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V O L . X X X N O. X V J U LY 8 , 2 0 2 4 10 H E A LT H C A R E / W E L L N E S S A s head of operations for LifeFlight of Maine, Bill Cyr has a front-row view of the turbulence at hospitals across the state's small towns and villages. "e rural places are really rural," says Cyr, a for- mer flight nurse who's been in health care since high school. Today at LifeFlight, he oversees operations for the Bangor-based nonprofit serving 136 communi- ties, islands and unorganized townships from bases in Bangor, Sanford and Lewiston with three helicopters, a fixed-wing airplane and a growing fleet of ambulances. During the pandemic, hospitals treated critical patients for longer, secured ventilators and other life- saving equipment and trained staff quickly on new skills, Cyr says. Today, "they do the best that they can with what they have, and they figure it out." With about half of America's rural hospitals oper- ating in the red, there's a lot to figure out in order to tackle staffing shortages, reduced reimbursements and lower margins. In Maine, the country's oldest state with a median age close to 45, rural hospitals care for some of the state's sickest, poorest and oldest residents. Many live in sparsely populated areas with subpar internet connectivity and transportation hurdles. Michael Topchik, an analyst with Chartis Group LLC, a Chicago-based health care consultancy, points to the erosion of a rural health safety net developed after World War II to bridge the divide between urban, wealthier areas and less-populated agrarian regions. He also says that rural hospitals are being paid less for their services while grappling with ever-changing reimbursement models, particu- larly around Medicare Advantage plans. "Programs and safeguards that were put in place have eroded. Reimbursements have eroded," says Topchik, who is based in Portland. "ere's an old say- ing, 'No margin, no mission,' and every one of these rural hospitals has a mission to support their local com- munity and their health care needs. It's pretty tough to do that if you can't keep the lights on." Widening national crisis While America's rural health safety net has been in crisis for 15 years, the situation has gotten worse over the past year, according to a report by Chartis published in February. Over the past year alone, the percentage of rural hospitals operating in the red jumped from 43% to 50%, the single-largest change in a 12-month period. e situation is leading to "care deserts" in rural areas, with many dropping services from obstetrics to inpatient care and more than 500 facilities nationwide considered vulnerable to closure. e downsizing comes as hospitals are no longer able to rely on government programs that sustained P H O T O / C O U R T E S Y, L I F E F L I G H T O F M A I N E F O C U S Bill Cyr, chief operating officer at LifeFlight of Maine, talks to graduate students from Northeastern University's Roux Institute. 24 rural hospitals 3 closed or converted since 2010 42% with negative operating margin 0.8% median rural hospital operating margin 0% vulnerable to closure Hospital Critical Access Hospital Psychiatric Hospital It's pretty tough to [support a local community] if you can't keep the lights on. — Michael Topchik Chartis Group S O U R C E : Chartis Group LLC MAINE RURAL HOSPITAL SNAPSHOT EMERGENCY TREATMENTS Trying times for Maine's rural hospitals spark entrepreneurial approaches B y R e n e e C o r d e s S O U R C E : Maine Hospital Association

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