Opinion: A different numbers game 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)


“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 this past week.

“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.

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.”