HJAR May/Jun 2025

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2025 43 Mellie Boagni CEO, President, and Founder Arkansas Rural Health Partnership minutes in 2022, following the 2020 closure of Helena Regional Medical Center’s labor and delivery unit. 5 Some hospitals are doing away with in- patient services altogether, seeking desig- nation as rural emergency hospitals. This new designation allows hospitals to receive additional Medicaid and Medicare funding for outpatient services, but those facilities are limited in the acute care services they can provide. Becoming a rural emergency hospital brings its own challenges, such as confusing state Medicaid payment policies, federal participation restrictions for certain programs (e.g., drug discount programs) and federal restrictions on the ability to provide rehabilitation and nursing home services. As of this writing, hospitals in fiveArkansas cities have converted to rural emergency hospitals: DeWitt, Eureka Springs, Helena, Pocahontas, and Osceola. 6 Other hospitals are looking for a cor- porate “white knight” to come to the aid of their community and save the hospital. Far too frequently in recent years, however, the apparent white knight has been a villain, a private equity–backed ownership group that prioritizes short-term profits for its investors over long-term value and viabil- ity. To be fair, not all private equity groups are the same. Some can bring expertise in hospital management and can infuse oth- erwise unavailable capital investment into a hospital, reinvigorating operations and spurring innovation and growth. But bad actors in private equity can burden hospitals with debt, cut wages and locally staffed jobs, and reduce the quality and scope of services, harming rural communities. Arkansas residents experienced private equity fallout recently whenWadley Region- al Medical Center facilities in Hope and in Texarkana, Texas, both risked abrupt closure last year after their owner, Dallas-based for- profit Steward Health Care, declared bank- ruptcy inMay 2024. In January, a bipartisan report by the U.S. Senate Budget Commit- tee warned of “systemic issues”with private equity investment in healthcare, including “underinvestment in critical hospital infra- structure, understaffing, and the pursuit of financial gains through leveraged buyouts and dividend extractions — often to the det- riment of patients and hospital operations.” 7 While the options for rural hospitals to keep their doors open are dwindling, their openness to and reliance on private equity groups for quick cash infusions are increas- ing. The bright side is that state policies can protect communities from bad actors with enhanced transparency and oversight over these transactions. Most states require that a government entity, such as the state attorney general or state health agency, be notified of any private equity transaction involving a healthcare facility, but Arkansas is one of 15 states that do not have oversight of such transactions. 8 At a minimum, state regulators should be notified of ownership transactions for hospitals and other healthcare entities, and Arkansas communities should be provided with an opportunity for public comment regarding transactions that could affect the services they receive. State and federal policymakers should also work with rural hospitals to ensure that regulatory and re- imbursement policies for rural emergency hospitals offer a pathway for long-term sus- tainability. Our rural hospitals have been re- silient compared to our surrounding states. We shouldn’t allow profit-driven investors to drain the healthcare pillars of our rural communities of capital and put them at risk of losing access to vital services. n REFERENCES 1 Chartis. “2025 Rural Health State of the State: Instability Continues to Threaten Rural Health Safety Net.” 2025. https://www.chartis.com/ sites/default/files/documents/CCRH%20WP%20 -%202025%20Rural%20health%20state%20 of%20the%20state_021125.pdf 2 Thompson, Joe. “Looking Back: Medicaid Ex- pansion in Arkansas.” Arkansas Democrat-Ga- zette. Jan. 4, 2024. https://www.arkansasonline . com/news/2024/jan/04/looking-back/ 3 Arkansas Center for Health Improvement. “Maternal and Infant Health.” Accessed March 27, 2025. https://achi.net/maternal-infant- health/#arkansas-birthing-hospitals 4 Minion, S.C.; Krans, E.E.; Brooks, M.M.; et al. “Asso- ciation of Driving Distance to Maternity Hospitals and Maternal and Perinatal Outcomes.” Obstet- rics & Gynecology 140, No. 5 (November 2022); 812-819. DOI: 10.1097/AOG.0000000000004960 5 Arkansas Center for Health Improvement. “Trav- el Time to Delivery Facilities for Arkansas Moth- ers” [infographic]. June 2024. https://achi.net/ wp-content/uploads/2024/08/240829A-Mater- nal-Travel-Time-.pdf 6 Arkansas Department of Health. “HFS — Pro- vider Lists.” Accessed March 27, 2025. https:// healthy.arkansas.gov/programs-services/licens- ing-military-member-licensure-permits-plan-re- views/health-facility-services/provider-lists/ 7 Senate Budget Committee. “Profits Over Pa- tients: The Harmful Effects of Private Equity on the U.S. Health Care System.” January 2025. https://www.budget.senate.gov/imo/media/doc/ profits_over_patients_the_harmful_effects_of_ private_equity_on_the_ushealthcaresystem1.pdf 8 Jaromin, S. “The Evolving Landscape of State Health Care Transaction Laws.” National Con- ference of State Legislatures. August 19, 2024. https://www.ncsl.org/health/the-evolving-land- scape-of-state-health-care-transaction-laws Mellie Boagni currently serves as the CEO,president, and founder of the Arkansas Rural Health Partner- ship; regional director of strategy,management,and administration at the University ofArkansas for Medi- cal Sciences (UAMS); and executive director of the Rural Health Association of Arkansas with over 26 years of experience in rural health strategic planning, grant writing, and program development. CraigWilson is the interimpresident and CEO of the Arkansas Center for Health Improvement (ACHI), a nonpartisan, independent health policy center that serves as a catalyst to improve the health of Arkan- sans.He is also a founding boardmember of the Rural Health Association of Arkansas. A graduate of Lyon College in Batesville, he is an attorney licensed to practice in Arkansas, having earned a law degree from Georgia State University College of Law and a Master of Public Administration degree from Geor- gia State University’sAndrewYoung School of Policy Studies in Atlanta.