Opinion: The other numbers crunch for Georgia’s rural hospitals

Sometimes, while working through a complex problem, a simple but inescapable fact pops up. Here’s such a fact about Georgia’s rural health-care crisis: The minimum population needed to sustain a hospital is 40,000.

(quick Google search)

More than two-thirds of Georgia’s counties, 110 of them, have fewer than 40,000 people.

(eyes grow wide)

Hoo-boy.

“The numbers are what the numbers are,” says Jimmy Lewis, the chief executive of rural advocacy group Hometown Health and the source of that 40,000 figure. Lewis spoke about the subject in Bainbridge at the most recent meeting of the House Rural Development Council. Family duties kept me from attending, but I caught up with Lewis by phone recently.

“If we know that, the decisions get to be very simple, because that number’s not going to change,” Lewis says, explaining it’s a function of the number of potential patients needed to support a minimum team of doctors and surgeons. He points to other “unforgivable benchmarks” for hospitals to meet, such as the proper number of workers, and other problems they face, such as uncompensated care. But all depends on that big demographic factor.

“So,” he continues, “we either have to talk rural hospitals into working together — and that can be consolidating and sharing services, or whatever — or a county with a lesser population has to say, ‘We’re not going to do that. We’re so proud, we’re willing to pay for the gap and loss that results from having less than 40,000 people.’”

Depending on the size of the county, and its hospital’s losses, the tab can hit $2 million to $4 million per year.

“They have to do that in order to get the experience of the pain of funding that kind of hospital loss,” Lewis says. “I call that the ‘will to live’ factor. And I can tell you every county and every community has got a different will to live. They’ve got to figure that out.”

It’ll take a lot of figuring by a lot of folks. Of Georgia’s 61 rural hospitals, only five are located in counties with at least 40,000 residents. Almost half are in counties with fewer than 20,000 souls.

Southwest Georgia Regional Medical Center in Cuthbert. (AJC Photo / Kyle Wingfield)

Consider Southwest Georgia Regional Medical Center in Cuthbert. It’s a small facility with a nursing home, in a county of about 7,200. Add the populations of the six neighboring counties, none of which has a hospital of its own, and the total barely reaches 36,000.

A bit further south, the problem is different. The state’s seven southwestern-most counties together have about 102,000 residents — but they’re trying to support six hospitals, not the two or possibly three their population suggests they could manage.

Altogether, the state’s sub-40,000 counties have enough people, if perfectly allocated, to support 46 hospitals. That implies 10 more rural hospitals may have to be shuttered, unless local officials can find enough tax revenue or innovative approaches to keep the doors open.

If financial losses, tax bills and looming closures don’t concentrate minds, a state pilot program might. Gov. Nathan Deal’s Rural Hospital Stabilization Committee aims to identify ways some rural hospitals can shore up their finances and then serve as “hubs” for neighboring areas and providers. The goal is a network of medical facilities that crosses county lines to offer sufficient access. Seven hospitals scattered across the state’s rural north and south are already involved, and 12 more were just added.

Those 19 hubs could eventually be the backbone of rural health care in Georgia. The (further) outlying areas may have little choice but to work with them, even if that means a loss of some jobs and civic pride.

“It may not be the same number of hospitals, it may not be the same access points,” Lewis says, “but clearly there are opportunities to provide access points to the population out there.”

Reader Comments 0

498 comments
breckenridge
breckenridge

There is far too much hysteria over Trump's fire-and-fury comment for my taste.  He gave the North Korean dictator, who weighs 290 pounds while ordinary citizens starve to death on the streets from time to time, a little tweak.  Message sent.


The thing Trump needs to avoid is this sort of bashing in the future.  Because if it's not followed up with action, he'll simply be the boy that cried wolf.  But yeah, one and done is fine.

breckenridge
breckenridge

In May 2017, the North Korean government claimed that the CIA and the South Korean National Intelligence Service hired a North Korean lumberjack who worked in Russia to assassinate Kim Jong-un with a "biochemical weapon" that was both radioactive and nano-poisonous at the same time and its effect would have been delayed by a few months. North Korea said that it would seek extradition of anyone involved in the assassination attempt.

Interesting idea but you can't put much stock in anything the North Korean government says. 

