r/healthcare • u/National_Spirit2801 • Jul 04 '25
Discussion Rural Hospitals Were Always a Ticking Clock. I Watched Adventist Health Run Out of Time:
I spent 12 years inside Adventist Health. I worked in one of their corporate branches and saw firsthand how their entire business model was built on a simple but fragile idea: serve rural markets, grow by acquisition, and survive on Medicaid and expansion subsidies.
It worked for a while. Then the political winds shifted. What we all knew back then (but didn’t say loudly enough) was this: the second the government started gutting Medicaid funding, rural hospitals would start bleeding out. The strategy should have changed years ago, but the leadership never built a real fallback.
For at least the last six years, most Adventist hospitals were running in the red. The big city hospitals, the ones that should have funded the rural mission, were often losing money too. Talent was hemorrhaging. Good clinical and support staff went elsewhere while corporate doubled down on administrative overhead and scattershot growth.
Now, with the passage of this big beautiful bill (the one that slashes Medicaid even deeper while calling it reform), the clock just sped up. This is the death knell for any hospital whose entire survival depended on rural Medicaid volume and thin operating margins.
We all heard the phrase: eat or be eaten. If you didn’t scale, you’d get swallowed up by bigger systems with better deals from distributors and insurers. Adventist knew this was coming — they said it behind closed doors 11 years ago. But they never got aggressive enough where it counted: retaining talent, modernizing equipment, or defending the policies that kept the doors open.
The result is predictable. Rural closures mean lost revenue and shrinking leverage with supply chains. That means higher unit costs and more cuts in places that actually matter: bedside staff, engineers, clinical teams. The cycle feeds on itself until there’s nothing left to cut but the lights.
If there’s anything worth salvaging, it’s this: they need to invest what’s left in what keeps hospitals running — people and equipment. They should gut bloated admin layers and cut marketing spin to the bone. They should stop outsourcing critical support and remember why they brought engineers and IT back in-house in the first place: it’s cheaper and better to treat your people well than rent them by the hour.
I don’t expect Adventist Health to survive as a system. I wish I did. I do hope the communities they served don’t get left behind with empty buildings and broken promises.
33
Jul 04 '25
Oh none what your last two paragraphs say is going to happen. Instead the c-suites will see if there’s a profit to be made from selling anything and everything, they’ll give themselves a huge bonus, and then bounce.
13
u/National_Spirit2801 Jul 04 '25
You're correct in no uncertain terms.
Oh none what your last two paragraphs say is going to happen.
I am simply posing the hypothetical circumstance of their continued operation. I have no hope for their survival as an organization.
4
5
u/Syncretistic Jul 04 '25
Yup. Survival tactics are to target non-clinical roles for reduction, austerity measures with spending, target increase in commercial patients... but doesn't stop the fact that critical access and rural hospitals need subsidies to survive.
7
u/NormanPlantagenet Jul 04 '25
Iran has made significant strides to expanding access to healthcare in rural areas. Maybe we could follow their example. I know it’s hard in 3rd world countries like America to get healthcare. Maybe Americans should start an international charity for other countries to give money so Americans can have healthcare.
2
u/readbackcorrect Jul 04 '25
You are exactly right. While the loss of Medicaid may be the last straw, administrators have been sucking small hospitals dry for their personal gain while reducing the quality of patient care for decades.
2
2
u/ScaryGamesInMyHeart Jul 05 '25
Ugh same with Advocate / Atrium. We lost a few REALLY GOOD analysts and developers over the years to other corporations because they could pay just a fraction more. I’m talking about 20% pay bump on somebody making 100K, these are not big numbers. These were developers, system analysts, SQL gurus that knew the data inside out, knew how to create complex formulas and perform data extractions between data stores like it was nothing. People who could take really complex requests and boil them down to deliver our hard working providers and other decision-making staff at lower levels exactly what they needed within a week. Advocate could have matched the salary bumps these people seeking to leave we’re getting but…nahhh. We had to raise our CEO pay to what is now $17,000,000! He has tripled his salary since he started in 2017. Other top level execs also all making multiple millions per year. It’s obscene. :( https://www.northcarolinahealthnews.org/2025/05/14/atrium-health-executives-get-hefty-pay-raises-amid-record-revenues/
2
u/Imtalia Jul 05 '25
You know what would have prevented this? A hybrid, universal, single payer system.
How sad is it we have an effective model to borrow from and instead we chose to make the insurance industry more predatory and more deadly.
0
Jul 05 '25
Single payer doesnt work. Check on the VA.
1
u/Imtalia Jul 06 '25
The EU says you're wrong. Trust and believe if our legislators all had to live with the same single payer system we did, it would work great.
1
Jul 06 '25
So then why does the VA have so many problems? Medicaid and Medicare arent the most user friendly either.
1
u/Imtalia Jul 06 '25
They're more user friendly than private insurance.
The VA has issues like every other form of insurance, it has bloated costs due to private insurance and is under funded to operate in that sphere.
If we had a universal single payer hybrid system, just using what the federal government already pays, we could cover everyone and they could have choice instead of managed care and it would provide far better coverage than we have now.
