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Kevin Stansbury, the CEO of Lincoln Community Hospital in the 800-person town of Hugo, Colorado, is facing a classic Catch-22: He could boost his rural hospitals revenues by offering hip replacements and shoulder surgeries, but the 64-year-old hospital needs more money to be able to expand its operating room to do those procedures.

This story also ran on Fortune. It can be republished for free.

I’ve got a surgeon that’s willing to do it. My facility isn’t big enough, Stansbury said. And urgent services like obstetrics I can’t do in my hospital, because my facility won’t meet code.

Besides securing additional revenue for the hospital, such an expansion could keep locals from having to drive the 100 miles to Denver for orthopedic surgeries or to deliver babies.

Rural hospitals throughout the nation are facing a similar conundrum. An increase in costs amid lower payments from insurance plans makes it harder for small hospitals to fund large capital improvement projects. And high inflation and rising interest rates coming out of the pandemic are making it tougher for aging facilities to qualify for loans or other types of financing to upgrade their facilities to meet the ever-changing standards of medical care.

Most of us are operating at very low margins, if any margin at all, Stansbury said. So, we’re struggling to find the money.

Aging hospital infrastructure, particularly in rural areas, is a growing concern. Data on the age of hospitals is hard to come by, because hospitals expand, upgrade, and refurbish different parts of their facilities over time. A 2017 analysis by the American Society for Health Care Engineering, a part of the American Hospital Association, found that the average age of hospitals in the U.S. increased from 8.6 years in 1994 to 11.5 years in 2015. That number has likely grown, industry insiders say, as many hospitals delayed capital improvement projects, particularly during the pandemic.

Research published in 2021 by the capital planning firm Facility Health Inc., now called Brightly, found that U.S. health care facilities had deferred about 41% of their maintenance and would need $243 billion to complete the backlog.

Rural hospitals dont have the resources of larger hospitals, particularly those in hospital chains, to fund billion-dollar expansions. Email Sign-Up

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Most of todays rural hospitals were opened with funding from the Hill-Burton Act, passed by Congress in 1946. That program was rolled into the Public Health Service Act in the 1970s and, by 1997, had funded the construction of nearly 7,000 hospitals and clinics. Now, many of those buildings, particularly those in rural areas, are in dire need of improvements.

Stansbury, who is also board chair of the Colorado Hospital Association, said at least a half-dozen rural hospitals in the state need significant capital investment.

Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, a think tank in Pittsburgh, said the major problem for small rural hospitals is that private insurance is no longer covering the full cost of providing care. Medicare Advantage, a program under which Medicare pays private plans to provide coverage for seniors and people with disabilities, is a major contributor to the problem, he said.

You’re basically taking patients away from what may be the best payer that the small hospital has, and pushing those patients onto a private insurance plan, which doesn’t pay the same way that traditional Medicare pays and ends up also using a variety of techniques to deny claims, Miller said.

Rural hospitals also must staff their emergency rooms with physicians round-the-clock, but the hospitals get paid only if someone comes in. The facility opened in 1959 after soldiers coming back from World War II decided that Lincoln County on the eastern Colorado plains needed a hospital. Now, management wants to expand it.(Lincoln Health)

Meanwhile, labor costs coming out of the pandemic have increased, and inflation has driven up the cost of supplies. Those financial headwinds will likely push more rural hospitals out of business. Hospital closures dropped during the pandemic, from a record 18 closures in 2020 to a combined eight closures in 2021 and 2022, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill, as emergency relief funds kept them open. But that life support has ended, and at least nine more closed in 2023. Miller said closures are reverting to pre-pandemic rates.

That raises concerns that some hospitals might invest in new facilities and end up shutting down anyway. Miller said only a small portion of rural hospitals might be able to make a meaningful difference to their bottom lines by adding new services.

Lawmakers have tried to help. California, for example, has loan programs charging low to no interest that rural hospitals can participate in, and hospital representatives are urging Colorado legislators to approve similar support.

At the federal level, Rep. Yadira Caraveo, a Colorado Democrat, has introduced the bipartisan Rural Health Care Facilities Revitalization Act, which would help rural hospitals get more funding for capital projects through the U.S. Department of Agriculture. The USDA has been one of the largest funders of rural development through its Community Facilities Programs, providing over $3 billion in loans a year. In 2019, half of the more than $10 billion in outstanding loans through the program helped health care facilities.

Otherwise, facilities would have to go to private lenders, said Carrie Cochran-McClain, chief policy officer for the National Rural Health Association. More from the Mountain States

Rural hospitals might not be very attractive to private lenders because of their financial constraints, and thus may have to pay higher interest rates or meet additional requirements to get those loans, she said.

Caraveos bill would also allow hospitals that already have loans to refinance at lower interest rates, and would cover more categories of medical equipment, such as devices and technology used for telehealth.

We need to keep these places open, even not just for emergencies, but to deliver babies, to have your cardiology appointment, said Caraveo, who is also a pediatrician. You shouldn’t have to drive two, three hours to get it.

