• The community of Ritzville must quickly pursue the Rural Emergency Hospital (REH) designation.  I think this is the only viable option to keep 24 hour emergency care available in Ritzville.

• REH is a federal designation that is not currently available in Washington State.  Because this type of facility is not currently licensed in the State of Washington, a change in the laws and regulations must be pursued as soon as possible.  This will require an effort from our state legislators and governor's office to modify the laws and allow such a category of healthcare facility to be operated in the Washington State.  Once this licensure category is approved, the Washington State Department of Health (DOH) will be required to write regulations governing the operation of this type of facility.  I would hope the DOH would begin working on these regulations immediately while the legislature works on their part of the process.  Both the Legislature and the DOH processes could take weeks or months.  Time is of the essence as East Adams Rural Healthcare (The Hospital) is out of resources to continue for much longer without such a change.

• REH facilities receive a $3.4 million grant from the federal government.  This should improve the Hospital's financial viability.  However, the Hospital will no longer be paid for Medicare services as a critical access hospital.  Federal healthcare services payments will decline from cost-based reimbursement to standard fee scale payments.  Without Hospital specific information such as the last annual Medicare cost report, an estimate of the lost reimbursement cannot be made.  I would suspect that decline is in the hundreds of thousands of dollars. 

• With the State recognizing REH status, will the Hospital continue to be paid Medicaid cost-based reimbursement?  This has yet to be determined.  I would hope the Hospital is talking with its legislators about continuing the current Medicaid cost-based reimbursement.   Without such a continuation of current Medicaid reimbursement, I would expect Medicaid payments would also decline.

• The Hospital has already announced the layoff of about 100 staff that will begin in January 2026.  Many of these individuals should be able to find employment in Spokane and other neighboring hospitals.  With the layoff of 100 hospital staff, economists suggest that the community can also plan on the layoffs of another 100 individuals that work in non-healthcare jobs in the local community.

• When healthcare services are reestablished as a REH, the rehiring of layer-off healthcare workers should be forthcoming as long as those employees believe that the long-term prospect of employment is a real possibility.  This reestablishment of healthcare services in Ritzville should prompt the rehiring of many non-healthcare individuals in the community.

• The REH is not a full-service hospital.  Healthcare services will be limited to outpatient services which include emergency room, laboratory, radiology, and other support services.  Inpatient hospital care will be eliminated, and long-term care will become cost- prohibitive.  With that said, I do not expect that all of the laid off employees will be rehired.  Essentially, the Hospital will provide fewer services and only about two-thirds of the laid-off employees would be needed.

• There has been discussion of the Hospital declaring bankruptcy.  East Adams Rural Healthcare is actually Adams County Public Hospital District No. 2 . (District).  The District is a political subdivision of the State of Washington.  I am not aware of any public hospital district in the State of Washington that has declared bankruptcy. I am not sure if that is even possible.  Some issues to consider:

  • If the Hospital declares bankruptcy, the District will continue to be a legal entity until such time as the Hospital's debts are paid.  The local taxpayers would continue to pay taxes even if the Hospital closes.  This is the worst case scenario.

  • I believe the State of Washington would also oppose bankruptcy.  All hospital districts, school districts, and other municipal governments in Washington State issue bonds and other debts under the assumption that these debts are guaranteed by the taxpayers.  If any municipal government defaults on its loans, the interest rates for all municipal corporations would increase because of the premise that “debts are guaranteed by the taxpayers” would no longer exist.   This would have wide-reaching implications.

• Other issues that should be considered:

  • Are there businesses in Ritzville that would relocate without emergency services available in Ritzville?

  • Will housing prices decline as a result of fewer jobs in Ritzville and fewer healthcare services?

  • Will elderly continue to reside in Ritzville without the availability of long-term care?

Since Ritzville would be a first for the State of Washington, it is difficult to anticipate all of the issues that must be addressed.