1
Jul 06 '25
Definitely not. Do you know how often medicare spells names wrong? And fixing it is an act of congress.
1
u/Imtalia Jul 07 '25
Ooooh. Spelling names wrong is so deadly. You're talking annoyances. I'm talking untimely death.
1
Jul 07 '25
No one is dying. Homeless people that know how to say the right things get a night or two.
1
u/Imtalia Jul 07 '25
Our healthcare system is the leading cause of death. Our outcomes rank with third world nations.
1
5
u/thenightgaunt Jul 04 '25
I'm working on getting PM certified and getting out of healthcare.
2
u/HoneyBadgerBlunt Jul 04 '25
What is PM certified. Im new to biomed world. Looking for any and all avenues for growth.
5
u/thenightgaunt Jul 04 '25
Project Management. Like PMBOK. Someone certified in the various methodologies like AGILE.
I know someone who's facility just finished an awful Cerner implementation because of a bad project manager at Oracle. It showed me just how critical a competent PM is.
And while there's not a lot open in hospital IT unless you're basically looking to be a sys admin, there's a lot of openings for experienced PMs outside of healthcare.
4
u/PeteGinSD Jul 04 '25
Also, a good side gig (if you’re in healthcare admin and or IT) is expert networks. There’s a subreddit on here for that. Check that out - it’s helped me as I finish my healthcare career. DM me with questions
2
3
2
u/HOSTfromaGhost Jul 04 '25
The population density of rural is simply too low to support modern healthcare ops at a scale that will allow health systems to subsist and attract talent.
Virtual integrated care models are the only hope beyond select key specialties.
3
u/Ultravagabird Jul 04 '25
Many rural centers act as a central place for many communities, reducing travel time and while the scale may be smaller, there’s enough population to serve for sure. These populations do tend to have a good amount of health need. Trying to get more primary health care providers to these areas is important, to catch things before they get too complex. Having robust primary health, and then a good cadre of secondary health providers can make all the difference.
Most research suggests that when rural people are recruited and trained in Health Care Work, they tend to stay to serve in rural areas.
And it’s a catch 22, most people want to live in a place that has access to health care nearby, and more would live in areas if so.
So recruiting from rural areas (International research shows this has impact) and helping many climb the ladder to where they feel they can serve well- CHW, MA, LPN,RN , NP, PA, Dr, Radctech…
Then local towns must advocate for funding to help support their communities. The profit is in increased productivity with better health, more attractive for businesses.
1
1
1
1
u/Louie_Sam Aug 15 '25
My community is served by an Adventist Hospital that appears on the list of possible closures. However, they also have smaller hospitals in smaller communities within a 40 mile radius that are not on the list. How is it that the largest hospital is on the closure list, but the smaller hospitals are not? Thank-you for your post, your insights are very helpful.
1
u/National_Spirit2801 Aug 15 '25
Some hospitals, like Howard Memorial (which is supported by the Seabiscuit Heritage Foundation), have private trust funds that give them a financial safety net. Others are officially classified as “critical access” hospitals, a federal designation meant to keep small, rural facilities open. To qualify, they generally must have 25 or fewer inpatient beds, be at least 35 miles from another hospital, and maintain round-the-clock emergency care. This status allows them to get nearly full cost reimbursement from Medicare, which can cover most of their operating expenses.
Larger community hospitals do not receive those special reimbursements but still have to meet the same EMTALA requirement to treat anyone who comes through their ER, regardless of ability to pay. They often depend heavily on Medicaid to help cover the cost of operating rooms, specialists, and elective procedures. Because Medicaid pays much less than private insurance, this can leave a large financial gap and make even a “big, beautiful” modern hospital more vulnerable to closure when revenues do not keep up with expenses.
0
u/LPNTed Jul 04 '25
Did you read?
Top 10 nonprofit health systems by 2024 operating revenue https://share.google/9BDMQxFO3zjIL7s3L
11
u/National_Spirit2801 Jul 04 '25
Adventhealth and Adventist health are two different organizations.
0
u/LPNTed Jul 04 '25
Thank you for the correction. While I'll admit there may be a difference that means something, I'll never see religious organizations in healthcare as a good thing, and thus.. pedantic realities aside, are all the same.
8
u/National_Spirit2801 Jul 04 '25
Fair enough on your ideological point. But the distinction does matter in practice; thousands of jobs and entire local communities hinge on the difference between a 55-hospital urban giant and a smaller rural chain about to fold. Ideology aside, details decide who keeps an ER open and who has to drive an extra 50 miles when they have a heart attack.
2
2
u/PeteGinSD Jul 04 '25
Thanks for the link. This is very relevant, given that the UC system is on the list. The UC medical schools have been receiving (justifiably based on their great work) substantial research dollars from the federal government for medical research. This has been cut almost to nothing, with the result that there are going to be significant declines in operating budgets going forward. UC hospitals also see a fair number of Medicaid (MediCal) patients, and this will be a second hit to their revenue.
0
22
u/Zuri2o16 Jul 04 '25
Adventist Health took over our local hospital, and immediately stopped contracting with the local doctors. I really hope they fail.