HJAR Jan/Feb 2025

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2025 11 transportation can still be challenging and expensive. Meanwhile, workforce shortages mean there are fewer doctors and nurses, so the staff who are on hand often feel over- whelmed, leading to longer wait times. Finally, social determinants such as poverty, food insecurity, and limited broadband fur- ther compound these challenges, making it harder for rural communities to access consistent quality healthcare. All these barriers come together to affect health outcomes in a very real way. If it’s tough or impossible to see a provider, peo- ple end up putting off care until it’s too late, resulting in their health problems becoming harder to manage. That’s why bridging these gaps is so crucial in rural Arkansas. Editor What are the biggest challenges facing rural hospitals and clinics today? Boagni Rural healthcare organizations in Arkansas face persistent challenges — financial instability due to payment reimbursement, infrastructure needs, and lack of resources to provide services; provider shortages due to lack of workforce and outward migration; limited services from lack of workforce and the inability to train residents in healthcare careers; and unhealthy residents with high prevalence of chronic disease, poor social determinants of health, lack of OB/GYN services, and lack of health education. Rural hospitals and clinics don’t have the workforce, infrastructure, transportation, funding, and reimbursement resources to address the needs of our state with high rates of chronic disease, obesity, infant mor- tality, and maternal mortality rates. Editor Rural hospital closures have been a concern nationwide. Tell us about the closures in Arkansas and how they have impacted access to care in those communities. Boagni Arkansas has fared well in hospital closures thanks to Medicaid expansion. However, hospital downsizing will create fewer beds, requiring residents to recover in larger, regional hospitals. Transportation is a real barrier for many living in rural areas, and time is essential for residents who work hourly jobs. Having a family member who cannot recover nearby is stressful for everyone and costly to the family. We must also recognize that America's "graying" is real and unmistakable. The senior population is growing. They are living longer, and many are living in rural areas. And, let’s face it: Getting older means a great chance of needing to recover in a hospital and having more complex health issues. We must think strategically about where and how rural healthcare should be delivered effectively and efficiently. Editor How many Arkansas hospitals are currently at risk of closure? What strategies are in place to prevent closures and strengthen the role of rural hospitals as community anchors? Boagni According to the Arkansas Center for Health Improvement, 10 rural hospitals inArkansas are deemed “at risk” of closure. Currently, there are positive moves to prevent closures and strengthen rural hospitals, including: 1) downsizing due to lack of patient volume and workforce; 2) collaborating with larger healthcare systems to reduce overhead costs and bring in needed healthcare resources and services; 3) collaborating with neighboring FQHCs to bring in workforce, mental and behavioral health, and resources; and 4) accessing federal assistance programs. Editor The Journal has written extensively on Arkansas’ dismal maternal and infant mortality rankings. How many hospitals across the state do not have — or have recently closed — their OB units? Do you envision any reopening? Boagni This is honestly one of the toughest challenges in rural healthcare. Over the past decade, more than half of Arkansas’ rural hospitals have either completely shut down their OB units or drastically cut back services, not because they wanted to, but because of a perfect storm of declining birth rates, financial strain, and persistent