Bothwell Regional Health Center responds to evolving health care landscape

In response to being listed as one of four Missouri hospitals facing greater risk and to President Trump’s signing on July 4 of the federal budget reconciliation bill, also known as the One Big Beautiful Bill Act, Bothwell Regional Health Center is addressing the impacts to rural health care.

In June, top-ranking U.S. senators asked the Cecil G. Sheps Center for Health Services Research at the University of North Carolina (Sheps Center) to provide information on the financial vulnerability of rural hospitals across the country and potential impacts on their viability.

In its study, the Sheps Center listed 338 rural hospitals across the country that face greater risk of “being forced to stop providing some services, converting or closing” for meeting one or both of two financial criteria. The information was used in a letter from the senators to President Trump urging him to reconsider funding cuts to Medicaid and Medicare in the budget bill.

Bothwell was listed in the study as one of four Missouri hospitals in this “at risk” category. Bothwell’s inclusion on the list was as a result of having three consecutive years of negative total margins. Bothwell CEO Lori Wightman said while the label has raised understandable concerns, it doesn’t mean Bothwell is closing or reflect its full story.

“Fiscal year 2024 was the first year since 2018 that we made money from operations,” Wightman said. “We are able to pay people and keep up with our bills yet we have limited savings to fall back on or invest in the future.”

Medicare and Medicaid are the major payment sources for 78% of the patients at Bothwell.

“These programs pay well below the actual cost of providing care,” Wightman said. “Commercial insurance alone cannot close the gap, and that is where subsidies available to rural hospitals are essential. Unfortunately, the cost of providing care, from personnel to technology, continues to rise making a difficult situation harder to stabilize.”

While Bothwell is a city-chartered organization, it has never received a tax subsidy and there is no exchange of funds between the city and the hospital.

“The fact that we virtually have no debt is high on the list of financial positives for us,” Wightman said. “We are continuing to meet our financial obligations, and are laser focused on decreasing our cost structure and exploring alternative revenue sources which include philanthropy and grants.”

In the past two years, more than 25 new physicians and advanced practice providers have joined Bothwell’s medical team increasing access to care in family medicine and specialty care. The thriving Bothwell-University of Missouri Rural Family Residency, the first of its kind in the state, continues to ensure a pipeline of new physicians for rural Missouri.

Wightman said the recent passage of the One Big Beautiful Bill has brought additional attention to rural hospital funding with changes predominately affecting Medicaid.

“Most of the bill’s provisions don’t take effect until 2028, which gives us time to prepare, adjust and advocate,” she said. “The bill also includes $50 billion in a Rural Health Transformation Program over five years, with the first $10 billion to be appropriated next year. Through the Missouri Hospital Association and Gov. Kehoe’s administration, we are actively engaged to ensure Missouri’s rural hospitals see a share of those funds.”

On July 15, U.S. Senator Josh Hawley (R-Mo.) introduced a bill to prevent future Medicaid cuts and to double the rural hospital program funding from $50 billion to $100 billion. In addition, State Rep. Brad Pollitt (R) has contacted Wightman personally and pledged support for Bothwell.

“We are grateful that our elected officials are looking for ways to invest in rural hospitals that ensure we can continue to care for our communities,” Wightman said.

Bothwell’s impact on the communities it serves cannot be understated. As Sedalia’s largest employer, more than 1,000 people work for the organization. The health center includes the hospital, a 24/7 Emergency Department (ED), 24 outpatient clinics and offers 29 services and specialties. Its service area includes Pettis and Benton counties with physical locations in Sedalia, Cole Camp, Lincoln and Warsaw. Annually, 318,000 patient visits occur and more than 24,000 people seek care each year in the ED.

“The Sheps Center list highlights the precarious position that many rural hospitals across the country find themselves in, a list that sadly grows every day.” Wightman said. “The financial picture is serious, yet it’s not fatal. What remains sure is our commitment to our community. We have served this region for 95 years, and we plan to be here well into the future delivering safe and compassionate care. Being in health care is not for the faint of heart. It takes grit, strategy and above all, support from our community. We ask that our community stay engaged, ask questions and use local health care whenever possible. Every choice to support Bothwell helps keep close-to-home care possible.”