Struggling Tenn. hospital takes care of Kentuckians, who get better care than Tennesseans thanks to expanded Medicaid

Jellico Community Hospital, just across the Kentucky border in Tennessee along Interstate 75, was taken over by Community Hospital Corp. last May, but that's not a guarantee it will survive, especially since Tennessee refuses to expand Medicaid to its poorest citizens, as Kentucky has, Harris Meyer reports for Modern Healthcare.

Meyer notes that one of the contributing factors to the hospital's struggle is the Tennessee Legislature's refusal to expand Medicaid under health reform to those who make up to 138 percent of the federal poverty level. That would decrease the hospital's level of uncompensated care.

About half the hospital's patients come from Kentucky, and its administrators, doctors and nurses all told Meyer that it is easier to get testing and specialty care for Kentucky Medicaid patients than for uninsured Tennessee patients who would qualify for expanded Medicaid.

“We're able to do more for Kentucky patients,” Christy Elliott, the hospital's case management supervisor, told Meyer. “For Tennessee patients, it's a struggle. If you don't have insurance, you don't get services.”

One such patient was Rebecca Jarboe, a mother of three from Kentucky. She told Meyer that she went into a "difficult" labor during a snowstorm on Valentine's Day. Because of the weather and her condition, she said she and her husband decided to travel 14 miles from their home to Jellico to have the baby, instead of making the 70-mile-journey down I-75 to the University of Tennessee Medical Center in Knoxville, 20 miles of which would have been over snow-covered Pine Mountain (known locally as Jellico Mountain).

“The care here is excellent,” a tired-looking Jarboe told Meyer while lying in her hospital bed cradling 2-day-old Silas and surrounded by her family. “Whatever you need, they are right at the door, and everyone is really friendly.”

The 31 states that have expanded Medicaid have been able to "shore up finances" in many of their rural hospitals, Meyer writes, but others have not fared so well. Nationwide, more than 50 rural hospitals have closed in the past six years, and nearly 300 more are in deep financial trouble, according to the National Rural Health Association.

A state report by then-Auditor Adam Edelen last year found that one in three of Kentucky's rural hospitals were in poor financial condition. Since the release of the report, several Kentucky rural hospitals have merged with larger hospital groups to make ends meet and rural hospitals in Nicholas and Fulton counties have closed.

Meyer also notes that Jellico hospital's problems go deeper than just not expanding Medicaid. In its service area good-paying jobs with health benefits have dwindled, only 10 percent of the population has private health insurance, residents have higher-than-average rates of disease, and there is rampant obesity and drug abuse. A similar story could be told about many rural Kentucky communities.

In addition to providing health care, the 54-bed hospital with its staff of 232 is the community's largest employer, as is often the case. The mayor of nearby Williamsburg, where the hospital has a clinic, noted that new businesses will often not consider moving to a community without a hospital.

“A lot depends on economic development in these communities,” Alison Davis, a professor of agricultural economics who studies rural healthcare at the University of Kentucky, told Meyer. “What are they going to do to create jobs? It's the No. 1 issue besides substance abuse they are facing. It's a struggle, and not every community will make it through.”

Adventist Health System, out of Florida, announced in May 2014 that it wanted to get rid of the hospital because it was losing "millions a year." A year later, CHC, a Texas-based not-for-profit with a mission to preserve access to healthcare in rural communities, took over the hospital and its clinic. CHC owns, manages and provides support to 21 community hospitals nationwide, according to a news release.

CHC told Meyer that it is optimistic the hospital will survive because of the medical staff's commitment to keeping quality healthcare in their community. It has also implemented cost-saving measures, like decreasing staff and installing a less costly electronic health record system, and is exploring ways to further save money, while increasing its client base.

But several local business leaders told Meyer they weren't so sure the hospital will survive.

“There have been so many layoffs that they don't have enough people to do lab work or X-rays, and you have to wait and wait,” Elsie Crawford, business manager of the Wilkens Medical Group in Jellico and a member of the City Council, told Meyer. “You can't draw more patients if you don't have enough people to take care of them.”

Dr. Charles Wilkens, who helped establish and maintain the hospital, told Meyer, “People would die for lack of health care if we didn't have a hospital in this community.”