From Becker’s Financial Management

Rural hospital closures picked up in 2023 and nearly 700 rural hospitals face continued risk of closing due to serious financial challenges, with some states facing critical conditions in the short term.

The finding comes from the Center for Healthcare Quality and Payment Reform’s latest report, “Rural Hospitals at Risk of Closing.” Eight rural hospitals closed in 2023, as many as in 2022 and 2021 combined, according to the report. This followed a landmark 18 rural hospital closures in 2020, more than any year in the previous decade.

Based on the latest hospital financial information released by CMS in April 2024, CHQPR analyzes rural hospitals’ financial vulnerability in two ways: risk of closure and immediate risk of closure.

For the first category, there are hospitals at risk of closure in nearly every state. This is partly measured by financial reserve limitations that cannot offset hospital losses on patient services for more than six to seven years. In more than half of states, 25% or more of the rural hospitals are at risk of closing; in eight states, the majority of rural hospitals are at risk.

Immediate risk of closure is partly measured by tougher financial reserve limitations: those that could offset hospital losses on patient services two to three years at most. Over 300 rural hospitals are at immediate risk of closing because of the severity of their financial problems, with nearly half of rural hospitals in New York and Alabama facing such an outlook.

Given that immediate risk of closure is the more urgent of the two categories, Becker’s has ranked 25 states by the percentage of their rural hospitals at risk of closure in the next two to three years maximum. The listing for each state also contains broader information about the number of hospitals at risk of closure over the next six to seven years. The report from CHQPR assessing each state’s rural hospital health and risks can be found in full here.

New York
45% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years
57% of rural hospitals — 29 — are at risk of closure in the next 6-7 years

Alabama
44% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years
58% of rural hospitals — 30 — are at risk of closure in the next 6-7 years

Mississippi
34% of rural hospitals — 25 — are at immediate risk of closure in the next 2-3 years
52% of rural hospitals — 38 — are at risk of closure in the next 6-7 years

Connecticut
33% of rural hospitals — 1 — are at immediate risk of closure in the next 2-3 years
67% of rural hospitals — 2 — are at risk of closure in the next 6-7 years

Tennessee
31% of rural hospitals — 17 — are at immediate risk of closure in the next 2-3 years
35% of rural hospitals — 19 — are at risk of closure in the next 6-7 years

Vermont
31% of rural hospitals — 4 — are at immediate risk of closure in the next 2-3 years
62% of rural hospitals — 8 — are at risk of closure in the next 6-7 years

Oklahoma
29% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years
43% of rural hospitals — 34 — are at risk of closure in the next 6-7 years

Arkansas
29% of rural hospitals — 14 — are at immediate risk of closure in the next 2-3 years
53% of rural hospitals — 26 — are at risk of closure in the next 6-7 years

Maine
28% of rural hospitals — 7 — are at immediate risk of closure in the next 2-3 years
44% of rural hospitals — 11 — are at risk of closure in the next 6-7 years

Virginia
27% of rural hospitals — 8 — are at immediate risk of closure in the next 2-3 years
30% of rural hospitals — 9 — are at risk of closure in the next 6-7 years

Kansas
26% of rural hospitals — 26 — are at immediate risk of closure in the next 2-3 years
56% of rural hospitals — 57 — are at risk of closure in the next 6-7 years

Florida
24% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years
38% of rural hospitals — 8 — are at risk of closure in the next 6-7 years

Nevada
23% of rural hospitals — 3 — are at immediate risk of closure in the next 2-3 years
38% of rural hospitals — 5 — are at risk of closure in the next 6-7 years

New Mexico
21% of rural hospitals — 6 — are at immediate risk of closure in the next 2-3 years
25% of rural hospitals — 7 — are at risk of closure in the next 6-7 years

West Virginia
21% of rural hospitals — 6 — are at immediate risk of closure in the next 2-3 years
36% of rural hospitals — 10 — are at risk of closure in the next 6-7 years

South Carolina
20% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years
40% of rural hospitals — 10 — are at risk of closure in the next 6-7 years

Massachusetts
20% of rural hospitals — 1 — are at immediate risk of closure in the next 2-3 years
40% of rural hospitals — 2 — are at risk of closure in the next 6-7 years

