Hospitals Provide a Pulse in Struggling Rural Towns

By DIONNE SEARCEYAPRIL 29, 2015


BEATRICE, Neb. — “This real estate to be auctioned,” reads a banner stretched across the abandoned warehouse of a store-shelving manufacturer that once employed generations living in and around this town of about 12,000.

This isolated rural community has lost a lot of the energy of its heyday, when shoppers roamed downtown sidewalks, freight trains rumbled past the Big Blue River, and streets clogged at quitting time as factory workers spilled out of their plants.

But it has yet to lose its economic pulse, thanks in large measure to the Beatrice Community Hospital and Health Center, housed in a sprawling new building of concrete and green glimmering windows on the outskirts of town. The hospital has become an economic anchor for the area.

Once home to vibrant downtowns, along with thriving local manufacturers and merchants, small towns were traditionally strongholds of the American middle class. In recent decades, many barely managed to hold on as young people migrated to cities and those who stayed behind had trouble even finding work.

Now, however, those towns that have been able to attract hospitals and other health care facilities have emerged as oases of economic stability across the nation’s heartland.

Rural hospitals face huge challenges; nearly 50 of them have closed in the last four years, according to the North Carolina Rural Health Research Program. But the many successful hospitals, beyond providing an array of jobs from the bottom to the top of the economic ladder, also stimulate local spending and help attract new businesses that offer a stable of insured patients.

“It’s feast or famine,” said Brock Slabach, senior vice president for member services at the National Rural Health Association, a group based in Leawood, Kan., that advocates for rural health interests. “What these providers do is offer not only access to health care, which is hugely important, but they contribute to the economic viability of these rural areas.”

Residents of Beatrice (pronounced bee-AT-ress) do not have to look far for towns that have shriveled since the railroads pulled out and Walmart lured away hometown shoppers. Ghost towns ring Beatrice, with nothing left beyond an old grain elevator or graveyard.

Health care has long provided a lift for Beatrice, which, beyond serving as a commercial hub for surrounding farms, is home to two centers for the developmentally disabled. Recently, several new nursing homes and assisted-living facilities have opened, reflecting the town’s aging population and the numerous farmers who move there to retire. Its median age of 42 is six years higher than that of the state.

The nonprofit Beatrice hospital, with a payroll of nearly $28 million, is an essential economic engine. After the Beatrice State Developmental Center, which employs 700, the 25-bed hospital and its network of clinics and home care services is the second-largest employer in town, with 512 workers. Revenue has grown from $45 million in 2004 to more than $100 million last year, according to Thomas Sommers, the hospital’s chief executive. Patient visits between 2009 and the end of last year have nearly doubled.

The starting salary for a registered nurse is just over $40,000, far more than workers could earn at the local dollar store or Dairy Queen, and more than many of the jobs at the town’s biggest remaining manufacturer, Exmark, a maker of lawn mowers.

That salary goes a long way in a community where movie tickets cost $6 and a recently remodeled three-bedroom, two-bath home with a two-car garage is on the market for $72,500.

Government support provides a crucial foundation for the health care industry, here and elsewhere. Beatrice, for example, is one of a number of beneficiaries of a federal program that certifies rural hospitals as so-called critical access hospitals, allowing for better Medicare reimbursement rates as long as the hospitals meet certain conditions.

That formula has also worked for a hospital in Batesville, Ind., roughly an hour’s drive from both Cincinnati and Indianapolis, a region where the manufacturing base has been eroded by waves of layoffs through the years. The top employers in the town of about 6,500 are a maker of hospital beds and a coffin company. With 550 employees, the Margaret Mary Community Hospital ranks third.

“It’s about gaining faith,” said Tim Putnam, Margaret Mary’s chief executive. “We have to focus on what we do well and partner with others who can provide care that we can’t.”

Instead of offering specialty surgery, the hospital has expanded its primary care access and rheumatology program to treat the county’s aging population. Mr. Putnam is working with a catch-a-ride service to arrange cars for elderly patients with no access to public transportation. And he has made a deal with a local bank to help new doctors with student loan debt qualify for home loans, a plan he hopes will keep trained and talented staff in place for years.

Even in the poorest communities, small hospitals can thrive. In Centreville, Miss., about 130 miles northwest of New Orleans, more than one-third of residents live below the poverty line. But in May the hospital in the town of 1,600 plans to open a new, $21 million facility, said Chad Netterville, chief executive of the Field Memorial Community Hospital, a quasi-public finstitution run by the two counties it serves.

To afford the new 16-bed operation, officials turned to a federal economic development program intended to increase investments in low-income communities.

“A lot of times in the rural communities your health care systems are your economic drivers, and that’s true here,” Mr. Netterville said.

He and a team of hospital officials traveled to Nebraska to tour the Beatrice hospital when it was under construction to glean ideas for their new building. “I was impressed,” he said.

Surrounded by acres of corn fields and a John Deere tractor dealership, the 144,000-square-foot Beatrice hospital is on a vast plains landscape; the wind lashes across its parking lot with a ferocity that nearly knocks over frail visitors.

Inside, the three-year-old building is like its own little city, bustling with activity. Workers mill about the atriumlike lobby and patients recover in window-lined rooms, each with a love seat, recliner and wooden rocking chair. In a sunny room that looks like a fitness center, an elderly man rides an exercise bike as his therapist takes notes.

“We tried to design the facility for where we thought the future was going,” Mr. Sommers, the chief executive, said.

The hospital’s biggest challenge has been improving its reputation; six years ago it came in dead last in a ranking of patient satisfaction at Nebraska hospitals. Residents bypassed it for bigger hospitals in Lincoln, the state capital, which is 40 miles away and home to the University of Nebraska.

Mr. Sommers, who took over in 2004, started by reaching out to the community, encouraging professionals on staff to participate in a local radio program. He disclosed the hospital’s financial information in hopes residents would feel more like stakeholders.

The hospital hired more women doctors — a request that came up in a community phone survey — and put up billboards that showed nurses holding babies, saying, “We Deliver.”

Mr. Sommers worked on giving staff more of a say in decisions and on attracting doctors who had family ties to the area in hopes of cutting down on turnover. He even offered better salaries than they might make in bigger cities. One moved from outside Aspen, Colo.; another picked Beatrice over the much bigger Wichita, Kan.

“I wanted to be able to still have a life outside of work,” said Dr. Amanda Loeffler, 33, who wound up in Beatrice after seeing a flier in the mail advertising an opening for a general surgeon here. “Everything you need is here, and there’s a strong sense of community.”

The Beatrice hospital now ranks above the national average in every category on Medicare’s website for comparing hospitals. One of the chief complaints staff members hear today is about the long, windy walk to the front door from the parking lot. But part of a recently announced $7.2 million expansion will address that, adding a new entrance with closer parking as well as more space for its women and children’s programs and its infusion center.

Still, there are plenty of remaining hurdles. The county’s population has been shrinking since its peak in 1910, and the community cannot rely on health care alone to sustain its economic base.

“We can help drive the economy here in Gage County, but one of the things that has to happen is the economy has to pick up,” Mr. Sommers said. “If it doesn’t pick up, we can’t drive it forever.”

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