Sometimes we neglect the importance of our hospitals in our communities.
EDITOR’S NOTE: Sharon Easterling, the newest member of the ICD10monitor editorial board, will be reporting on health equity while also sharing thoughts about her personal experiences as a Black woman working in the healthcare industry.
We all think small towns are a great place to go when you are ready to hang up that coding, clinical documentation improvement (CDI), or physician advisor hat, right? Ahhh … if only to kick back on that front porch or fire up that grill in the backyard with the birds singing and the grandkids playing in the yard. Sounds like the life, right?
Well, maybe, but…maybe not. You see, I’ve lived in a few beautiful small towns. Sometimes I do think I would love to move back and take in nature again. But then I reflect on what has happened over the past few years. Could it be the limited access to care causing me to pause and rethink that?
You may say wait…why would you say that? Well, let me give you some insight into healthcare in small-town America.
In 2015, it was decided to close a small-town local hospital in Marlboro County, South Carolina. With the closure, patients were routed to two hospitals in neighboring towns, 15 and 20 miles away from the closing hospital. You may think that does not sound like so big an issue, but we are talking about a very rural county with high population density. That equals more miles to cover between people and hospital.
Hospitals began to consolidate and close around the U.S. around this same time due to the impact of insurance changes, recovery audits, and economic challenges. Fast forward to 2021, and this disruption in healthcare has continued, and we continue to see the fallout even though there have been some success stories. Some hospitals still struggle to stay open due to revenue challenges, and have difficulty maintaining adequate staff and resources.
We all know that if there are no hospitals, there are fewer physicians. As you can see below (Table A), something changed within the county. There is drastic impact to access for primary care. In Marlboro County, starting around 2019, there were well over 5,000 patients for one primary care physician. This, of course, causes delays in care, no care, late referrals, decreased trust, and impact on chronic conditions: in other words, poor outcomes. This is a problem all over the United States, but it is in my thoughts because of the personal connection. I worked at the hospital and saw the needs of the community challenged by the closure of major industries. I also wonder how this is affecting the Black community, as the demographic most impacted by economic disadvantage nationwide.
Table A
https://datausa.io/profile/geo/marlboro-county-sc#health
The chart above immediately made me think about how residents are faring with chronic conditions and mortality. Of course, this was in my mind from the moment the doors closed for the last time, but it may be playing out on paper. If you look at tables B and C below, you too will find that the county has higher rates in more disease areas and death. This makes me wonder about the true impact of access, coupled with socioeconomic disadvantages. This data is only three years out from 2015, but should be monitored. You may want to look at your towns as well that may have concerns with access due to closures.
Table B
Table C
It is important to remember that this is only one example, and sometimes we neglect the importance of our hospitals in our communities. Closures are many times addressed with alternatives such as diverse medical groups or standalone emergency departments/urgent care centers, if the money or sponsorship is there. Ultimately, revenue and quality are needed for facilities to survive. Either one could be an endgame if subpar and detrimental to our minority populations.
As for me, I won’t be moving away anytime soon, but hope to one day. As a patient, we must be our own advocates, and stay abreast of what may impact our livelihood. Are you watching?
The Centers for Medicare & Medicaid Services (CMS) has proposed a significant new development in the 2024 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical
Rural health is in trouble. EDITOR’S NOTE: In this final installment of a three-part series as to why rural health is in trouble, more of
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
