STEVE INSKEEP, HOST:
Rural hospitals are in crisis. Fifty-three have closed in the last few years, and more are in danger of closing.
RENEE MONTAGNE, HOST:
Many that survive have tried to save money by cutting services, and then there's the Missouri hospital that rescued itself by doing the opposite. Bram Sable -Smith reports from our member station KBIA.
BRAM SABLE-SMITH, BYLINE: Cattle farmer Greg Fleshman became so concerned about keeping the local hospital opened that he joined its board in 2011.
GREG FLESHMAN: I mean, they've saved my dad's life twice. He had a heart attack and a stroke, and they've flied him out here both times.
SABLE-SMITH: But keeping Putnam County Memorial Hospital in Unionville, Mo., opened seemed an impossible task.
FLESHMAN: Things was just falling apart. That was really what it was - financially and morale of the employees. And it just seemed to get worse and worse.
SABLE-SMITH: Putnam County ails from the same conditions that squeeze the finances of many of the nation's rural hospitals. Only about 5,000 people live here, and they tend to be older, poorer, sicker and less insured than the rest of the state. Also like many of those hospitals, Putnam County Memorial looked to cut costs by reducing staff and services. But as more and more patients went to bigger towns for treatment, the hospital came to the brink. As Fleshman recalls...
FLESHMAN: We had - one day, I come in here, and we had $8,000 in the bank. We had a payroll of about 70 or 80,000 coming up.
SABLE-SMITH: One CEO had left. So had the temporary CEO hired to replace him.
FLESHMAN: Those was the darkest days. We didn't think we could get anybody to come in.
SABLE-SMITH: Right about then, Jerry Cummings received a phone call from a physician in the area. Cummings runs a medical consulting business with his wife, Cindy.
JERRY CUMMINGS: We were the only people that he was aware of that he felt could save the hospital.
SABLE-SMITH: So the Cummings loaded up their car at the home in Jefferson City in central Missouri...
CUMMINGS: We drive in our little Fusion.
SABLE-SMITH: ...Drove the three hours north to Putnam County...
CUMMINGS: The wife always drives.
SABLE-SMITH: ...And brought a new idea to the board.
CUMMINGS: Our original thoughts was we would just handle if they was interested in doing a psychiatric wing for the hospital.
SABLE-SMITH: Rather than close its doors, the Cummings were proposing to expand the hospital instead and offer the kinds of services Putnam County residents were driving hours away to receive. The board was sold. They hired the Cummings to run the hospital.
CUMMINGS: Immediately, within 30 days, I brought in three other brand-new physicians.
SABLE-SMITH: And the Cummings brought new specialties to the hospital - anesthesiology, gynecology, cardiology. They rallied the county to pass a more than $7 million bond initiative to buy out the hospital's old debt and renovate an unused wing, and patients started coming back.
CUMMINGS: Our revenues went from 4 million to 22 million - a huge increase. Our average daily census - it was less than one patient a day. Our average daily census now is around 11 to 12 patients.
SABLE-SMITH: And according to a paper published by the Rural Policy Research Institute last November, more cash-strapped rural hospitals could benefit from expanded services. One of the paper's authors is Timothy McBride, a health care columnist at Washington University in St. Louis.
TIMOTHY MCBRIDE: We think that's the way forward for rural hospitals, rather than just sort of a bunker mentality and say we can't proceed.
SABLE-SMITH: And while parts of the Putnam County story are unique, he says if other rural hospitals review how they meet their own missions...
MCBRIDE: It's not impossible to say that you might expand in certain areas. We believe that rural hospitals often can provide very high quality services.
SABLE-SMITH: And to rescue the hospital in Unionville, board member Greg Fleshman says the community had to believe that, as well.
FLESHMAN: I think people had to decide are we going to have a hospital or not, you know? And they wanted it here.
SABLE-SMITH: For NPR News, I'm Bram Sable Smith in Columbia, Mo.
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