Ascension St. John Nowata has become a rural emergency hospital, losing inpatient services despite a months-long community battle to keep them.
Tanner Holt, the hospital’s president, said in a press release the new status allows the facility to “better align our resources with the healthcare needs of the community.”
Congress established the rural emergency designation in 2020 to help maintain local access to outpatient and 24/7 emergency services amid growing concerns over hospital closures. Rural emergency facilities receive a monthly payment of around $295,000 to do this.
“This means that emergency services will be available around the clock, while important outpatient services will continue to be offered,” Holt said.
The caveat is that rural emergency hospitals can no longer offer acute inpatient or swing-bed services. Swing-bed programs allow patients to transition from an acute hospital stay to skilled rehabilitation while remaining in the same facility. These hospitals can't exceed an annual per-patient average length of stay of 24 hours.
Patients requiring hospitalization will be stabilized and transferred to the “closest, most appropriate hospital” for specialized and acute inpatient care, according to the release.
The nonprofit health system said the change is expected to have “minimal impact” on hospital employees, and there are no planned changes to staffing in radiology and laboratory services or layoffs.
“For 100 years, Ascension St. John has cared for patients and communities across Northeast Oklahoma,” the release said. “That commitment does not change with this designation.”
Ascension St. John Nowata is the seventh hospital in Oklahoma to become a rural emergency facility. There are 56 nationwide as of Sept. 23.
Many Nowata residents opposed the change, arguing that inpatient care is essential for Nowata County, where residents are older and more likely to live in poverty than Oklahoma's population as a whole.
An Ascension St. John spokesperson told StateImpact in July that, since 2020, the Nowata hospital has experienced a 58% decline in inpatient admissions, while emergency department visits have increased by 12% since 2022, "highlighting a shift in patient utilization patterns." The rural model better reflects the community’s needs, the spokesperson said.
Hospital cost reports show that the facility’s average daily inpatient census over the past decade is 4.85 patients. Though the hospital saw modest increases during the COVID-19 pandemic, this number has remained generally consistent. StateImpact asked the spokesperson for clarification on the data they cited. They referred back to their original statements.
Dr. David Caughell, president of Green Country Medical Inc. and a medical staff member at Ascension St. John Nowata, said although it is still early, the transition has been a challenge.
“We are trying to figure out how to help people and not just send everybody to Bartlesville. But that's kind of the rules," Caughell said. "If somebody is sick enough that you know they need to be in the hospital, you're supposed to send them over there.”
Ascension St. John’s Bartlesville location is about 30 minutes away from the Nowata hospital.
Caughell said the most difficult part has been sending patients away. He mentioned an older individual who fell and broke their pelvis. He said he would have liked to admit them and later set them up in a nursing home. But under this new designation, he couldn’t.
“My fear is they're going to not have enough volume to justify the full-time equivalent staff that they have over there,” Caughell said.
How are Nowata residents moving forward?
A community group called Save Our Hospital formed this summer as Ascension St. John considered the rural emergency designation. The group collected about 1,000 signatures around Nowata County in favor of the hospital maintaining inpatient care.
Group member Kelly Parsons, who lives in Nowata County, called the change unfortunate. But now that the designation has been approved, she said the group is focused on promoting legislation that is being considered at the federal level.
The Rural Emergency Hospital Designation Improvement Act is a bipartisan measure introduced by Sens. Jerry Moran, R-Kan. and Tina Smith, D-Minn.
Moran said in a press release this bill was inspired by provider recommendations on how to strengthen the rural emergency hospital designation.
The National Rural Health Association is supporting the bill. Chief Operations Officer Brock Slabach said the act addresses almost all of the organization's concerns with the designation. It only left out their ability to participate in the 340B program, which allows certain healthcare facilities to purchase prescription and non-prescription medications at reduced cost.
Currently, the only way a rural emergency hospital can offer inpatient services is by creating a distinct part unit licensed as a skilled nursing facility. This unit must meet separate licensing requirements and be staffed separately, making it expensive and not feasible for most hospitals, Slabach said.
“The loss of these skilled nursing beds through the swing-bed program is a real concern that may even keep a hospital from converting to REH,” Slabach said.
The act would provide some flexibility so a rural emergency hospital wouldn’t have to create a distinct part unit, he said. Instead, they could use existing beds to serve patients in need of extended care services.
Hospitals would also be paid based on the reasonable cost of providing these services, instead of receiving a flat reimbursement under the Medicare program for skilled nursing facilities.
Other provisions in the Rural Emergency Hospital Designation Improvement Act include:
- Creating a 5% add-on payment for laboratory services.
- Authorizing previously closed rural hospitals to reopen and apply for the rural emergency hospital designation if they met all eligibility requirements between Jan. 1, 2015, and Dec. 27, 2020.
- Allowing rural emergency hospitals to be eligible as a National Health Service Corps site. The federal program offers scholarships and loan repayment to healthcare professionals who commit to working in medically underserved areas.
Slabach said he hopes the measure moves forward, citing how many rural hospitals are struggling to stay open. Seven hundred rural hospitals are at risk of closure in the U.S., according to a report from the Center for Healthcare Quality and Payment Reform. Right now, 45 of those are located in Oklahoma.
The rural emergency hospital model isn’t the answer for many communities, Slabach said. He said he wishes reimbursement for rural facilities could be improved so they aren’t forced to convert to this designation.
But he said this federal measure could be a “real lifesaver” for those struggling under current reimbursement systems.
“This model has shown to be successful, at least in stabilizing access to care for patients and their families in rural places that have vulnerable populations,” Slabach said.
Parsons said her biggest concern is maintaining healthcare in Nowata.
“I am nervous that if we lose true hospital support, that it's not going to help Nowata grow. And that's really what I want, is to see Nowata succeed as a city,” Parsons said. “Because if you look at old pictures and videos of Nowata, even up until the 90s, it was a happening place for a small town. And to see its state now and know what it used to be is really sad.”
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