Governor Bill Haslam is funding a $1 million project to help rural hospitals on the brink of closure. But advocates say that doesn't mean all of those hospitals can or should be saved.
Tennessee has watched more rural hospitals close in recent years than any other state but Texas. And some of them were struggling well before the state opted not to expand Medicaid. They're in communities that have fewer people than they used to. Yet, local officials know that letting the only hospital close could drive even more people away.
"If you want to see a rural town not thrive, close it's hospital," says Rebecca Jolley, executive director of the Rural Health Association of Tennessee. "It's really, really hard to survive in those circumstances."
Hospital advocates like Jolley and the Tennessee Hospital Association have been trying to start a delicate conversation about downsizing since many communities haven't done any planning for a future without a full-service hospital.
"You have a situation where the hospital closes and abruptly, tomorrow, when you have a heart attack, where do you go?" she asks. "So I think that it's advanced planning and looking at how we best do that in order to provide more of a smooth transition and not do it in crisis mode."
The bill passed by the legislature is called the Rural Hospital Transformation Act and passed with bipartisan support. The only question was whether there would be money to fund the idea. Governor Haslam put a million dollars in the state budget to fund consultants who would help struggling hospitals restructure.
The Department of Economic and Community Development plans to work with the Tennessee Hospital Association to create a new business model or partner with other hospitals within the area. There are currently 66 rural hospitals in Tennessee. Roughly a third of them would likely receive consultation services under the law.
"The individuals that work at rural hospitals work extremely hard, but are limited in their assets and ability to seek outside counsel about how best to navigate the complicated world that is healthcare,” state Sen. Bo Watson, R-Hixon, said while the bill was under consideration.
So far, some hospitals have transitioned into freestanding emergency rooms. Others have become primary care clinics. A few have closed altogether, with one parking an ambulance out front in case someone shows up with an emergency.