurse anesthetist who worked at St. Mark’s until his retirement in 2016, said the REH designation is close to what rural communities need.

“What is needed in rural settings as I see it is, unfortunately, things that don’t pay,” Babcock said. “You need an emergency room facility (for) getting care quickly, and then the other thing you need is a birthing center.”

St. Mark’s closed its maternity services in 2017 to save money, he said. What supports a rural medical center, he said, are the elective surgeries, like total joint replacements.

“But, quite frankly, if you’re going to have a total joint replacement, which is a totally elective procedure, you can go to Austin or Houston,” he said. “We’re simply not that far now to other hospitals. Those are not convenient for anyone, certainly, but it’s not that far away to get very definitive types of healthcare.”

And getting those procedures done in La Grange wasn’t something a good portion of the community was doing, he said.

“Years ago, we were able to support three nurse anesthetists doing enough cases to keep three and four operating rooms running Monday through Friday,” he said. “La Grange has a lot of retirees from Houston and Austin… They have their doctors and physicians in the cities and they would go to the city (instead of St. Mark’s).”

According to Mark Kimball, St. Mark’s president and CEO, that factored into the decision to move to an REH. Kimball said declining patient volumes and increases in uncompensated care were part of the hospital’s challenges.

“Similar to other rural areas, our community frequently utilizes us for emergency and outpatient services, but bypasses us for many inpatient and surgical services,” he said.  

Kimball said if patient volumes increase, St. Mark’s could turn back the new designation.

“Rural Emergency Hospital is the only viable option at this time,” he said. “If our patient volumes increase and our financial status improves, one of the benefits of REH is that St. Mark’s could reopen inpatient and surgical services.”

But just becoming an REH is not a panacea, Kimball said.

“Even with this new designation, St. Mark’s will need additional financial support from the community to survive,” Kimball said.

Cotter said the chamber and others in the community are working to determine what options are available to reverse the REH designation, and to keep the hospital open.

“We’d like to be a part of the conversation,” she said of the Chamber’s involvement. “The (Chamber) board chair and I have started doing research on rural funding opportunities… We think it will be a combination of philanthropic and government funding that will be necessary to keep the hospital operating.”

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