Kevin Ciresi Exposes Hidden Costs of Rural Healthcare Consolidation

During decades of clinical practice, Dr. Kevin Ciresi performed thousands of surgical procedures. But what stuck with him was the growing realization that corporate healthcare was transforming everything. Now a healthcare operations consultant and medical tourism strategist, Ciresi is speaking openly about what he calls the "financial engineering" behind hospital consolidation and how it impacts rural communities the hardest.

Financial Engineering Behind Hospital Mergers

Between 2017 and 2024, 62 rural hospitals shut down while only 10 new ones opened. That's a net loss of 52 facilities, according to the Kaiser Family Foundation.

Hospital execs often pitch these mergers as ways to boost efficiency or improve care. Kevin Ciresi isn't convinced.

"I don't want to be bitter, but it's more about moving money around than improving outcomes," he says. "Most of the time, these mergers don't lead to better care because no one puts the integration into practice."

His view echoes what many healthcare professionals are feeling. Over the past decade, rural hospitals have been consolidating into larger systems. And often, it's the patients, not the balance sheets, who pay the price.

Rural Healthcare Crisis Deepens

By late 2024, the data was precise:

• Over 66% of primary care shortage areas in the U.S. are rural
• There are only 68 doctors per 100,000 people in rural areas, compared to 80 in urban ones
• People in these communities often travel hours for care that used to be local

Kevin Ciresi's experience runs deep, from founding Tresanti Surgical Center to serving as Chief Medical Officer at multiple facilities. His background in healthcare entrepreneurship has given him insights into how closing a hospital can devastate a town. Healthcare jobs are usually among the top three employers in rural areas. When a hospital closes, it's not just health services that disappear; it's local livelihoods, too.

Erosion of Physician Autonomy

For Kevin Ciresi, the most significant loss is something less measurable: trust.

"The most obvious damage is what happens to the physician–patient relationship," he says. "We train for years to care for people. The system? It cares about margins. It's just numbers to them."

Once a hospital is taken over, vital services are often the first to go:

• ICU beds
• Labor and delivery
• Mental health units

And when those are gone, patients are left to fend for themselves, often with no easy way to get to the nearest hospital. For the elderly, those with disabilities, or patients who don't speak English or own a car, this isn't just inconvenient. It's life-threatening.

Physicians, meanwhile, are stuck in a web of bureaucracy. Ciresi describes the feeling bluntly: "It's like being a five-year-old asking for permission from your mom."

"You're buried in paperwork. You know what the patient needs, but now you have to write a letter. Then revise it. Then wait. Then the appeal. It's a scam," he says.

Insurance Industry's Disruptive Role

Kevin Ciresi doesn't sugarcoat his views on the insurance industry.

"They provide the customers and collect the money. They don't provide care, we do. This model exists already in some ancient professions."

It's crude, but it captures the power imbalance at the center of the problem. In consolidated systems, insurers and corporations hold the cards. Doctors and patients are left to deal with the fallout.

Here's how bad it's gotten:

• Over one-third of rural Americans skip care because they can't afford it
• The average rural resident earns nearly $10,000 less than the national average
• 40% of rural kids are on Medicaid or CHIP
• 20% of non-elderly adults rely on public programs

Quality Concerns and Service Reductions

Despite claims about quality improvements, evidence suggests otherwise.

Mergers or acquisitions of rural hospitals have shown no significant improvements in profitability, clinical outcomes, or patient experience, according to recent research in the Journal of Rural Health.

Kevin Ciresi's operational experience reveals how efficiency metrics mask quality degradation. During his tenure in the healthcare system, he implemented standardization processes, improving throughput while questioning the benefits to patients. His perspective on board room priorities versus patient care highlights how financial optimization pressure drives service eliminations.

"I set a spreadsheet. I said, I want all the turnaround times documented. I want to know how long it takes me to do an operation, how long it takes to turn over the room, get the patient recovered, get the next patient seen," Ciresi explained.

"And yeah, I got it up to 97th percentile, but why did I do it? Decreased cost, increased profit."

Rural hospitals offering obstetrics care dropped from 57% to 48% between 2010 and 2022, according to KFF analysis.

Corporate Healthcare's Market Dominance

Hospital systems often emphasize "efficiency." However, Kevin Ciresi notes that focus can sometimes mask a decline in quality.

"I had my team track every metric—turnaround times, recovery times, the works," he says. "I got us to the 97th percentile in efficiency. But why? It wasn't for better care. It was for better profits."

That same financial pressure leads systems to cut services that don't make money, even if they're essential. Between 2010 and 2022, the number of rural hospitals offering OB care dropped from 57% to 48%, leaving expectant mothers with nowhere nearby to deliver safely.

Research supports this finding: a recent study in the Journal of Rural Health found no consistent improvement in outcomes, profits, or patient satisfaction following mergers. It's the illusion of progress, not the real thing.

Human Cost Analysis

The human impact of healthcare consolidation on rural communities extends beyond statistics.

Kevin Ciresi emphasizes the importance of maintaining physician-patient relationships as a cornerstone of quality healthcare. "If I could make it better, that would be a better thing," he said, explaining his move from clinical practice to healthcare operations while still focusing on patient outcomes. His professional background demonstrates decades of commitment to improving healthcare delivery systems.

Rural hospital closures eliminate access to primary care, since most rural hospitals own and operate clinics. This forces residents to travel long distances for emergency, inpatient, or primary care, according to data from the National Rural Health Association.

Economic ripple effects devastate rural communities:

• Hospital facilities contribute approximately $200,000 per employee to local economies
• A 300-employee hospital generates $60 million annually for its rural community
• Hospital closures eliminate both healthcare access and major employment centers

Reform Requirements

Kevin Ciresi's analysis highlights a fundamental mismatch between corporate profit motives and patient care needs, calling for reform.

"There has to be one, you can't have insurance companies making billions of dollars in profits while the lower end suffers," he argued, advocating balanced approaches prioritizing patient outcomes over financial engineering.

His international medical tourism work provides additional context for the challenges facing America's healthcare system. Developing safe medical tourism frameworks across Europe, Ciresi observed healthcare systems prioritizing universal access and community responsiveness over shareholder returns. Moving forward requires acknowledging the hidden costs of consolidation, which disproportionately impact vulnerable populations, even when necessary for the survival of rural hospitals.

Recent research suggests that policymakers must closely monitor rural hospital mergers, striking a balance between preserving patient access and considering the consequences of healthcare consolidation.

Kevin Ciresi's approach to healthcare delivery demonstrates that the success of a healthcare system should not be measured by operational efficiency or profit margins, but also by placing an emphasis on preserving meaningful physician-patient relationships and genuine community responsiveness.