Overseeing a rural hospital isn’t exactly a soft landing as you prepare for the retirement phase of your career. But that's the path Bill Miller has chosen for himself. More than a hundred and ninety rural hospitals in the U.S. have closed since two thousand five. According to the Center for Healthcare Quality and Payment Reform, thirty percent of the ones that are still accepting patients are at risk of closing.

Usually, the problem comes down to simple math: most of the revenue at rural hospitals comes from government insurance – Medicaid for low-income patients and Medicare for the elderly. But it often costs more to provide that health care than what the hospitals receive in reimbursements from the states.

Making matters worse is the reputation that many small hospitals far from the big cities have acquired. But St. Luke’s is not about to shut down, it’s not having troubling finding qualified staff, and it isn’t facing a major funding shortfall. In fact, its accounting department is probably going to have even more flexibility in the years ahead thanks to North Carolina’s decision to finally expand Medicaid eligibility to another 600,000 residents.

The nuts and bolts of running a 25-bed hospital, even one with a 50-million-dollar budget, don’t usually get much attention — unless one threatens to close, of course. But I thought it would be good idea to ask some questions now, while things at our non-profit, community-owned hospital are going well. My guest agreed, so we sat down for a chat at the end of September in his old stomping grounds at the Stearns Education Building in Columbus.

Further reading
Rural hospital reputations:https://www.kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/
Closings:https://ruralhospitals.chqpr.org
https://www.aha.org/infographics/2021-05-24-fast-facts-us-rural-hospitals-infographic
https://nursejournal.org/articles/rural-hospital-closures/

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