Originally published in the Missourian on December 15, 2021.
Almost two years ago, the only hospital in Boonville shut its doors, leaving the community of 8,000 without 46 inpatient beds, an emergency room, rural health clinic and outpatient services.
“They didn’t give us any warning or anything. Boom. It was closed, and then we hear about it,” said Gigi Quinlan McAreavy, director of economic development for Cooper County.
Pinnacle Regional Hospital closed in January 2020 and tried to reopen after filing for bankruptcy in February, but the pandemic blocked those plans. An estimated 100 hospital workers ended up leaving Boonville after the hospital closed.
To fill the gap, MU Health Care is building a 14,000-square-foot, multi-specialty clinic scheduled to open in July. Meanwhile, many Cooper County residents have lost access to their regular doctors and must travel to Columbia or Sedalia to see a physician or find emergency care.
Rural health
Pinnacle Regional Hospital closed after a routine state inspection found that the HVAC system in the hospital needed immediate repairs. Without the ability to pay for the repairs, owner Doug Palzer filed for Chapter 11 bankruptcy.
According to a notice sent to employees, the closure was the result of “unforeseen and unexpected business circumstances, including the disruption to a wide range of surgeries and business operations created by the COVID-19 pandemic.
Since 2014, a total of 15 hospitals have closed in Missouri. Ten were rural hospitals and nine were acute care facilities, according to the Missouri Hospital Association.
The trend is reflected nationwide with a record 20 rural hospitals closing in 2020 alone, according to Becker’s Hospital Review. Nearly 1 in 5 Americans live in a rural area and depend on local medical care. But the economies of scale make it difficult for small hospitals to survive.
“Rural hospitals themselves are financially unstable,” said Mona Brownfield, a former physician at Pinnacle. “It’s just hard to provide a service that bigger hospitals can absorb the costs of. They have surgeries and specialists, and that brings in a lot more money than just primary care.”
The health care system is largely volume-based, which puts rural communities at a disadvantage.
“Hospitals have to rely on putting people in their inpatient beds for revenue,” said Sheldon Weisgrau, vice president of health policy at the Missouri Foundation of Health. ”That has been a really difficult thing for a lot of rural hospitals to cope with.”
Brownfield pointed to the emergency room wing of the Boonville hospital as a costly asset.
“I think we were losing like a million dollars a year just out of the emergency room,” she said. “You can’t have an acute care hospital without having an emergency room.”
Hospitals often provide long-term services as well, meaning a community may lose nursing home beds and other types of long-term care when one closes. The impact of these losses on a community can have a broad reach.
“They’re often the largest employers in their communities, the biggest economic generator,” Weisgrau said about rural hospitals. “In those terms, the loss of a hospital goes much beyond just the immediate loss.”
“As soon as there is a closure, there is a loss of service, and for most people, that means a loss of a 24-hour emergency room that was easily accessible,” he said.
Broad impact
The immediate fallout of the hospital closure was the flight of medical personnel from Boonville.
“As soon as the announcement was made, all of these surrounding hospitals were calling and trying to hire (our doctors) away,” McAreavy said. “We didn’t even hardly have time to regroup and do anything.”
A group of former Pinnacle doctors helped form a committee to fill the loss of the hospital.
Talks began with MU Health, which announced in March that it would build a multi-specialty clinic through a partnership with local doctors. It will have primary care providers, specialty services, X-ray, imaging, a lab, physical therapy services and extended hours.
Until the MU Health multi-specialty clinic opens next summer, several medical offices do provide services in Boonville, but they close at 5 p.m. Even when the new clinic opens, the community will not have an emergency room with patients still needing to seek that kind of care in Columbia.
“We are going to get some resources back here. But the main one, the emergency room, the university wasn’t willing to bring that to our community. So that’s something we’re still going to be missing,” McAreavy said.
As a doctor who also grew up in Boonville, Brownfield said it was scary for her patients to adjust to the new lengths they must travel for care.
“Making sure there was no wreck on the bridge, or traffic on the interstate, other things that made it a lot more concerning because people had to adjust to how they did things,” she said.
Pandemic timing
Closing at the beginning of the pandemic also left Boonville stretching to establish temporary clinics to hand out vaccines and conduct tests. Once COVID-19 started to spread, the Cooper County Health Department kicked into high gear.
“Our Health Department really helped in setting up a vaccination clinic through Rolling Hills Park where people can drive in a circle area and they would get the (COVID) shot administered,” McAreavy said.
That shows the resilience of Boonville in responding to a crisis, but Weisgrau said a long-term solution for sustaining rural hospitals is problematic.
“Until we can find a way to not rely on how many beds are used and how many services are provided to finance health care,” he said, “it’s going to be really difficult to keep viable health care services in a lot of communities.”
