In health care, distance is measured in more than miles. It can be measured in the months someone waits to see a specialist, or in the manageable condition that becomes an emergency because care came too late.
For many Arkansans, living a longer, healthier life depends, unfortunately, on where they live.
We see this most clearly in rural Arkansas, but the consequences affect our entire state. When a rural hospital closes or reduces services, patients travel farther for care, ambulances spend more time transporting patients, and communities lose both an essential service and an economic anchor.
Rural health care is part of Arkansas' infrastructure, just like our highways, power grid and broadband network. Protecting it begins with an honest conversation about the financial realities facing rural hospitals.
A hospital can be essential to its community and still lose money.
Hospitals must be ready around the clock to respond to heart attacks, strokes, serious accidents and other medical emergencies. That requires trained professionals, laboratory and imaging services, medications, technology, equipment and safe facilities.
Those expenses do not disappear on a slow day. A hospital must be prepared whether 10 patients come through its doors or 100. Yet hospitals are generally paid for the services they provide--not for maintaining the capacity to respond when their communities need them.
Rural hospitals also treat higher percentages of Medicare, Medicaid and uninsured patients. Government programs often pay less than the full cost of care, and treatment provided to uninsured patients may result in little or no payment. Small hospitals also have less leverage when negotiating with commercial insurers.
The result is a system in which rural hospitals often receive the least favorable reimbursement while serving communities with some of the greatest health needs.
According to the Center for Healthcare Quality and Payment Reform, a national health-care policy organization, 32 of Arkansas' 47 rural hospitals--68 percent--are at risk of closing because of continuing financial losses and limited financial reserves. Nine of those hospitals are considered to be at immediate risk.
These are not simply numbers on a spreadsheet. They represent Arkansas communities, families and patients who could lose access to care close to home. This is a crisis.
To remain financially viable, many hospitals have reduced or eliminated services such as labor and delivery, behavioral health, emergency medicine and trauma readiness. Ending a service may improve a hospital's financial statement, but it does not eliminate the community's need for that care.
Workforce shortages add to the pressure. Rural hospitals compete with larger systems for health-care professionals and often must pay premium rates for temporary staff. Staffing shortages can lead to further reductions in services and revenue, even as other operating costs continue to rise.
The federal Rural Health Transformation Program gives Arkansas an important opportunity to invest in prevention, workforce development, technology and new models of care. In August, UAMS received nearly $17 million through the program to support rural health initiatives.
We will use this investment wisely. While the grants will be helpful in expanding telehealth and launching innovative programs, they cannot repair a payment system that consistently fails to cover the cost of essential services.
Arkansas does not need a major medical center in every community. It needs a connected statewide system that gives every resident a reliable place to enter care and a clear path to more advanced treatment when needed.
As Arkansas' only academic health system, UAMS has a responsibility to help build that network. That means listening to rural hospital leaders and bringing UAMS' workforce, technology, research and clinical expertise to the table. Our goal is not to replace local hospitals. It is to help them remain strong so more Arkansans can receive high-quality care closer to home.
We must also work with hospitals, clinics, insurers, employers and policymakers to explore payment models that recognize the value of readiness, access and better health--not simply the number of services delivered.
UAMS is partnering with hospitals in Warren, Mena, Helena and Pine Bluff to help strengthen health care in those communities. In central Arkansas, our acquisition of the former Encore Health facility in Bryant will bring UAMS-quality services closer to families in one of the state's fastest-growing areas.
These are meaningful steps, but they are only a beginning. Lasting progress will require collaboration, regional planning and a willingness from all of us to consider what we can do differently.
The future of Arkansas health care cannot be built around asking every patient to come to Little Rock. It must be built by extending knowledge, partnerships and access throughout our state while ensuring that advanced care is available when needed.
Every Arkansan should be able to enter the health-care system close to home, receive appropriate care there whenever possible, and connect quickly with specialized treatment when necessary.
No family facing a medical emergency should have to wonder whether the care a loved one needs is still available nearby. And no Arkansan's ZIP code should determine the length or quality of that person's life.
Dr. C. Lowry Barnes is chancellor of the University of Arkansas for Medical Sciences.