Bucktail Medical Center, an independent hospital in western Clinton County, Pennsylvania, is asking for nearly $1.5 million on the crowdfunding platform to help it stay open. 

Tim Reeves, the hospital’s administrator, said in an interview with the Daily Yonder that the 16-hospital bed and adjacent 43-bed nursing home are the only hospital with in-patient facilities for nearly 40 miles. While the hospital has struggled for years, he said, it had just come out of bankruptcy reorganization and plans were being made to attract more patients and increase revenue.

But some unexpected financial news hit the hospital hard. 

Over the course of less than two weeks, the hospital saw a series of financial setbacks. First, one of its employee retention credit applications, worth up to $400,000, was delayed. That filing became mired in a bureaucratic chain of events that meant a delay of up to 14 months. Next, the Pennsylvania Department of Human Services sent a notice that it had overpaid the hospital in 2018, and they needed to pay back $255,000.

“They want to recoup that and the way they do it is they just stop paying us our medical assistance payments until they make it up,” Reeves said.

Following that, the hospital was informed by one of its commercial insurers that the hospital needed to pay back $82,000 because of documentation problems over physical therapy charges, and then the company that provided physical, occupational, and speech therapy announced they were pulling their services out of the hospital, eliminating that potential revenue stream.

“Could we weather one of those? Probably,” Reeves said. “But the four of those together? It’s just made it impossible to have the cash that we need to operate.”

Without some short-term funding, Reeves said, the hospital may be forced to close. 

The idea to put a fundraising call out on GoFundMe came from one of the hospital’s board members, he said. So far, the campaign has raised just over $15,500.

Still, the hospital is working with its state legislators and Congressmembers to get some help.

“We’re in contact with all of them pretty much on a weekly basis, and they’ve been able to come up with some things to help in the long term, but not a lot so far for short-term assistance,” he said. “We’re trying to reach out in every direction that we can, it just seems very difficult to find any readily available funding.”

Bucktail’s situation is not far off from that of other rural hospitals. According to the Chartis Center for Rural Health, 141 rural hospitals have closed since 2010. Of the rural hospitals in the U.S. nearly half (43%) are operating in the red, the center said.

“There are 453 rural hospitals that are considered vulnerable to closure, over 215 of them at high risk,” Brock Slabach, COO of the National Rural Health Association, told The Daily Yonder. “I’m hearing about more financial distress in rural hospitals, due to lower volumes and increased expenses, especially due to higher labor costs.”

Slabach said the situation at Bucktail is one that the NRHA is monitoring.

Reeves said when he took over Bucktail Medical a little over nine years ago, the hospital was struggling. After filing for Chapter 11 organization in 2015, it seemed like there was a light at the end of the tunnel when the hospital came out of bankruptcy in 2018. But when the Covid-19 pandemic hit, financial stresses came with it.

Once the pandemic subsided, the hospital decided to change the facility in order to better meet the needs of the community, he said, and to increase patient volume.

“We’d come up with a master plan,” Reeves said in an interview with the Daily Yonder. “We’d started to implement the first two steps of that, which was to start up our ambulance service, which we did on June 15, and to increase our diagnostic testing ability.”

In October, the hospital will have a CT facility in its parking lot to add to the hospital’s diagnostic abilities. Previously, he said, patients might be transported to other facilities with better diagnostic capabilities but would never return for treatment.

“We were hoping that these two improvements would generate greater patient volume,” he said. “Increased patient volumes in our emergency room will also increase patient volumes in our acute care hospital, but also generate revenue through other services like our laboratory, physical therapy, and other things.” 

Kyle C. Kopko, executive director for the Center for Rural Pennsylvania, said in an email interview with the Daily Yonder there are 18 hospitals in that state that are at risk for closure. There is pending legislation in the state that would help struggling rural hospitals, but nothing has been enacted yet, he said.

The nature of rural hospitals makes them financially vulnerable, Kopko said. Rural hospitals tend to have higher percentages of patients on Medicare and Medicaid, but reimbursement rates for those patients are inadequate. Additionally, declining populations in rural areas lead to less demand for services, while staffing shortages lead to hospitals relying on more expensive contract workers.

NRHA’s Slabach said that as the federal government reduces the number of people on Medicare and Medicaid, it’s an issue that will face many more struggling rural hospitals.

“We’re now at over seven million people having been disenrolled from Medicaid coverage,” Slabach said. “This won’t help troubled rural hospitals, that’s for sure, since rural communities have higher percentages of older, sicker, and poorer populations than their urban counterparts.”

Still, Reeves said, the hospital is working with its vendors and trying to meet its payroll every week. At 85 employees, it is the largest employer in western Clinton County, he said. The impact of the hospital closing would be devastating for the county, he said.

As he works on a short-term solution, there are long-term decisions America has to make about healthcare in rural areas, he said.

“I think as a society we need to make a choice – do all Americans deserve the same level of health care?” he said. “Are we okay with the disparity where you may receive a lesser quality of health care because of where you decide to live?”

In the meantime, Reeves said he will continue fighting for Bucktail and the community it serves.

“We are still providing services, we’re still billing, we’re still collecting some money, but it just has not been enough,” he said. “We’re going to keep pushing as long as we can. And we’re going to keep looking for solutions until we find something that works.”

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