SGTGrit
SGTGrit

The Kim Jong Un, regime must be taken down by whatever means necessary. Ideally by China's involvement, however unlikely, but by other means should China not cooperate. Next would be by clandestine action with a bullet to the base of Kim's skull followed by an upheaval in the military leadership. Lastly, through a preemptive strike by overwhelming military force to remove this regime from the face of the earth. And yes with full understanding of the horrible collateral damage. Why, well because it would have to be done anyway sooner than later.

SGTGrit
SGTGrit

And oh BTW....concurrent destruction of the Iranian military capability.

breckenridge
breckenridge

@SGTGrit 

China is not keen on the idea of North Korea having nuclear weapons.  But they are even less keen to see a reunited Korea, which would put an American presence on their doorstep.

SGTGrit
SGTGrit

@breckenridge @SGTGrit 

China has a formidable military capability but not to the extent of ours. I saw the PLA in China and while a respectable land force not overwhelming.

Starik
Starik

@SGTGrit @breckenridge So we should go to war with Iran and North Korea, and damn the consequences? Have you become unhinged?

JohnnyReb
JohnnyReb

re, N. Korea mess.

Anyone that thinks there is not a connection between Iran and N.Korea where the billions released back to Iran by Obama has not to some degree benefited N.Korea and sped up their nuke program is a fool of the highest order.

bu22
bu22

Another reason Trump has support:

"The firing of the Google employee for writing a memo will inevitably bring about different excuses. It shouldn’t. It should chill your bones. Nothing could be more dystopian than the largest information, communication, and documentation hub controlling your thoughts and punishing you for wrongthink.

This is the most chilling development of our times, as anything you say, no matter how scientific and valid it is, can be used against you to say that you’re a bigot. Your life, career, and livelihood will be at risk. These are the new dark ages. Orwellian is a word used often, mostly without proper context by people without the barest hint of irony, but this is one of those rare times when it is justified, in the true sense of the term, as nothing could be more Orwellian than blaspheming against the church of inclusivity, or getting fired for the sake of diversity. It could happen to anyone. It could happen to you."  http://thefederalist.com/2017/08/09/google-firing-employee-diversity-discussion-frighteningly-authoritarian/

Doomy
Doomy

@bu22


And that Orwellian political correctness is in large part a reason for Trump's historic victory. The proglodytes have only themselves and their nuttiness to blame. 

JohnnyReb
JohnnyReb

@bu22

Annoying nauseating Political Correctness.

Pajama boys them all.

skruorangeclown
skruorangeclown

Love it Orange Clown now blaming McConnell for legislative failures. 

Who is   he going to blame for all his failures of diplomacy with China and North Korea?

JohnnyReb
JohnnyReb

@skruorangeclown

Try to keep up, will you?

China just voted in the UN Security Council for sanctions on N. Korea.

No one including the dimmest of Dims calls that a failure.

Can China do more with N. Korea?  Yes, and Trump's team is working it.

As to the Turtle, his rhetoric is CYA and it would not be surprising to see a move to replace him, which I would support.

Eye wonder
Eye wonder

@JohnnyReb @skruorangeclown

McConnell is the only reason Gorsuch is on the Supreme Court, and the only reason President Lyingscumbag can claim to have done something during his pathetic presidency. Careful what you wish for, Lil J.

Doomy
Doomy

@Eye wonder @Doomy @JohnnyReb @skruorangeclown


Yeah. Right. A booming economy approaching 3% or greater GDP growth, unemployment now at an unimaginable 4.3%, a record shattering stock market boom filling people's pockets as well as govt coffers with tax revenue. Bad, bad, bad. LOL!

JohnnyReb
JohnnyReb

@Eye wonder @JohnnyReb @skruorangeclown

No, one-eye.

Any Senate majority leader would have done the same.

The Turtle loves "regular order" which is code for compromising with Dims.

Therein lies the problem as all us Cons know there is no compromising with Dims.

Attempts at doing so put us where we are today.

Doomy
Doomy

@Eye wonder @Doomy @JohnnyReb @skruorangeclown


When you have to resort to personal attacks you've lost the debate. Seems like you always get reduced to being able to come back with nothing more than that. So saddy, sad, sadz! 

Eye wonder
Eye wonder

@Doomy @Eye wonder @JohnnyReb @skruorangeclown

Spare me the fake snowflake, Doomy. You're a big boy. You can  handle it. President Lyingscumbag has almost nothing to do with the current economic environment; any suggestion to the contrary is either the height of naivete or flat out intellectual dishonesty. I'll give you the benefit of the doubt and go with "naive."

