Recognizing a Critical First Line of Defense: National Rural Health Day

In recent years, Texas has become widely recognized for its explosive population boom – a distinction hard to deny as urban congestion expands further into the Texas countryside. Managing this growth has been a dominating point of discussion for Texas, yet attention toward the increasing challenges of the state’s rural communities has remained sparse.

With recent data showing over a quarter of rural hospitals in Texas are at risk of closure, the time for action is quickly running out. Combatting these closures requires bringing awareness, and the National Organization of State Offices of Rural Health (NOSORH) set this as a goal when establishing National Rural Health Day 14 years ago.

Honoring National Rural Health Day on the third Thursday of November presents an opportunity to highlight the unique challenges that exist for rural health care providers. NOSORH also envisioned this holiday as a way to showcase different programs and policies that “help address and reduce health care disparities in rural communities.”

“Rural health is about access and local economic development, but it’s much more than that,” said John Henderson, president and CEO of Texas Organization of Rural & Community Hospitals. “It’s neighbors helping neighbors, taking care of each other, being resilient, removing travel burden, and innovating to build healthier communities. So we will pause on Thursday to honor that important, lifesaving work.”

With rural hospital closures an imminent threat for Texas, this year’s National Rural Health Day provides awareness at a critical point for the state. The impact of losing these facilities not only threatens the lifeline that protects the over 4 million Texans living in rural areas, but it also threatens Texas’ robust agricultural industry.

According to the Texas Department of Agriculture, 86% of land in Texas is used for some form of agriculture – most of which is classified as a rural area. For these workers, losing access to a health care facility within close proximity creates vulnerability by extending the time needed to receive care.

Adam Willmann, FACHE, CEO of Goodall Witcher Hospital in Clifton, Texas, said that his facility also provides a significant portion of services to those beyond his community. These include visitors and travelers who need medical attention for various reasons, such as car accidents. Willmann noted that even when rural facilities are unable to provide higher levels of care, they play an important role in patient stabilization and transport process.

“Rural health care really is the first line defense keeping the backbone of this country moving forward,” said Willmann. “We stabilize them and then get them to our counterparts in those urban areas.”

One of the biggest challenges for rural hospitals in Texas has been recruiting and maintaining a fully staffed workforce. In 2023, more than 60% of hospitals were operating with fewer beds and reduced services due to a lack of staff. Texas also has well-documented shortages of primary care physicians and other specialists, including psychiatrists.

“Our number one challenge is staffing, but it’s also compounded because there’s no affordable housing either,” said Willmann. “So when you really think about us recruiting some of the new staff, a lot of them live in a larger community like Waco and drive back and forth.”

One way that rural hospitals have been able to help alleviate the burden of recruiting is through programs that create incentives. A number of these programs were created or funded through the passage of Senate Bill 25 during the 88th Texas Legislature. Willmann mentioned that one of these – the Rural Community Loan Repayment Program – has been particularly beneficial to his facility.

“I think probably half of my current workforce has either received it in the past or are on it,” said Willmann.

Beyond staffing, many rural hospitals are Medicare-dependent and have low volumes. Barriers such as prior authorizations and low reimbursement rates have made it difficult to cover costs.

“We’re constantly having to spend more money just to get the money we’re owed. And I think ultimately with a lot of rural hospitals when it’s critical access or just Medicare-dependent hospitals, we’re seeing all of those safety net programs are being eroded by the Medicare Advantage programs,” said Willmann. “There hasn’t been any changes to put some guardrails up on all of this, and so it’s just going to create a harder path to survivability.”

Despite these many challenges, rural hospitals in Texas continue to fight for their communities. For the Texas Hospital Association, National Rural Health Day serves as a time to honor the important role these facilities play, as well as a time to reflect on the difficulties they endure.

“Our rural hospitals have a story to tell at the Capitol in Austin and DC, one of their vital importance to the communities that rely on their continued success and advocacy from legislators,” said Will Holleman, THA’s vice president of advocacy and public policy. “Whether it is increasing funding for loan forgiveness programs for hospital personnel or tamping down unnecessary regulatory burden that drives up the cost of care, it’s important to keep reminding policymakers of the unique needs of the rural hospital community across the state of Texas.”