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rural healthcare

Rural Healthcare: What to Expect in 2016

Posted on Mon, Feb 22, 2016
Rural Healthcare: What to Expect in 2016

EmCare cares for more than 1.5 million patients in 170 rural hospitals around the country, and more than 2,000 clinicians dedicate their practice to this critical need. EmCare Physician Services (EPS) is the EmCare division which manages rural, community and other small-volume hospitals and medical centers. Bill Yarbrough, Chief Executive Officer of EmCare Physician Services, provides his insight on what rural hospitals and clinicians can expect this year.
What trends do you foresee in 2016 for healthcare in general and rural medicine specifically?

We’ll see the cost of coverage increase, affecting patients’ decisions on the affordability of coverage, and where and how they’ll seek care. The use of technology will increase to help address costs and barriers to access to care, particularly in rural and other underserved areas. In the healthcare in general, we’ll see even more consolidation and partnership among healthcare entities and an increased focus on post-acute care management.

Will the presidential election affect healthcare?

The election could have an impact on non-Medicaid expansion states in that there’s a significant difference in access to and affordability of coverage/care for patients, particularly in rural areas. From a national perspective, certain elements of the Accountable Care Act (ACA) may change depending on the composition of Congress or the White House.
What will be the top challenges for rural hospitals in 2016?

  • The ACA will continue to cause a negative financial impact in Medicare and Medicaid, which represents a large percent of rural hospitals’ of payor mix. We may see some regulatory fixes, such as removing the 96-hour conditional payment for critical access hospitals.
  • Rural hospitals will need to consolidate services, particularly for specialty care and referrals, to remain competitive. This may mean further horizontal integration of hospitals via mergers and partnering with systems.
  • And, rural hospitals will be challenged to expand the use of telemedicine for specialty consultation.

What will be the top challenges for rural physicians in 2016?
  • Declining reimbursement makes becoming employees of hospitals and healthcare entities more attractive. It’s expected that 75 percent of physicians will be employed by 2020.
  • Becoming proficient using the technology expected for documentation while trying to stay engaged with patients amidst the shift to pay for performance will be a noted challenge. 

What changes do you foresee with the rural patient population?
  • More patients are transitioning back to self-pay due to affordability/usability of exchange healthcare coverage. There will be a continued shift toward higher deductible plans and copays. In fact, only 4 percent of healthcare consumers selected high-deductible plans in 2006, compared with 22 percent in 2014.
  • Telehealth will be used more by patients for routine, preventive, primary and psychiatric care.
  • Bundling of post-acute services will be more difficult for care coordination for rural patients.

Bill Yarbrough, Chief Executive Officer of EmCare Physician Services (EPS), joined the company in 1989 has had a dedicated focus on meeting the needs of community hospitals. He previously served as EmCare’s EPS Chief Operating Officer and Vice President of Client Services.  His prior experience includes leadership positions in Spectrum Healthcare and Professional Anesthesia Services.


National CRNA Week: Our Growing Role, Especially in Rural Hospitals

Posted on Mon, Jan 25, 2016
National CRNA Week: Our Growing Role, Especially in Rural Hospitals

During National CRNA Week – January 24-30, 2016 – We will recognize some of the amazing men and women providing care in this important clinical role. Visit EmCare’s Facebook page to learn more about our CRNA superstars.

By Linda Caccamo, CRNA, MS, MBA/MHA

America’s rural hospitals are struggling. It seems that I read news of a hospital closure nearly every week. One way that financially strapped hospitals are working to deliver quality care more economically is through the use of advanced practice registered nurses, specifically Certified Registered Nurse Anesthetists (CRNAs).

CRNAs, the primary providers of anesthesia services in rural America, provide the majority of anesthesia care in U.S. counties with lower-income populations and populations that are more likely to be uninsured or unemployed, according to Nursing Economic$.

About CRNAs

CRNAs administer approximately 40 million anesthetics each year in the United States, according to the AANA’s 2014 Practice Profile Survey. The industry began credentialing registered nurse anesthetists in 1956.

CRNAs provide anesthesia in collaboration with surgeons, anesthesiologists, dentists, podiatrists and other qualified providers. They are responsible for patient safety before, during and after surgery. Nurse anesthetists administer every type of anesthesia to patients in a variety of healthcare settings. CRNAs provide continuous pain relief and sustain patients’ critical life functions during surgical, obstetrical and other medical procedures. CRNAs monitor and interpret diagnostic information throughout the course of a patient’s procedure.

