VCOM Carolinas Research Day 2023

Educational Reports

Analysis of Potential Risk Factors of Rural Hospital Closure and Identification of At-risk Rural Alabama Hospitals Katie Hogge, Robyn Sawyers, Carsten Steinmetz, Tom Lindsey DO Edward Via College of Osteopathic Medicine – Carolinas Campus, Spartanburg, SC

Abstract # EDUC-5




Rural hospitals in the United States are facing increasing closure rates. Through data analysis, we identified Alabama as a state with one of the greatest number of at-risk hospitals. Alabama is also a state with which VCOM has close ties, presenting an opportunity to potentially help mitigate this risk. A strong general surgery program can be very profitable for hospitals, and such a program could help prevent hospital closure. We found 7 characteristics which indicated a higher risk of future closure and used them to stratify individual rural hospital risk within the state. We then identified 3 hospitals within 2 hours (driving) of each other which could potentially work together to strengthen and minimize closure risk. Once hospitals were filtered to include “rural” designations as according to the standards of the American Hospital Directory (AHD) we began searching for characteristics that had the greatest predictive value for at risk hospitals. Next, a point system was created, a higher score meant a greater chance of closure. Points were totaled and stratified into different risk categories based on their value. Regions were then divided into a map grid to identify proximity of at-risk hospitals. Methods

Table 1. Determination of point values for defined characteristics At- Risk Characteristics Point Value Sole community 2 Rural referral 2 Medicare dependent 1 CMI trend <0 = declining 2 0-0.04 = stagnant 1 0.4+ = rising 0 Cost to charge Operating room: 0.5+ 1 Gen Med / Surg: 0.5-0.75 1 Gen Med / Surg: 0.75-1 2 Gen Med / Surg: 1+ 3 CMI Average <1.3 = below average 1 >1.3 = above average 0

Table 2. Total Hospital Points

References We identified D.W. McMillan Memorial Hospital, Mizell Memorial Hospital, and Dale Medical Center as our chosen at-risk hospitals. D.W. McMillan Memorial Hospital and Mizell Memorial Hospital were in our highest risk category, and Dale Medical Center was in the second highest risk category. These hospitals are all within 2 hours (max) of each other. This will allow facilitation between the three hospitals in future projects to help prevent closure. This procedure allowed for the identification of hospitals at risk in Alabama in order to potentially prevent closure of these hospitals. 1. Caring for Rural Communities . Alliance for Rural Hospital Access. (2022, September 12). Retrieved January 3, 2023, from 2. The financial importance of the sole community hospital payment designation . Rural Health Research Gateway. (n.d.). Retrieved January 3, 2023, from lina 3. RHI Hub. (n.d.). Rural Health Information Hub . Rural Hospitals Overview. Retrieved January 3, 2023, from an%20tertiary,based%20on%20location%2C%20bed%20size%2C%20and%2For%20referral%20patterns 4. HRSA. (n.d.). Rural Referral Centers Eligibility . Health Resources and Services Administration. Retrieved January 3, 2023, from 5. Office, U. S. G. A. (n.d.). Medicare: Information on Medicare-Dependent Hospitals . Medicare: Information on Medicare Dependent Hospitals | U.S. GAO. Retrieved January 3, 2023, from 300#:~:text=The%20Centers%20for%20Medicare%20%26%20Medicaid,located%20in%20a%20rural%20area 6. Caring for Rural Communities . Alliance for Rural Hospital Access. (2022, September 12). Retrieved January 3, 2023, from 7. Cost of Rural Hospital Services . Saving Rural Hospitals. (n.d.). Retrieved January 3, 2023, from 8. Case mix index (CMI) . Definitive Healthcare. (n.d.). Retrieved Ja nuary 3, 2023, from

Alabama Hospitals with Rural Designation


Andalusia Health Bryan W. Whitfield Memorial Hospital Cullman Regional Medical Center




D.W. McMillan Memorial Hospital Dale Medical Center DeKalb Regional Medical Center

9 7


Highlands Medical Center Jackson Hospital

5 2

Marshall Medical Center South


Medical Center Enterprise

6 9

Mizell Memorial Hospital

Northwest Regional Health


Regional Medical Center of Central Alabama Russell Medical Center Russellville Hospital Troy Regional Medical Center

4 6 6

Rural Hospitals at Risk of Closure • DW McMillan Memorial Hospital • Dale Medical Center • Mizell Memorial Hospital



Ann Peton for providing and gathering data on rural hospitals in Alabama.

Vaughan Regional Medical Center



2 0 2 3 R e s e a r c h R e c o g n i t i o n D a y

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