Small Eastern North Carolina Town Losing its Hospital

Nearly 70 years after first opening its doors, Scotland Neck’s critical access hospital will close its emergency room, inpatient beds and other acute care services at the end of the month.

Our Community Hospital has been losing money for eight years, said Tom Majure, the hospital’s administrator, and he and the hospital’s board could no longer find a way to make it financially viable.

Like many small, rural hospitals, Our Community just couldn’t pull in enough revenue.

Seventy percent of patients were on Medicaid and Medicare, and another 20 percent were self-pay, Majure said. Just 6 to 8 percent were on private insurance, which reimburses at the highest rates. And, he said, many of the private insurance patients had large deductibles and coinsurance they couldn’t afford, effectively turning them into self-pay or charity care cases.

“We just can’t make the numbers work anymore.”

But the bigger problem was the 20-bed hospital’s shrinking patient volume.

“At the present rate if they were (all) private pay and we collected every penny, we still would be losing money,” Majure said.

On a typical day now, four to five people come to the emergency room. Seriously ill patients are stabilized and then transported to one of the four larger hospitals nearby. Our Community doesn’t provide surgery or obstetrics services.

“We would have about two or three admissions in an entire month and some months we didn’t have anybody,” Majure said. “Inpatient services were practically nonexistent.”

Last year, Majure said, the hospital lost about $1.2 million on total revenue of $4 million.


Over the years, Majure said, he and the hospital board sought ways to keep the hospital open, including exploring relationships with other health systems. But nobody, he said, could figure out how to keep the hospital open in this rural, northeastern North Carolina town of fewer than 2,000.
“We just can’t make the numbers work anymore,” Majure said.

Economic woes

Steve Lawler, president of the North Carolina Hospital Association, said Our Community’s struggles, like that of many small rural hospitals, reflect the local economy.

“That community has struggled economically,” he said. “They’ve had a difficult time recruiting an adequate base of physicians.”

Doctors are key to hospital vitality. Primary care physicians, along with specialists such as surgeons, obstetricians, oncologists and others draw patients and create revenue streams for hospitals.

Now patients in and around Scotland Neck will have to go elsewhere.

Vidant Edgecombe Hospital in Tarboro, about 20 miles south of Scotland Neck, will likely see more of those patients said Wick Baker, president of Vidant Edgecombe.

“Maybe some additional ED visits,” he said. “We’re kind of serving that area to some extent already.”
There will still be some non-hospital services provided in Scotland Neck, Majure said.

Hospital officials will continue to operate a 60-bed nursing home that’s part of the hospital, Majure said. The Scotland Neck office of Rural Health Group, a federally qualified community health center, will extend its hours into the evenings on weekdays and open up for half a day on Saturdays.

Majure hopes to convert some of the inpatient hospital rooms to nursing home rooms, allowing it to increase the number of private rooms the nursing home offers from five to 22. Majure said he’s also talked with local physicians about using hospital space to operate a part-time primary care clinic.


“The board was adamant about trying to keep what we could here,” Majure said. “[We] wanted to continue to provide something for the community.”

Post-war roots

Our Community’s current building opened 25 years ago. But its roots stretch back to the post-World War II years when Congress passed the 1946 Hill-Burton Act to fund hospital construction.

In the decades that followed, Hill-Burton helped fund the construction of thousands of hospitals and clinics across the country. The goal was to increase access to care for returning World War II veterans and their families.

Our Community tapped those funds and opened in 1948 or 1950, “depending on who you ask,” Majure said.

“Every little place got their own hospital, which was a good idea,” Majure said. “Here it made a difference for the people for a long time. And then things kind of changed.”

Fifteen or 20 years ago, Majure said, the hospital’s ER was seeing about 350 people each month — two to three times its current volume. But the area’s population is older now and northeastern North Carolina has struggled economically.

Halifax County, where Scotland Neck is, had an unemployment rate of 6.8 percent in October, well above North Carolina’s 4.1 percent rate.

The hospital’s board agreed in principle about six months ago to close the hospital. They approved it formally earlier this fall and announced it to staff and the community at the beginning of December.

Majure said about 15 people — nurses, technicians and physicians — will lose their jobs, though he anticipated most of them would be able to find work in the area.

When he arrived in Scotland Neck in the early 1990s, though, he did not anticipate one day closing the hospital.

“I opened the doors,” he said. “We built this building in ‘92 and moved from the old hospital and added long-term care in the mix of what we did. It’s personal for me.”

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