Kristin Juliar, a capital resources consultant for the National Organization of State Offices of Rural Health, has been studying the challenges rural hospitals face in borrowing money and planning big projects.

Theyre trying to do this while they’re doing their regular jobs running a hospital, Juliar said. A lot of times when there are funding opportunities, for example, the timing may be just too tight for them to put together a project.

Some funding is contingent on the hospital raising matching funds, which may be difficult in distressed rural communities. And most projects require hospitals to cobble together funding from multiple sources, adding complexity. And since these projects often take a long time to put together, rural hospital CEOs or board members sometimes leave before they come to fruition.

You get going at something and then key people disappear, and then you feel like you’re starting all over again, she said. Expansion of Lincoln Community Hospital could keep locals from having to drive the 100 miles to Denver for orthopedic surgeries or to deliver babies.(Lincoln Health)

The hospital in Hugo opened in 1959 after soldiers coming back from World War II decided that Lincoln County on the eastern Colorado plains needed a hospital. They donated money, materials, land, and labor to build it. The hospital has added four family practice clinics, an attached skilled nursing facility, and an off-site assisted living center. It brings in specialists from Denver and Colorado Springs.

Stansbury wold like to build a new hospital roughly double the size of the current 45,000-square-foot facility. With inflation easing and interest rates likely to go down this year, Stansbury hopes to get financing lined up in 2024 and to break ground in 2025.

The problem is, every day I wake up, it gets more expensive, Stansbury said.

When hospital officials first contemplated building a new hospital three years ago, they estimated a total project cost of about $65 million. But inflation skyrocketed and now interest rates have gone up, pushing the total cost to $75 million.

If we have to wait another couple of years, we may be pushing up closer to $80 million, Stansbury said. But we’ve got to do it. I can’t wait five years and think the costs of construction are going to go down.

Markian Hawryluk: MarkianH@kff.org, @MarkianHawryluk Related Topics Health Industry Rural Health States California Colorado Hospitals Contact Us Submit a Story Tip

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Sports

Canes’ Andersen, 35, secures deal before Round 2

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Canes' Andersen, 35, secures deal before Round 2

RALEIGH, N.C. — The Carolina Hurricanes have signed goaltender Frederik Andersen to a one-year contract for next season, worth $2.75 million for the 35-year-old veteran.

General manager Eric Tulsky announced the deal Saturday, a little over 48 hours before his team starts the second round of the playoffs against the Washington Capitals.

Andersen could earn up to $750,000 in incentives for games played and his participation in a potential run to the Eastern Conference finals next season. He would get $250,000 for playing 35 or more games, another $250,000 for getting to 40 and $250,000 if the Hurricanes reach the East finals and he plays in at least half of the playoff games.

“Frederik has played extremely well for us and ranks in the top 10 all-time for winning percentage by an NHL goalie,” Tulsky said. “We’re excited that he will be staying with the team for next season.”

Andersen and the Hurricanes, the No. 2 seed in the Metropolitan Division, advanced past the New Jersey Devils in Round 1 last week. They will meet the Capitals, who won the division crown, for the right to make the NHL’s final four.

Extending Andersen could give the team a goaltending tandem with Pyotr Kochetkov for less than $6 million combined.

Anderson, a Denmark native who previously played for the Anaheim Ducks and Toronto Maple Leafs, has become coach Rod Brind’Amour’s most trusted option in net. He is expected to return to the starting role for Game 1 of the Capitals series after getting injured in the first round against New Jersey.

The Associated Press contributed to this report.

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UK

Child sexual abuse victims ‘denied justice’ after compensation scheme scrapped over cost

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Child sexual abuse victims 'denied justice' after compensation scheme scrapped over cost

Sky News can reveal that the government has rowed back on a national compensation scheme for victims of child sexual abuse, despite it being promised under the previous Conservative administration.

Warning – this story contains references to sexual and physical abuse

A National Redress Scheme was one of 20 key recommendations made by the Independent Inquiry into Child Sexual Abuse (IICSA), but a Home Office report reveals the government has scrapped it because of the cost.

Marie, who is 71, suffered alleged sexual, physical, and emotional abuse at Greenfield House Convent in St Helens, Merseyside, between 1959 and 1962, and is still fighting for compensation.

Greenfield House Convent, where Marie says she was abused
Image:
Greenfield House Convent, where Marie says she was abused

As soon as she arrived as a six-year-old, Marie says her hair was cut off, her name changed, and she experienced regular beatings from the nuns and students.

She claims a nun instigated the violence, including when Marie was held down so that her legs were “spread-eagled” as she was sexually abused with a coat hanger.

Merseyside Police investigated claims of abuse at the convent, but in 2016, a suspect died before charges could be brought.

More on Children

Marie has received an apology from the Catholic body that ran the home; she tried to sue them, but her claim was rejected because it was filed too long after the alleged abuse.