Typically, the requirements to be a CRNA are:

  • A Bachelor of Science in Nursing (BSN) or other appropriate bachelor’s degree
  • A current license as a registered nurse
  • At least one year’s experience as a registered nurse in a critical care setting
  • Graduation with a minimum of a master’s degree from an accredited nurse anesthesia educational program
  • Pass the National Certification Examination following graduation.

To be recertified, CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure, and certify that they have not developed any conditions that could adversely affect their ability to practice.

Job Outlook

Due to increased financial pressure on hospitals, there is a significant and growing need for CRNAs across the country. A 31 percent growth rate is predicted over the next decade, according to

EmCare employs CRNAs in facilities across the country. They are valued members of our clinical team, and our integrated care approach enables CRNAs to practice at the top of their licenses.

EmCare supports CRNAs in a variety of ways, including:
  • Leadership, teaching and mentoring opportunities
  • Flexible scheduling
  • Earn While You Learn, a program that provides a monthly stipend to providers completing a CRNA program

During National CRNA Week – January 24-30, 2016 – We will recognize some of the amazing men and women providing care in this important clinical role. Visit EmCare’s Facebook page to learn more about our CRNA superstars.

Linda Caccamo

Linda Caccamo, CRNA, MS, MBA/MHA, is Senior Vice President of Operations for EmCare Anesthesia Services. Caccamo received her master’s degree in anesthesiology from the Medical College of Pennsylvania and combined MBA/MHA from Wilmington University in Delaware. In her current role, she offers supervision and support for anesthesia site medical directors and professional staff. Before joining EmCare, she served as an executive director for a large anesthesia group practice at a Level 1 regional referral center. She is a former instructor for Advanced Cardiovascular Life Support (ACLS) and has earned a Black Belt Certification in Lean Methodology for Healthcare. She has served on numerous professional and state level committees and continues to practice anesthesia as an anesthetist in EmCare’s North Division.



Rural Hospitals Are Closing. Rural Patients Are Vulnerable. Legislation is the Solution

Posted on Thu, Nov 19, 2015
Rural Hospitals Are Closing. Rural Patients Are Vulnerable. Legislation is the Solution

In honor of National Rural Health Day, the National Rural Health Association penned a post for EmCare's blog.
Fifty-seven rural hospitals have closed; 283 more are on the brink of closure. Since the start of 2013, more rural hospitals have closed than in the previous 10 years combined. Continued cuts in hospital payments have taken their toll, forcing far too many closures. Medical deserts are appearing across rural America, leaving many of our nation’s most vulnerable populations without timely access to care.
That’s why the National Rural Health Association (NRHA) is advancing H.R. 3225, the Save Rural Hospitals Act, introduced by U.S Reps. Sam Graves (R-Mo.) and Dave Loebsack (D-Iowa).
The bipartisan bill will stabilize and strengthen rural hospitals by:

  • Reversing the Medicare cuts that all rural hospitals have struggled with for years,
  • Providing rural hospitals with new funding so they can provide quality primary care to rural patients across the nation, and
  • Creating a path forward for struggling rural hospitals by allowing them to provide the care their communities need and receive fair reimbursement for providing essential emergency room and primary care.
It is clear that continued cuts in hospital payments have taken their toll leaving 69 percent of rural hospitals with negative operating profit margins. If Congress doesn’t act to stop the multitude of cuts the closure of the 283 hospitals on the brink will result in 700,000 patients losing local access to care. When the hospital closes the community dies, since the local hospital can represent as much as 20 percent of the local rural economy. If only the hospitals on the brink closes, 36,000 direct healthcare jobs and another 50,000 community jobs will vanish. But more importantly, when these hospitals close, most physicians, nurses, physician assistants and other health care providers linked to the hospital leave the community and result in medical deserts forming across the nation.
Rural Americans are more likely to be older, sicker and poorer then their urban counterparts. Specifically, they are more likely to suffer with a chronic disease that requires monitoring and follow up care, making convenient, local access to care necessary to ensuring patient compliance with the services that are necessary to reduce the overall cost of care and improve the patients’ outcomes and quality of life. Rural patients already face a number of challenges when trying to access health care services close to home. Yet, since care in rural America is high quality primary care, instead of costly specialty care, when rural Americans can receive care locally CMS actually spends 2.5% less on rural beneficiaries it does on urban beneficiaries. This saves taxpayers billions of dollars each year.
Access to quality, affordable health care is essential for the 62 million Americans living in rural and remote communities. When a hospital closes, neighbors, family and friends must seek care outside the community, traveling to receive care in a far-away urban area. Rural hospitals are a vital access point to get timely and quality care. If rural hospitals close, patients suffer, and so does the rural economy.
How can you help?
Join NRHA in telling Congressional leadership you support this important legislation to save rural hospitals.
  • Call, email, tweet and Facebook your elected officials and colleagues using #SaveRural.
  • Attend town halls. Ask questions and share your stories about rural hospitals.
  • Invite your members of Congress and health legislative assistants to tour your facility.

