By Paul Bremmer

Eighteen acute-care hospitals across the United States shut their doors in 2013.

At least 12 more hospitals have closed this year in rural areas alone. More are getting out the plywood to nail over windows and barricades for doors.

Don't worry, it's just the new normal under Obamacare, says Lee Hieb, M.D.

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"Events happening now give us some idea of what medicine will be reduced to in the future," Hieb writes in her forthcoming book, "Surviving the Medical Meltdown: Your Guide to Living Through the Disaster of Obamacare."

"Today, all over America, small and midsize hospitals as well as hospitals in inner-city, poor areas are closing," she said.

Hieb is an orthopedic surgeon and past president of the Association of American Physicians and Surgeons.

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She said the reasons for the closures aren't complicated. Most of the victims are smaller hospitals or those in poor areas, which often serve the greatest number of Medicare and Medicaid patients.

A report at Modern Health Care just a few weeks ago confirmed that among just the critical-access hospitals, which have 25 beds or fewer, there were 14 closures in 10 states in 2013.

And the federal bureaucracies that set reimbursement rates for needy patients simply aren't keeping up with the costs, she said.

Hieb writes that "whereas private insurance might pay the surgeon $4,500 for a spinal surgery (my specialty), Medicare paid less than $1,200."

In addition, she says the federal government refuses to pay hospitals for certain services, deeming them "not medically necessary," regardless of what doctors and patients say.

"The result is predictable: economic failure of hospitals and physician practices that have become dependent on government payment for large segments of their population," Hieb writes. "The hospitals and offices that will close are those with the least private insurance."

One case she cites: Temple Community Hospital of Los Angeles closed its doors Sept. 9. Among the reasons the hospital gave for its closure were "low reimbursement rates" and "regulatory requirements."

And then there was Vidant Pungo Hospital of Belhaven, North Carolina, which shut its doors July 1. It was the only hospital in a small, economically destitute farming town.

There, Kaiser Health News reported, "The closing has left local doctors wondering how they will make sure patients get timely care, given the long distances to other hospitals, and residents worrying about what to do in an emergency and where to get lab tests and physical therapy."

Said Dr. Charles Boyette, "Half of them aren't going anywhere. They're taking a chance on if they'll be alive or dead after the emergency passes. The disaster has already started."

In November, the company that owns Quincy Medical Center, near Boston, announced the hospital will close by the end of this year. QMC suffers from too much competition – there are more than a dozen hospitals within a 10-mile radius – but also from having too many patients with government insurance. Roughly 70 percent of the hospital's patients are on Medicare or Medicaid.

Some hospitals, rather than closing completely, have dramatically reduced their workforces. In fact, 37 hospitals and health systems cut, or are preparing to cut, at least 100 employees from their payrolls this year.

Hospital closures and staff reductions have left fewer facilities and health-care workers to take care of more patients. Consequently, wait times have increased.

That was the case in West Memphis, Arkansas, after Crittenden Regional Hospital closed Sept. 7. Physicians at local urgent care clinics told the Memphis CBS TV affiliate they were overloaded and had to stay open an extra hour or two every day. Patients had to wait several hours to see a doctor.

Hieb warns of that very phenomenon in her book.

"The hospital in Arizona where I used to work is a 250-bed facility with the latest state-of-the-art cardiac care," Hieb writes. "It is a referral center for about 400,000 people. Although you will get great care there, if you go by foot or car to the emergency room with chest pain, you may wait over six hours for an evaluation because the system is overloaded."

She previously had warned of the increasing workload for doctors and the negative consequences that can result.

She told of her own experience with government-run health care, in the form of Medicare. As more and more elderly Medicare patients moved to her city and as the government dropped physician reimbursement levels, doctors began to leave town for cities with more private-pay patients. This put added stress on the doctors who remained, she said.

"In general medicine and other areas, hospital on-call nights were so brutal – keeping doctors up all night in spite of working all the next day – that all the doctors who could function outside the hospital chose to leave the hospital staff for purely outpatient practices," Hieb wrote. "Those who could afford to retire did so. And in orthopedics, we were left with four surgeons doing the work that was being done elsewhere by 10 or more."

She continued: "In areas where fewer and fewer physicians remain, it is very difficult to recruit new physicians to the job – since the new docs do not want to be forced to cover impossible patient loads. Around the country, there are already these medical 'black holes' – areas without coverage for certain specialties."

Just a week ago, a report from Fierce Healthcare said one of the impacts of hospital closures is that mothers-to-be lack prenatal care.

And a report from Becker's Hospital Review found a total of 20 "closures and bankruptcies" for 2014.

"Numerous acute-care hospitals and health systems have filed for bankruptcy protection, closed or announced upcoming shutdowns," the report said, citing the loss of divisions of even major organizations like Indiana University Health and the University of Missouri Health.

Also, Specialty Hospitals of America sold off two of its facilities in Washington to an investment firm, the report said.

In another case, the Regional Medical Center in Natchez, Mississippi, filed for bankruptcy for the second time in five years.

Healthcare Dive reported there's a domino effect following a closure.

"Times are tough for our nation's hospitals, and not just the ones forced to close their doors. While employees from hospitals that stayed open believed that inter-hospital communication could mitigate the stress of closures on the healthcare system, when there is too much demand for hospital care, it takes a toll on patients and their families."

Get "Surviving the Medical Meltdown: Your Guide to Living Throught the Disaster of Obamcare"