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.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s third quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
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