Texas
18% of rural hospitals — 29 — are at immediate risk of closure in the next 2-3 years
48% of rural hospitals — 77 — are at risk of closure in the next 6-7 years

California
18% of rural hospitals — 10 — are at immediate risk of closure in the next 2-3 years
32% of rural hospitals — 18 — are at risk of closure in the next 6-7 years

Louisiana
17% of rural hospitals — 9 — are at immediate risk of closure in the next 2-3 years
44% of rural hospitals — 23 — are at risk of closure in the next 6-7 years

Pennsylvania
17% of rural hospitals — 7 — are at immediate risk of closure in the next 2-3 years
32% of rural hospitals — 13 — are at risk of closure in the next 6-7 years

Missouri
16% of rural hospitals — 9 — are at immediate risk of closure in the next 2-3 years
38% of rural hospitals — 21 — are at risk of closure in the next 6-7 years

Georgia
15% of rural hospitals — 10 — are at immediate risk of closure in the next 2-3 years
32% of rural hospitals — 22 — are at risk of closure in the next 6-7 years

Colorado
12% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years
21% of rural hospitals — 9 — are at risk of closure in the next 6-7 years

Alaska
12% of rural hospitals — 2 — are at immediate risk of closure in the next 2-3 years
18% of rural hospitals — 3 — are at risk of closure in the next 6-7 years

Congratulations to the 90 local government groups selected to receive training and funding through our READY Local Governments capacity-building program!  Fifteen are in Pennsylvania!

Each of the 90 participating local governments will receive nine-weeks of no-cost training designed to help them identify, manage and implement federally-funded projects. 🛠️ Many of the participant entities serve economically distressed or historically marginalized areas.

READY Local Governments is one learning track in our READY Appalachia initiative, which aims to increase the region’s capacity to solve its most pressing issues. ⏱️ Stay tuned to apply to our next READY learning track — READY Foundations!

The Pennsylvania Broadband Development Authority (PBDA) opened its BEAD Challenge Submission Window this morning. The Challenge Portal is available online. If you are an eligible participant for the challenge process and have not registered, you will need to complete a registration before you can submit challenges.

The PBDA strongly encourages that all Internet Service Providers (ISPs) register for the challenge portal so they may be notified of challenges they may receive through the portal.

Please visit the BEAD Challenge webpage for additional details to include registering for the BEAD Challenge portal, review the public map that identifies those areas deemed unserved, underserved, served, funded and statewide Community Anchor Institutions (CAIs). You can also watch the recording of the BEAD Challenge webinar that was held on March 29, 2024 and download the PowerPoint presentation used during the webinar.

The PBDA would like to remind eligible entities interested in submitting bulk challenges to consider requesting a license from CostQuest Associates. Tier D licenses are available here. Tier E licenses are available here. While a license is not required to participate and access the BEAD Challenge portal, it will help to simplify the submission of bulk challenges.

The timeline for the BEAD Challenge process is broken down into 3, 30-day windows which are as follows:

1. Challenge Submission Period: Eligible entities will be able to submit challenge for 30 days. (April 24 – May 23)
2. Rebuttal of Challenges: Entities that have been challenged will have 30 days to respond (May 24 – June 22)
3. Final Determinations: The PBDA will decided if challenges and rebuttals are valid or not within 30 days (June 23 – July 22)

Lastly, as a reminder, the PBDA will be holding the last of three Office Hour Sessions tomorrow, please click on the link below to obtain additional details and to register.

• Thursday April 25, 2024

Garrett Clark estimates he has spent about six years in the Sanpete County Jail, a plain concrete building perched on a dusty hill just outside this small, rural town where he grew up.

He blames his addiction. He started using in middle school, and by the time he was an adult he was addicted to meth and heroin. At various points, he’s done time alongside his mom, his dad, his sister, and his younger brother.

“That’s all I’ve known my whole life,” said Clark, 31, in December.

Clark was at the jail to pick up his sister, who had just been released. The siblings think this time will be different. They are both sober. Shantel Clark, 33, finished earning her high school diploma during her four-month stay at the jail. They have a place to live where no one is using drugs.

And they have Cheryl Swapp, the county sheriff’s new community health worker, on their side.

“She saved my life probably, for sure,” Garrett Clark said.

Swapp meets with every person booked into the county jail soon after they arrive and helps them create a plan for the day they get out.

