Ahead of the curve: Re-imagining rural health care

On Jan. 17, MUSC accomplished something that goes against one of the longest running trends in rural health care. We opened a brand new, state-of-the-art, 25-bed rural facility in Cades, South Carolina: MUSC Health Black River Medical Center. This will serve the communities located in southern Florence and Williamsburg counties. It will also serve as a direct connection to the excellence and expertise that comes with being part of the state’s only comprehensive academic medical center. Why is this such a big deal? I’ll explain.

There is a constant stream of media and articles, peer-reviewed and otherwise, related to the current state of rural health care (or lack thereof) in the U.S. To this point, we live in a state that is considered mostly rural once you get outside of the larger metro areas of Charleston, Columbia and Greenville. And every single one of these articles offers similar dire-straits stats:

• A recent report conducted by the American Hospital Association highlights the causes of 136 rural hospital closures from 2010 to 2021 – 19 just in 2020.
  • All rural hospitals that closed suffered from issues, such as staffing shortages, low patient volume, regulatory barriers and financial challenges like skyrocketing costs in the supply chain.
• A report from the University of North Carolina at Chapel Hill found 184 rural hospital closures since January 2005, where in some cases, hospitals shifted to no longer offering inpatient care, instead offering emergency services only.
• This report details how in South Carolina, we’ve had four rural hospital closures since 2005, and of the 26 current rural hospitals, five are at immediate risk of closing.

Why does this matter? What is the impact for these communities when a local hospital closes?

To state it clearly – a community without health care is a community without a future.

This last point is why MUSC was invited to the table with county, state and federal government representatives, local hospital leaders and community members to discuss the future of health care in the Lake City/Williamsburg County area. Fast forward to today, and Black River is the only newly constructed rural hospital that has or will open in 2023 – not just in South Carolina – but likely in the NATION.

Now, you might be thinking, “Well, Dave, does this mean that MUSC is running INTO a burning house while everyone else is running OUT?” Excellent question … and my answer is that this facility is one of the most forward-thinking, collaborative and innovative solutions to the rural hospital dilemma in action.

In the previously mentioned AHA report, the authors outlined some ideas for how rural hospitals could become more solvent. And while yes, more federal support, decreased regulatory burdens and Medicaid expansion are logical pathways, it's hard to negotiate those pathways for most smaller hospitals – it’s rare for them to get ahead of that curve. Where the report gets more interesting is when it talks about partnership arrangements and flexible models of care – think telehealth. MUSC Health has been working with local and regional rural health systems over the past five years to create an innovative and effective means of balancing and re-imagining the challenges facing rural hospitals: staff recruitment and retention, patient outmigration, increasing overhead costs and requirements and truly delivering the best local care with access to any level of care required.

Because of who we are, and what we do, MUSC is able to bring many tools to the table with our local partners to help to address many of these issues that block best patient care and sustainability for critical access for these rural hospitals – physician recruitment, quality oversight, brand recognition, staff retention, access to subspecialists, telehealth and shared services, system infrastructure and pricing. All of this springs from our core commitment: putting our patients and those we serve, the citizens of South Carolina, first.

What the AHA report itself doesn’t really talk about, but what we know to be true, is that rural health care facilities like Black River are the heart of their communities. They provide a sense of belonging and trust that only occurs when neighbors care for other neighbors. It is hard to place a numerical value on the importance of that – it evokes hometown, community pride, apple pie. Sort of like going to your local barbershop and getting a good haircut and a good conversation because they know you. Maybe its human nature, but we tend to feel safer when we’re closer to our homes and have the benefit of knowing that we can access the care we need. It’s one of many reasons that MUSC embraces the basic truth that the best care is local, and providing the right care, at the right place, at the right time, for every patient – rural or not – is a cornerstone of any growth decision we make. We pursue innovative approaches because we are actively listening and engaged with the communities that come to us for help … because we have a higher purpose.

Our great privilege and duty to the citizens of South Carolina means that we must deliver outstanding health care, educate future health care providers and change the future of health and wellness in our state through innovation and research. What this all means for Black River Medical Center is that as it matures into the high-quality community hospital we know it can be, it will also be poised to solve major health care issues in the long term by helping to increase the number of local care providers through training consortiums and by participating in groundbreaking clinical research that brings cutting-edge treatments closer to home.

Our organization has made incredible progress under some of the most challenging and transformative forces affecting modern health care, and I want you to know that it has required more than merely having a vision. It has required partnership, teamwork, common goals and values – and above all, trust. From our trustees, advisory board members, donors, elected officials and community leaders to our amazing boots on the ground, each individual’s contribution means that not only will health care delivery survive in this community, but I predict it will thrive for generations to come.