“This should not have happened,” Gov. Laura Kelly said in October 2018 after Fort Scott’s Mercy Hospital closed. “Simply put: if Kansas had expanded Medicaid, Fort Scott would still have a hospital.”
But that simply wasn’t true.
As Kansas State Rep. Ken Collins (R-Mulberry), whose district includes Fort Scott, told the Morning Sun, the hospital was losing far more money than a KanCare expansion would have brought in.
“In Fort Scott, the figure that was given to me was around $14 million that the hospital had lost and that expansion of Medicaid would have only brought in around two million,” Collins (R-Mulberry) wrote in an emailed response to questions from the Morning Sun in April last year. “That would not have saved that hospital.”
Indeed the Kansas City Star found much the same thing, as did the Morning Sun’s parent company.
“The Kansas Health Institute estimates about 130,000 Kansans would enroll in Medicaid if the legislature expands coverage. But it would have a minimal impact in Fort Scott,” the Star wrote in April of last year. “About 6% of its population — families that can’t afford private insurance but make too much to qualify for Medicaid — would be eligible for coverage under the proposed expansion.”
Likewise, Gannett — at the time GateHouse Media — found that Kansas is the least profitable state in the nation for rural hospitals, with 64 percent of hospitals statewide losing money.
For Mercy Hospital in Fort Scott, part of the problem was large hospitals in Kansas City a mere 90 minutes away, in Joplin, Missouri, roughly 45 minutes, and a medium-sized hospital in Pittsburg, just 30 minutes to the south.
But wouldn’t the residents of Fort Scott be left without critical services after the closure of the hospital?
Rural Town Realizes: We Don’t Need a Hospital
Shortly after the closure, the Community Health Centers of Southeast Kansas, headquartered in neighboring Pittsburg, agreed to place a clinic in the hospital and Ascension Via Christi Hospital agreed to temporarily operate the emergency room.
What city officials have found, according to a story by Kaiser Health Network, is that they didn’t need a hospital.
City Manager Dave Martin told KHN, “we will not have – or do we need – a hospital,” late last year — roughly one year after the hospital closed.
CHC/SEK’s Executive Vice President Jason Wesco told KHN, most of the care that was available at Mercy Fort Scott is available through his organization — and a few services that weren’t available are now.
“Wesco estimates 90-95% of the health care offered before the hospital closed is still available locally,” KHN wrote. “And services have been added, including a much-needed therapist on-site for behavioral health and telehealth access to a psychiatrist and substance abuse services.
“Drive up there, go into the parking lot, you’re like ‘There’s a lot of people here,’” Wesco told KHN. CHC’s Fort Scott facilities have filled more prescriptions and done more mammograms in a month than the hospital “ever did.”
One of the advantages CHC/SEK has is that it’s a federally-qualified health center and gets a higher level of reimbursement for Medicare and Medicaid patients than Mercy did and has the ability to apply for grants for the uninsured, although it has not applied for any for Fort Scott, Wesco said.
As Gannett noted in its rural hospital project last year: “High rates of poverty in rural areas, combined with the loss of jobs, aging populations, lack of health insurance and competition from other struggling institutions will make it difficult for some rural hospitals to survive regardless of what government policies are implemented.”
The research also noted that Utah, which only recently voted to expand Medicaid, already had an innovative solution which was helping to sustain rural hospitals — one that Kansas Legislators and hospitals might take note of.
Urban hospitals were willing to sacrifice and to work with their small-town counterparts and rural hospitals in Utah were among the most profitable in the country from 2011 through 2017. None shut down, and only 14 lost money.
“Twenty years ago, we instituted a policy where we would take a little money from urban hospitals and give it to rural hospitals,” said Dave Gessel, executive vice president of the Utah Hospital Association. “That’s provided a base for all our hospitals.”
As the Kansas Policy Institute’s Michael Austin noted almost one year ago:
“Rural hospitals aren’t failing because there isn’t Medicaid expansion and other government income redistribution programs. KPI is the parent company of the Sentinel.
“It is possible that Medicaid expansion helps improve the bottom line of hospitals. However, making broad strokes that Medicaid expansion reverses the financial downturn from population loss is unrealistic. Market forces are in effect and expansion won’t reverse that.”