Arkansas City ? Rising health-care costs and declining patient volumes are combining to force closings and cutbacks at rural hospitals across Kansas.

One such hospital is South Central Kansas Regional Medical Center in Arkansas City, where chief executive Joe Jirinec is hoping financing will come through to break ground on a new $25 million hospital this fall.

If the financing doesn’t come through, the town might be without a hospital. Jirinec said the city’s existing hospital costs too much to operate.

Similar problems have caused closures or cutbacks in Halstead, Andover, Augusta and other Kansas towns.

Although the same market forces are hurting urban hospitals, the effect tends to be more dramatic in rural areas, where the closing of a hospital can force residents to drive miles for medical care and cause severe economic loss for small towns.

Lawmakers are trying to help rural hospitals with more Medicare funding and programs to recruit doctors to rural areas.

The U.S. Senate voted Thursday to increase Medicare payments to doctors and hospitals in rural areas by $25 billion during the next decade. Rep. Jerry Moran and Sen. Sam Brownback of Kansas have proposed similar bills.

But that’s probably not enough to keep all rural hospitals open, Jirinec said.

Rural hospitals have to innovate to survive and even with that, some of them won’t.

“I’m sorry about how this sounds,” Jirinec said, “but it’s all about money.”

Arkansas City’s hospital is licensed for 85 beds, but hasn’t filled that many in years. The normal patient load is just 13 or 14.

The hospital has about that many doctors on staff. They spend their time on outpatient work, many seeing the same patients they have treated for decades.

The hospital doesn’t have an orthopedic surgeon, among other things. In recent years, it’s been losing patients to Wichita hospitals and specialty clinics.

Some factors fueling rural hospitals’ problems include Medicare compensation that isn’t keeping up with rising costs; patient demands for better, more expensive equipment; patient willingness to drive farther for care; and a tight health-care employment market in which higher-paying urban areas have an edge in recruiting nurses and doctors.

Small-town hospitals have limited tools to fight the decline.

Greg Lundstrom, administrator for Lindsborg Community Hospital, said his hospital aggressively works with other hospitals, pooling purchasing, maintenance and staff when possible.

At the South Central Kansas Regional Medical Center, the doctors are the investors in the planned new hospital.

With an up-to-date structure and a smaller facility better sized for its patient base, Jirinec said he hopes to attract more patients and keep maintenance costs down.

Jirinec said the government can help, but it can’t do everything.

He gazes at his hospital plans and hopes the financing comes through.

“If this doesn’t work, we’re in deep doo-doo,” he said.