Burkesville hospital open, similar one 24 miles away in Tenn. is closed; big differences: Medicaid expansion and diversification

OpenStreetMap contributors, via The Daily Yonder, adapted by Ky. Health News

Along the Cumberland River in Southern Kentucky and Middle Tennessee are two towns 24 miles apart by road. One has a hospital, and one does not, partly because Kentucky expanded Medicaid and Tennessee has not. But Cumberland County Hospital in Burkesville, Ky., hasn't just been lucky.

Cumberland River Hospital in Celina, Tenn., closed March 1, ending 146 jobs and undermining economic-development prospects in Clay County, which has a population of about 8,000. A physician assistant who has clinics in other rural Tennessee communities recently bought the hospital from Cookeville Regional Medical Center and says "he plans to reopen the hospital in phases, beginning with a clinic" Taylor Sisk reports for The Daily Yonder. "But the new owner will face the same challenges as did the former owners – as do most rural hospitals."

Neikirk and Capps (Daily Yonder photo)

Most recent rural-hospital closures have been in states that haven't expanded Medicaid under the 2010 Patient Protection and Affordable Care Act. Tennessee is one of those states. The expansion in Kentucky meant "survivability" for the Burkesville hospital, which is the main employer, with 340 jobs, in a county of 7,000, Chief Financial Officer Rick Capps told Sisk.

"He acknowledges, though, that expansion alone isn’t enough," Sisk reports. "A nonprofit owned by shareholders in the county, Cumberland County Hospital has diversified quite a bit over the past decade." It bought a local pharmacy and the county nursing home, runs the local 911 center and includes the practices of two physicians, Robert Flowers and Sam Rice, who have worked in the county for more than 30 years, Sisk reports: "That partnership, says CEO Rick Neikirk, has been key to the hospital’s success." So has its critical-access status, which gives it slightly higher government reimbursements in return for limits on its beds, services and patient stays.

Medicaid expansion also helps, in another way, Sisk notes: "With far fewer uninsured patients now entering their doors – a lighter burden of uncompensated care – the hospital has more flexibility to deviate from the standard model." In Celina, Medicaid expansion “would have helped, no question,” but probably wouldn't have kept the hospital open, Cookeville Regional CEO Paul Korth told Sisk.

Daily Yonder map, adapted by Kentucky Health News