Virtual Town Hall

The State of Rural Health Care in North Carolina

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In North Carolina’s 80 rural counties, health systems and hospitals help residents get the care they need close to home, including through innovative partnerships. Rural hospitals are constantly confronted with unique obstacles that need to be explored and addressed to provide the best possible care to the people in those communities.

Six healthcare and community leaders recently came together in a virtual town hall to discuss the challenges rural hospitals face and opportunities ahead to continue improving rural healthcare in our state.

The conversation was part of a series of virtual town halls hosted by the North Carolina Healthcare Association.

Panelists featured Joann Anderson, Senior Advisor, Ascendient; former CEO, UNC Health Southeastern; Bert Beard, CEO, Maria Parham Health, a Duke LifePoint Hospital; Roxie Wells, MD, President, Cape Fear Valley Hoke Hospital; Paul Hammes, CEO, Hugh Chatham Memorial Hospital; James Hoekstra, MD, President, Atrium Health Wake Forest Baptist – High Point Medical Center; and Mark Gordon, President, Cone Health Alamance Regional Medical Center


Here are some of the key takeaways from the conversation:

The role of hospitals in rural communities

Hospitals play a vital role in their communities and often serve as economic drivers, especially in rural cities and towns. “It’s not uncommon that the top employer in town is a health care facility,” said Mark Gordon, President, Cone Health Alamance Regional Medical Center.

Gordon expressed how critical it is for healthcare organizations to maintain relationships with the local entities, such as chambers of commerce, community colleges, and other key anchors in the community.

Dr. Roxie Wells, President, Cape Fear Valley Hoke Hospital, said that 68% of health care providers choose to practice in the state in which they were trained, and more than 50% decide to live within a 50-mile radius. Therefore, placing an emphasis on healthcare education and training in rural areas can directly impact the quality and accessibility of care.

Read more: Finding The Way – Reimagining Rural Health


COVID-19’s impact on rural hospitals

“The stresses that were put on the healthcare systems, especially the rural hospitals, during the pandemic are actually continuing,” said Dr. James Hoekstra, president of Atrium Health Wake Forest Baptist – High Point Medical Center. “What we’ve been left with is less staff, more overburdened, and more expensive.”

While the pandemic has burdened hospitals, it has also accelerated critical health care solutions, such as telehealth. Providing telehealth as an option helps to ensure everyone in North Carolina has access to health care. Through virtual visits, providers in urban areas can treat patients and counsel providers in rural areas.

Telehealth will likely remain prominent for the foreseeable future, so it is important to consider how to permanently integrate it into the healthcare landscape.

Read more: Hospital-Level Care, Right at Home


Impact of Medicaid expansion on rural hospitals

North Carolina is one of 12 states in the country that has not expanded Medicaid, and this takes a toll on hospitals, especially those in rural areas. Bert Beard, CEO, Maria Parham Health, a Duke LifePoint Hospital noted that urban hospitals are not as negatively impacted as rural community hospitals. LifePoint hospitals operate in 30 states, some of which have expanded Medicaid, and Beard pointed out that “nobody has regrets on expanding Medicaid.”

“We definitely need to think about expanding Medicaid. I think that’s a huge investment because it covers everything,” said Dr. Wells. Expanding Medicaid in North Carolina would provide hospitals with the necessary resources they need to keep their doors open so they can continue to serve their communities.

Read more: N.C. General Assembly: Close the Coverage Gap in 2021 


Accessibility of behavioral health in rural hospitals

The pandemic has exacerbated the behavioral health crisis in North Carolina, especially in rural areas where behavioral health services are less accessible. “There is a dearth of supply when it comes to psychiatrists and behavioral health professionals in general let alone in rural settings,” said Paul Hammes, CEO, Hugh Chatham Memorial Hospital.

There has been a 25% increase worldwide in anxiety and depression diagnosis, surely in part due to the pandemic, noted Hammes. In 2021, there was a 50% increase in emergency department visits for suicide attempts among girls aged 12 to 17. Due to these increases, the American Academy of Pediatrics has declared a national emergency in children’s mental health.

“We’ve seen an overall increase of 65% in behavioral health patients presenting in our emergency department,” said Hammes, highlighting how Hugh Chatham Memorial has directly felt the impact of this public health emergency.

Read more: Behavioral Healthcare Expands in N.C.’s High Country


Impact of repealing Certificate of Need

Repealing Certificate of Need will increase hospital financial losses and further imperil rural hospitals, said Beard. “That will put us under. It will impact us from a workforce standpoint. It will take all the payers that have anything that support our safety net services, and all you’ll be left with is 24/7 urgent cares.”

Hospitals worry that repealing the law will result in competitors offering select medical services to patients that are privately insured, which will leave hospitals to care for those that are uninsured or rely on Medicare and Medicaid.

Dr. Wells said legislators could help rural hospitals by applying for a federal program that increases payments for Medicaid patients’ hospital care. “It really doesn’t cost North Carolinians anything, but it would be beneficial to be able to obtain those funds and use them for fixing outdated buildings, having services, strengthening the workforce and so many other things.”


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