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A recent report examined how some rural Tennessee hospitals have managed to stay afloat despite financial challenges.

The report includes interviews from staff at five different rural hospitals, which range in size from 25 to 125 beds.

Judy Roitman, executive director of the Tennessee Health Care Campaign, said some of the hospitals are drowning in uncompensated care. She explained as part of their research, they did an interview with a CEO from a rural hospital in Kentucky who expressed the importance of Medicaid expansion.

“Kentucky has expanded its Medicaid program and Tennessee has not,” Roitman pointed out. “He said that’s the key to our stability is actually having the funds coming in to treat these patients. And the CEOs and others in Tennessee hospitals said it would make a huge difference to have that federal funding.”

Roitman added the federal government is offering Tennessee a nine-to-one match. If Tennessee were to expand Medicaid, at least 330,000 people would gain access to coverage.

Roitman pointed out the report suggested further steps hospitals could take, including examining how they are reimbursed for services provided. She noted private insurance plans tend to provide the highest reimbursement rates, and said more funding is needed to support TennCare, which does not cover enough of the cost.

“TennCare is all managed by managed-care organizations,” Roitman explained. “They negotiate with every hospital about how they’re going to reimburse and the big hospitals have some leverage to demand better payment and the smaller hospitals are just, they’re just not getting paid.”

Roitman added the report credited strong community engagement and effective hospital leadership as key factors in staff retention. Robust management and maintaining an engaged workforce significantly affect a hospital’s viability, according to the report.