The National Rural Health Association (NRHA) is a national nonprofit membership organization with more than 20,000 members. The association’s mission is to provide leadership on rural health issues.  NRHA membership consists of a diverse collection of individuals and organizations, all of whom share the common bond of an interest in rural health.


6 Reasons to Consider a Career in Rural Medicine

Posted on Mon, Aug 10, 2015
6 Reasons to Consider a Career in Rural Medicine

By Andy Scoggins

Nearly 25 percent of the U.S. population lives in a rural area, yet only 10 percent of the nation’s physicians practice there. There’s a shortage of qualified clinicians throughout the country, but in America’s least-populated areas, this dearth of doctors can mean the difference between life and death.

As medical professionals we’re hard-wired to go where we’re needed to serve our patients, yet for some, rural America is akin to Siberia. Here are six reasons you may want to reconsider a career in a “fly-over” state.

  1. Better Quality of Life: While practicing in larger cities may pay more, living in rural areas often costs less. You may be able to afford a larger home and more property, and you will probably sit in a lot less traffic! If you are nature-lover, most rural areas offer incredible hiking, fishing and biking opportunities, and who doesn’t love farm-fresh produce?

  2. Options to Lower Your Loans: Many states encourage physicians to practice in rural communities by offering financial incentives, including federal or state-funded student loan reimbursement or repayment programs. The amount of loan forgiveness usually increases each year that the physician continues to practice in the rural community.

  3. Ways to Expand Your Experience: Ever seen a snake bite or scorpion sting? Work in a rural area and you just might! Physicians in these areas often see cases that they might not normally come across in medical school or residency. Because a rural EM physician also serves as PCP, dentist, OB/GYN and more, they see a broader scope of chief complaints, and that’s experience you just can’t buy.

  4. Emphasis is on Technique, Not Technology: In many rural areas, access to high-tech diagnostic equipment and cutting-edge treatments isn’t readily possible. Rural EM doctors will need to rely on their more low-tech skills – palpation, data collection and H&P interviewing skills, including asking questions that might not seem common: interaction with livestock, access to dental services, access to preventive care. Your initial clinical evaluation and examination will be even more important when you don’t have access to the technologies that can hasten diagnosis.

  5. You Get to Be the Decider: In rural settings, it’s often a one-person show. You will need to be decisive, autonomous and authoritative. These are skills best learned through repetition and experience, and a rural post will offer you the ability to hone them. Of course, if you are fortunate to have a lot of clinician support, be collegial and collaborative, but odds are you won’t have residents, advanced practice providers or scribes to help with the work load. It may be all you, so be bold.

  6. You Become a Part of a Community: Yeah, urban trauma centers see a lot of action, but in a rural ED, you’ll interact with patients in a way you may never see in a larger city. Critical access hospitals are, as the name suggests, critical to the overall health of the community’s population. Your facility may be the only option for medical care for 100 miles. Your patients will appreciate you. They will trust you. And they will need your expertise and teaching skills to avoid another illness or injury. The need is real, but the reward is enormous. It can – and probably will – change the way you deliver care for the rest of your career.

Nearly 30 percent of EmCare’s clients serve patients in rural areas. Recruiting and retaining competent, committed physicians for these communities is one of our top goals. In fact, we’ve dedicated an entire division to this mission. For more information about a career in a rural hospital, including a Cost of Living Calculator, visit

Andy Scoggins is Chief Operating Officer of EmCare Physician Services.