HJAR Jul/Aug 2020

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2020 35 Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement having the nation’s sixth-highest portion of rural hospitals—37 percent—at risk of closing. Some federal COVID-19 relief funds have made their way to Arkansas hospitals, but not enough tomake up for all of the revenue lost since the pandemic began. Hospital closures are devastating to com- munities, not only through reduced access to healthcare, but also through job losses and the impact on local business’ ability to recruit workers. Healthcare leaders and policymakers at the community, state, and federal levels must develop strategies to preserve rural healthcare. We are already seeing efforts to change the rural healthcare business model, some of them accelerated by the pandemic, such as regulatory changes to give hospitals more flexibility, increased use of telemedicine, and the expansion of outpatient care. We need to keep working on solutions; the stakes are too high not to. Read more about the challenges facing rural healthcare in Arkansas at achi.net/ ruralhealth. n A2019 report by the University of Arkan- sas Cooperative Extension Service found that Arkansas’ total population grew by 2.8 percent between 2010 and 2017, but in rural counties, the population decreased by 2.5 percent. Of the state’s 75 counties, 52 had decreases in population over that period, and of those 52 counties, 50 were rural. There has been significant out-migration of younger, healthier people from rural parts of the state, leaving rural hospitals to care for a population that is not only shrinking, but also is increasingly older and sicker. In 2017, according to the Cooperative Ex- tension Service report, Arkansans age 65 or older accounted for 19.4 percent of the population of rural counties, compared to 14.7 percent in urban counties. Among Ar- kansans 18 or older, 23.8 percent of those who lived in rural counties reported being in poor or fair health, compared to 20.7 percent in urban counties. There is also an economic divide between rural and urban parts of the state. In 2016, Arkansans living in poverty accounted for 21 percent of the population of rural counties, compared to 17.2 percent in urban coun- ties, according to the Robert Wood John- son Foundation’s County Health Rankings & Roadmaps. Patients seeking care in rural areas are more likely to be on Medicaid or Medi- care, which provide lower reimbursement rates than private insurance. Many of the poorest patients are on private insurance, however, thanks to Arkansas’ unique ap- proach to Medicaid expansion under the Affordable Care Act. This has helped shore up rural hospitals, as has the reduction in uncompensated care that resulted from ex- tending coverage to about a quarter of a mil- lion low-incomeArkansans. At this writing, 56 rural hospitals have closed since 2010 in neighboring states that did not expand Medicaid, while only one rural hospital in Arkansas, De Queen Medical Center, has shut its doors in that time. Medicaid expansion can only help so much, however. A2019 analysis by the con- sulting firmNavigant identifiedArkansas as