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An Ohio University professor’s research shows the struggles of rural hospitals are complex
By: David Forster
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ATHENS, Ohio (WOUB) — Most of the hospitals in the United States are nonprofit organizations. In lieu of paying taxes, there are requirements that they invest in improving the health of their community overall. This is called a community benefit budget.
Cory Cronin is an associate professor at Ohio University’s Department of Social and Public Health and co-director of the Institute to Advance Population Health. He recently submitted a paper that looks at how rural hospitals spend their community benefit budgets differently than non-rural hospitals.
Cronin sat down to speak with WOUB’s David Forster for “Modern Science.”
This interview has been edited for brevity and clarity.
On common examples of community benefit budgets
“The one I think we can all picture is what’s called charity care. I think we all know that if we lack other access to health care, an emergency room will see us, right? The reason that belief has become so ingrained in the United States is out of this community benefit requirement that hospitals will treat patients in the emergency room.
“Even if they can’t pay, they’ll classify it as charity care. That’ll be a piece of what they submit to the IRS justifying their tax-exempt status.”
How rural hospitals face different challenges than others
“Rural hospitals are doing less. This makes sense. They’re smaller organizations. They have fewer staff. There’s real financial distress of rural hospitals in the United States today. They might not have a lot of extras to invest in community health.
“From a pure business decision, if an organization’s losing money on an item, they would stop selling that item and replace it with something else or do market research. Here we have hospitals feeling like this is very needed by the community, so they’re still offering it. While I can’t say exactly what these services are, I don’t have that level of detail, it certainly highlights some other conversations going about rural health care and rural hospitals.”
There’s a balance between offering care and keeping the lights on
“We hear about maternity care deserts. We’re hearing about chemotherapy deserts more and more. These are rural hospitals that can no longer offer these services to the community because they risk closing due to finances.
“I think that’s a lot of what’s happening in this one category of community benefit. We see hospitals trying to maintain these services they feel the community needs, even though they’re financial losses to them.”
On what it would take to help rural hospitals
“It’s incredibly complex, and I don’t have a solution. What I can tell you is where rural hospitals really struggle is that much of our health care systems are designed on volume and rural hospitals just aren’t going to have the volume. What they’re going to have is the fixed costs to have an emergency room open. You still need a minimum level of staffing that is very costly.
“In a rural hospital, that E.R. might not be jam packed and people might not be waiting a long time. But we also don’t want them to put a closed sign on their door if something does happen.
“A lot of this is thinking about the value of rural hospitals, beyond the finances, beyond the volume models, and the fact that a hospital’s there and ready if something happens, if a baby needs delivered, if an accident happens on the highway.
“It’s considering if the volume isn’t going to be there, what is the right financial model?”
The first draft of the transcript used for this story was created in Adobe Podcast, which includes an AI transcription tool. A WOUB news editor then reviewed, corrected and reformatted the transcript before publication.