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Bristol Hospital President and CEO Kurt Barwis has been sending policymakers a report that paints a grim picture of the future of small community hospitals like the one he runs. Based on more than a year of research, the report from the Massachusetts Health Policy Commission suggests community hospitals in that state face something of a downward spiral: Patients are increasingly seeking routine care at large academic medical centers or teaching hospitals, drawn by perceptions of quality or referred by doctors who are now affiliated with the larger hospitals. (Levin Becker, 4/3)

Across Tennessee, 61 hospitals help keep small towns healthy and bustling through access to a variety of health care services and salaries. The hospitals have a combined economic impact of $994.7 million and support 15,654 jobs, according to the Tennessee Hospital Association. Many of the facilities, and smaller communities, are struggling amid a confluence of factors, including changes in how hospitals are reimbursed, expensive technology and challenges in physician recruitment. Since 2013, eight hospitals have closed or drastically changed their services. This often leaves a crater in the community as jobs and emergency care disappear. (Fletcher, 3/31)

A long-pending plan to bring more federal Medicaid dollars to more than two dozen private Virginia hospitals has run into opposition from Gov. Terry McAuliffe and General Assembly budget leaders who now fear the plan could cost the state big money in the long run. (Martz, 4/2)