Few options for rural communities that lose their hospital
In the waiting room of the Boone Health Primary Care clinic on Medical Park street in Mexico, patients are greeted by the sound of a half-dozen Gouldian finches, chirping in a cage in the corner. The birds belong to Dr. Peggy Barjenbruch, who, alongside Dr. Michael Quinlan, has served the Mexico community for decades.
That looked like it might come to an end this past fall, when the hospital they were associated with closed suddenly. Since its founding in the 1980s, Audrain Community Hospital was a community fixture. But in September it joined a growing list of rural hospital closures. Missouri has lost ten rural hospitals in less than a decade, amid the pressure of shrinking populations and lower reimbursement for care due to uninsured patients.
For Barjenbruch and Quinlan, who were associated with the hospital, the closure brought uncertainty. “We always thought that we were big enough to keep one going," Quinlan said.
A Mexico native, Quinlan grew up with the hospital at the heart of the Mexico community. It closed shortly after changing ownership for the second time in two years.
Kansas City-area company Noble Health acquired the hospital in 2021. After increasing turmoil at the company, Noble sold the hospital to Texas-based Platinum Team Management, which shuttered the facility. Quinlan says toward the end, staff were working without pay to keep serving the community.
Craig Brace, CEO of the county health department, says the department had to scramble in the wake of the closure, setting up a phone line to answer patient questions. “We had a nurse dedicated to dig in to those questions and find answers and make that available," Brace said.
But some of those questions didn’t have easy answers. Of the biggest losses for the area with the hospital’s closure was emergency care. Now the nearest option for area residents is Columbia, some 40 miles away.
Dr. Quinlan says that’s left his patients in a difficult situation. “You’ll hear some mornings that, ‘Oh I had chest pain at 2 a.m. and I just was waiting to see if I could see you guys.” ... We don’t want to take a chance on that.”
Quinlan says patients have also put off important appointments like cancer screenings, preferring to wait until the hospital reopens. There’s no sign of that happening soon, but other providers have moved in.
Boone Health CEO Troy Greer found benefits in the move for both his health system as well as the community. "We went and found these doctors that wanted to stay in the area; it was good for that local community," Greer said. "It allows Boone to continue to grow in those areas to serve their needs, but also creating a more convenient place for those people to use Boone services."
But stepping in to run the hospital, isn’t something Boone or any other institution is in a position to do, according to Greer.
Emergency care hard to replace
One option for emergency care that has proliferated in other states is the freestanding ER — an emergency department that's not attached to a hospital. Freestanding ERs can often provide faster care than traditional ERs, but can also come with higher price tags.
Dr. Cedric Dark is an assistant professor of emergency medicine at the Baylor college of Medicine in Houston who studies freestanding ERs. While much of the freestanding ER wave has come in suburban areas, Dark believes they may be an option for rural towns as well.
"When we’re talking about rural hospital closures, I feel like you at least ought to be able to keep the ER open as a freestanding ER because people in those communities still need access to emergency care,” Dark said.
Regulations in several states, including Missouri, effectively ban freestanding ERs. According to the Missouri Hospital Association, the state does not recognize or license freestanding ERs.
That means communities like Mexico have to find other ways to keep their hospitals open, whether that be through private equity firms or individual investors. Both Dr. Quinlan and health department CEO Craig Brace say they’re hopeful they’ve identified a potential investor who could re-open the hospital.
It's still early in that process though, and if that prospect doesn't work out, the community could lose its hospital for good.