Marie is still fighting for compensation for the abuse she suffered
Image:
Marie, 71, is still fighting for compensation for the abuse she says she suffered as a child

In February, ministers said the law would change for victims of sexual abuse trying to sue institutions for damages, which was a recommendation from the IICSA.

Previously, people had to make a civil claim before they were 21, unless the victim could prove a fair trial could proceed despite the time lapse.

Campaigners argued for the time limit to be removed as, on average, victims wait 26 years to come forward. Changes to the 1980 Limitation Act could lead to more people making claims.

Peter Garsden, President of The Association of Child Abuse Lawyers
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Peter Garsden, President of The Association of Child Abuse Lawyers

Civil cases ‘can take three to five years’

But Peter Garsden, president of the Association of Child Abuse Lawyers, worries that when it comes to historical abuse where the defendant is dead, institutions will still argue that it is impossible to have a fair trial and will fight to have the case thrown out of court.

Mr Garsden said it takes “between three and five years” for a civil case to get to trial.

He warned that claimants “can end up losing if you go through that process. Whereas the Redress Scheme would be quicker, much more straightforward, and much more likely to give justice to the victims”.

Victim awarded £10 compensation

Jimbo, who was a victim of abuse at St Aidan’s children’s home in Cheshire, took his case to the High Court twice and the Court of Appeal three times, but, after 13 years, all he ended up with was £10 for his bus fare to court.

Despite the Lord Justice of Appeal saying he believed that the abuse had occurred, Jimbo lost his claim because of the time limit for child sexual abuse claims to be made.

Read more from Sky News:
Call for Labour minister to resign over grooming gang remarks
PM says govt will fund further local grooming gangs inquiries if ‘needed’

Neither Marie nor Jimbo is likely to benefit from the removal of the time limit for personal injury claims, which is why Mr Garsden is calling on the government to implement a National Redress Scheme for victims of sexual abuse, as recommended by the IICSA.

Hundreds of millions paid to victims

The governments in Scotland and Northern Ireland have set up compensation schemes and paid hundreds of millions of pounds to victims.

In 2023, the then Conservative government said a similar scheme would be organised for England and Wales.

But the Home Office admitted in its Tackling Child Sexual Abuse: Progress Update that it “is not currently taking forward any further steps on the IICSA proposal for a separate, national financial redress scheme for all survivors of child sexual abuse”.

“In the current fiscal environment, this recommendation is very difficult to take forward,” it added.

For victims, the scheme was the last chance of compensation for a lifetime blighted by abuse.

“The money is about justice and about all the other people who have had to suffer this abuse,” Marie said.

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Politics

OKX fires back at Tron’s Justin Sun over mysterious ‘freeze notice’

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<div>OKX fires back at Tron's Justin Sun over mysterious 'freeze notice'</div>

<div>OKX fires back at Tron's Justin Sun over mysterious 'freeze notice'</div>

OKX founder and CEO Star Xu has publicly defended the crypto exchange after Tron founder Justin Sun accused it of failing to act on a law enforcement request to freeze stolen funds following a recent hack of Tron’s official X account.

“OKX also has consumers protection policy according to law, we can’t freeze a customer’s funds according to your personal X post or an oral communication. I think you should understand it as the CEO of HTX,” Xu said in an X post.

OKX says there is no communication in the spam box, either

Xu said that the crypto exchange had not received any related correspondence through OKX’s official channels. “Our LE cooperation team just checked the email, including the spam box; we haven’t received any request related with this case,” Xu said.

Cryptocurrencies, Tron, OKX
Source: Star Xu

In what is now an unavailable X post, but was screenshotted by Xu, Sun had earlier claimed that OKX has not responded to a “freeze notice” sent to its official email address from a “relevant law enforcement agency.” Sun said that he had no other way to contact OKX’s compliance department.

“These stolen funds do not belong to me; I’m acting to protect the community,” Sun said. On May 3, Tron DAO told its 1.7 million X followers that its account had been compromised. Tron explained that during the breach, an unauthorized party posted a malicious contract address, sent direct messages, and followed unfamiliar accounts.

“If you received a DM from our account on May 2, please delete it and consider it the work of the attacker.”

In response to Sun’s claims of inaction, Xu publicly called on him to provide a screenshot showing when and where the law enforcement request was made.

The Tron incident is one of several recent security breaches involving high-profile crypto accounts on X.

Related: Over 14,500 Tron addresses at risk of silent hijacking

Kaito AI, an artificial intelligence-powered platform that aggregates crypto data to provide market analysis for users, and its founder, Yu Hu, were the victims of an X social media hack on March 15. The hackers opened up a short position on KAITO tokens before posting that the Kaito wallets were compromised and advised users that their funds were not safe.

The Pump.fun X account was compromised on Feb. 26 to promote a fake governance token called “PUMP” and other fraudulent coins.

Meanwhile, the X account of UK member of Parliament and Leader of the House of Commons, Lucy Powell, was hacked to promote a scam crypto token.

Magazine: Crypto wanted to overthrow banks, now it’s becoming them in stablecoin fight

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