Access is not only an issue for local residents. When you travel across the country on our highways to visit families for holidays, take children to college, or visit remote recreation areas, access to care changes along the way and is variable depending upon your destination.
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ACEP Now: Vol 34 – No 01– January 2015Hospital closures are not just a health care problem. There are economic impacts as well. In addition to providing health care services, rural hospitals contribute to local economies. They bring outside dollars into rural communities and stimulate local purchasing power. They also help attract industry and, in some locations, a steady flow of retirees.
Crucial Importance of Rural Areas
Rural America is not just “flyover country.” Everyone, even those in large metropolitan areas, benefits from the fuel, fiber, and food that America produces. It has been estimated that without rural America’s contributions, you would be paying at least 15 percent more for these products. What would you do without that extra 15 percent in you pocket? Failing to invest in rural America, ignoring the importance of rural America, and disregarding its significance to everyone in the country is foolish and based on ignorance, if not arrogance.
The federal government has historically supported rural hospitals. Since 1997, it designated many as critical access facilities, recognizing that their small size limited their scope of service. Such hospitals received extra federal funding to focus on critical medical services.
Last year, the US Department of Health & Human Services Office of Inspector General recommended that the federal government tighten rules on critical access hospitals to save money. Such a move would likely reduce the number of such facilities by two-thirds.
Funding for the poorest Americans is also changing, with the Affordable Care Act having cut payments for indigent care in anticipation that the impoverished and uninsured would move to Medicaid. However, 23 states have not expanded their Medicaid programs in fear of escalating financial burden. In those states, a gap in federal support for the poor has emerged. Surprisingly, poverty is a greater burden in rural than urban areas, and the ability of small hospitals to absorb losses is far less. Urban and larger facilities can cost shift and offer other services to offset losses, or they may tap local governments for financial support for indigent care. Rural and smaller facilities don’t enjoy the same options or support.
The application of telemedicine to rural emergency care should be explored, developed, and tested, particularly in remote and rural areas. Issues with fair payment and licensure requirements for telemedicine services need to be resolved.
Georgia’s governor, Nathan Deal, is concerned that further hospital closures will cause significant issues with access to care. For this reason, he has created a Rural Hospital Stabilization Committee to explore options. One proposed idea is to allow rural facilities to convert to freestanding EDs. This would allow access to emergency care and treatment for time-sensitive conditions without requiring the presence of a hospital. The hospitals would maintain their Certificate of Need (CON) and could reopen should conditions improve.
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2 Responses to “Rural Hospital Closures Leave Whole Communities Without Access to Emergency Care”
February 1, 2015
JGraykoskiThank you Dr. Rogers for raising this important issue.
1. Rural Critical Access Hospitals DO provide important local services for select patients. Not every elderly pneumonia patient should be transported 2 hours to a tertiary hospital. The scope of services needs to be clearly defined and funded.
2. Rural Critical Access Hospitals need systems of training and quality monitoring so that standards of care are met.
3. A nod of appreciation to ACEP Rural Section for endorsing Comprehensive Advanced Life Support training, a team based, evidence based training for rural Emergency Departments.
4. Regionally directed, adequately funded, paramedic staffed EMS is critical in addressing needs of rural communities.
5. The role of PAs certified in Emergency Medicine coupled with telemedicine is an effective and cost effective way to deliver emergency care in rural hospitals or free-standing EDs.
6. All rural hospitals should establish close collaborative linkages with tertiary facilities for referral, consultation, training and outreach.
ACEP and the Society of Emergency Medicine PAs need to lead advocacy efforts for comprehensive reform of rural emergency health care, based on the above points.
February 2, 2015
William RogersOne of the easiest ways to help save our rural hospitals is to encourage states that have refused to expand Medicaid to accept the generous subisdy offered by the Federal taxpayer (100% initially but never less than 90%) and expand the program so that all of the citizens of their state will be covered. The idea that americans who earn less than a thousand dollars a month dont deserve health care is hard to understand in a country that pretends to admire the actions of the good samaritan.