SGTGrit
SGTGrit

@Eye wonder @JohnnyReb @skruorangeclown 

"Pathetic presidency" LOL....We just experienced eight years of a pathetic presidency. Kind of early to write this one into that same category. Particularly, when you access the accomplishments against the headwinds even coming from his own party.

Doomy
Doomy

"The GOP’s current 52-seat majority makes the Senate look tantalizingly competitive. But a look at the map reveals that the Democrats hold far more seats on borrowed time than Republicans do. The GOP doesn’t hold a single Senate seat in those 14 states that are more Democratic-leaning than the country overall. Meanwhile, Democrats hold six seats in the 26 more-Republican-than-average states, and all six are at risk in 2018."- From Johnny's link


Doomy likee.  

McGarnagle
McGarnagle

@Doomy


spiking the ball too soon are we. 2018 election is still long time away but I can see why you are gleeful.

Eye wonder
Eye wonder

@Doomy

Remember how, not so long ago, people (you included, sir) were convinced that President Lyingscumbag wouldn't win the election? 

Doomy
Doomy

@McGarnagle @Doomy


Spiking the ball? Nah. Things could still go awry for the Rs. My only point is that its a very uphill climb for the Ds. Lot could happen though- A recession, a war, etc that could benefit the Ds.  And a lot could happen the other way for the Rs with people realizing this is just a witch hunt against Trump. Combined with a booming economy the resentment against Ds trying to subvert a Democratically elected president could bring an epic landslide for the Rs.  

Doomy
Doomy

@Eye wonder @Doomy


Yep. I was thoroughly convinced Trump could not win. Seems I underestimated the degree to which people were ticked off over the ruling political class. The silent majority had had enough after 8 years of Obama. 

Eye wonder
Eye wonder

@Doomy @Eye wonder

Proving that Doomy is not capable of learning from his mistakes. "Those who refuse to learn from history are doomed to repeat it."

Doomy
Doomy

@Eye wonder @Doomy


No doubt. Looks like folks may finally be learning what history has been telling us over and over and over- that the burdensome administrative state doesn't work and that a return to a true market economy is the only thing that will work. 

McGarnagle
McGarnagle

@JohnnyReb


These are the same folks who thought Hillary was going to win. So theres that.

JohnnyReb
JohnnyReb

@McGarnagle @JohnnyReb

Yes, but they are also the same folks who the Dims put their faith, lock stock and barrel.

It's speculation I agree, but it's startling don't you agree?

McGarnagle
McGarnagle

@JohnnyReb @McGarnagle


Oh yea. Fair to say Repubs will control congress until 2020. But I doubt they will fall in line with Trump agenda. 

Anyways still too soon to talk 2018. So much can change.

Doomy
Doomy

@JohnnyReb


Yeah. I just heard that if the Dims win every single seat in 2018 that Hilz won and in addition they won every seat that Trump won by 3 points or less that they still would not win the house and in fact would lose 5 senate seats. They have quite a hill to climb in 2018 in a year which normally favors the party out of power. Also, they have 3 times as many Senate seats up for grabs as the Rs. Good luck retaking the Senate. 

Doomy
Doomy

@McGarnagle @JohnnyReb


Yep. But with the Dims having 3 times as many senate seats up for grabs things don't look good for them. 

JohnnyReb
JohnnyReb

Here's another reason Dims are soo deranged....

A new study shows that should Dims win every House and Senate seat where Hillary beat Trump AND all those where Trump beat Hillary by less than 3 points......

The Dims would still not control The House....

And, they would lose 5 Senate seats.

Starik
Starik

@JohnnyReb Another study. John Oliver had a wonderful show last season about studies. Every position and speculation has one. Link?

JohnnyReb
JohnnyReb

@Starik @JohnnyReb

John Oliver?

Is that the same John Oliver who busted a gut laughing on his show about the possibility of Trump beating Hillary?

You're hopeless.

Linkie tomorrow.

Doomy
Doomy

@Starik @JohnnyReb


He can be funny at times but anyone knowledgeable about the issues can see right through his emotional appeals and his lack of knowledge about anything other than his own biased viewpoints.