She makes sure everyone has a state ID card, a birth certificate, and a Social Security card so they can qualify for government benefits, apply to jobs, and get to treatment and probation appointments. She helps nearly everyone enroll in Medicaid and apply for housing benefits and food stamps. If they need medication to stay off drugs, she lines that up. If they need a place to stay, she finds them a bed.

Then Swapp coordinates with the jail captain to have people released directly to the treatment facility. Nobody leaves the jail without a ride and a drawstring backpack filled with items like toothpaste, a blanket, and a personalized list of job openings.

“A missing puzzle piece,” Sgt. Gretchen Nunley, who runs educational and addiction recovery programming for the jail, called Swapp.

Swapp also assesses the addiction history of everyone held by the county. More than half arrive at the jail addicted to something.

Nationally, 63% of people booked into local jails struggle with a substance use disorder — at least six times the rate of the general population, according to the federal Substance Abuse and Mental Health Services Administration. The incidence of mental illness in jails is more than twice the rate in the general population, federal data shows. At least 4.9 million people are arrested and jailed every year, according to an analysis of 2017 data by the Prison Policy Initiative, a nonprofit organization that documents the harm of mass incarceration. Of those incarcerated, 25% are booked two or more times, the analysis found. And among those arrested twice, more than half had a substance use disorder and a quarter had a mental illness.

Read more

The Pennsylvania Broadband Development Authority (PBDA) has released the details of the BEAD Challenge process. Please visit the BEAD Challenge webpage for additional details to include registering for the BEAD Challenge portal, review the public map that identifies those areas deemed unserved, underserved, and statewide Community Anchor Institutions (CAIs). You can also watch the recording of the BEAD Challenge webinar that was held on March 29, 2024 and download the PowerPoint presentation used during the webinar.

The PBDA would like to remind eligible entities interested in submitting bulk challenges to consider requesting a license from CostQuest Associates. Tier D licenses are available here. Tier E licenses are available here. While a license is not required to participate and access the BEAD Challenge portal, it will help to simplify the submission of bulk challenges.

The timeline for the BEAD Challenge process is broken down into 3, 30-day windows which are as follows:

1. Challenge Submission Period: Eligible entities will be able to submit challenge for 30 days. (April 24 – May 23)
2. Rebuttal of Challenges: Entities that have been challenged will have 30 days to respond (May 24 – June 22)
3. Final Determinations: The PBDA will decided if challenges and rebuttals are valid or not within 30 days (June 23 – July 22)

As a reminder, the PBDA will be holding three Office Hour Sessions, please click on each below to obtain additional details and to register.

• Friday April 19, 2024
• Tuesday April 23, 2024
• Thursday April 25, 2024

Please don’t hesitate to reach out with questions to PABroadbandAuthority@pa.gov.

Last week, the Pennsylvania Workforce Development Association reinstituted their annual NextGen Youth Summit after a five-year hiatus to help Pennsylvania youth program providers collaboratively discover new opportunities for youth and young adults entering the workforce. Caitlin Wilkinson, Co-Director of the Pennsylvania Primary Care Career Center, represented PACHC and made some exciting new connections with the attendees that could lead to innovative collaborations that will help address Community Health Center workforce needs. Over the next few weeks, Caitlin will be meeting with these new connections but is happy to discuss individual health center needs or ideas in the meantime.

The Health Resources and Services Administration (HRSA) has announced Chantelle Britton as Director of the Office of Pharmacy Affairs (OPA) within the Office of Special Health Initiatives (OSHI). Britton will provide strategic leadership and oversight for the 340B Program and will guide OPA’s overall policy and implementation work. Britton has served as Acting Director of OPA since December 2023. She brings deep knowledge and experience with the 340B Program, drug pricing issues, health policy, access to care issues, safety-net programs, and HRSA’s federal and external partners to the permanent role. Prior to her appointment as Acting Director, Britton served for eight years as Senior Advisor in the Office of the Director of OPA.

Pennsylvania’s mandatory Managed Long Term Services and Supports (MLTSS) program, Community HealthChoices (CHC), was developed to enhance access and improve coordination of medical care. The Department of Human Services administers the Community HealthChoices program and is committed to increasing opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. Individuals 21 or older with Medicare and Medicaid may qualify for the CHC program. Pennsylvania’s CHC program was highlighted in this 2024 report.