Rural Nebraska Hospital Closes Dialysis Unit, Displacing Patients
Hospital CEO Jon Reiners stated the decision was due to annual financial losses of approximately $1 million, attributed to operational costs exceeding reimbursement rates.
Chadron Hospital, a critical access hospital in Nebraska, ended its outpatient dialysis service at the end of March 2024. The closure displaced 17 patients who now must travel significant distances for life-sustaining treatment, highlighting broader challenges in rural healthcare funding and access. This coincides with the launch of a major federal program aimed at transforming rural health services.
Financial Rationale for Closure
The hospital's critical access designation provides increased Medicare reimbursement for inpatient care but does not apply to outpatient dialysis services. Reiners reported the hospital contacted four private companies about taking over the dialysis service over the course of a year, but all declined after determining the operation would not be profitable.
Impact on Patients
The 17 affected patients, who require dialysis multiple times per week, now face substantially longer travel times. Specific impacts include:
- Mark Pieper now drives approximately 100 miles each way to Scottsbluff, Nebraska, for treatment, a round trip of about 200 miles.
- Jim and Carol Wright have rented a temporary residence near Rapid City, South Dakota, to reduce travel time during weekdays.
- Linda and Alan Simonson face a round trip of over four hours from their ranch to Scottsbluff.
- Some nursing home residents have relocated to facilities closer to dialysis centers, moving farther from their families.
Some patients, including Mark Pieper, have stated their doctors have told them they are not candidates for home dialysis or kidney transplants.
Broader Context and Patient Responses
The closure occurred as Nebraska received $219 million in first-year funding from the federal Rural Health Transformation Program, a five-year, $50 billion initiative. A review by KFF Health News found at least 11 other states have proposed using program funds for rural dialysis initiatives, such as mobile units or home-based treatment support. Nebraska is not among those states.
Patients and family members have contacted politicians and hospital officials to express concerns. Linda Simonson stated she spoke with aides for the governor and state representatives but did not receive a call back from the officials themselves.
Rural Health Disparities and Potential Alternatives
A 2024 study in the American Journal of Nephrology indicates people in rural America face higher rates of end-stage kidney disease and higher mortality rates after diagnosis compared to urban residents.
Data shows rural dialysis patients use home dialysis at a higher rate than urban patients. Training for home dialysis is available in Scottsbluff, Nebraska, and Cheyenne, Wyoming, which is a three-hour drive from Chadron.
Mark Unruh, a nephrologist, noted the closure reflects broader challenges with staffing and funding in rural health care. He suggested prevention programs, increasing kidney transplantation rates for rural patients, and recruiting more staff to train patients for home dialysis as potential strategies.
Related Funding Challenges in Rural Crisis Care
Separately, mobile mental health crisis teams, which respond to 911 calls as an alternative to police, are facing funding instability nationwide, leading to closures in some areas.
Funding obstacles for these teams include:
- Many private insurance companies do not reimburse for mobile crisis services.
- Medicaid often only reimburses for active time on a call, not for administrative work or standby capacity.
- Programs in Great Falls and Billings, Montana, have recently closed.
Some states have taken action, with eight mandating private insurer coverage and ten implementing cellphone bill fees to help fund services.
Concerns Over Federal Health Program Implementation
The federal Rural Health Transformation Program has raised concerns among some hospital administrators regarding its potential impact on services. The program emphasizes new approaches to care.
Several state applications mention "right-sizing select inpatient services," a concept that can imply reducing unprofitable or nonessential service lines. Hospital leaders have expressed apprehension about potential "top-down" directives to cut services.
Some states, including Nebraska, North Dakota, and Tennessee, plan to use program funds to help hospitals convert to Rural Emergency Hospitals, a designation that requires halting inpatient services in exchange for enhanced payments.
Analysts have noted that removing high-margin services without alternative financial support could harm local hospitals. Brock Slabach of the National Rural Health Association warned that cutting services could contribute to depopulation in rural areas.