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rural hospitals

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.


How You Can Help Save Rural Hospitals

Posted on Thu, Oct 01, 2015
How You Can Help Save Rural Hospitals

By Bill Yarbrough

Fifty-five rural hospitals have closed since 2010, and 283 more are on the brink of closure, risking access to much-needed health care for more than 700,000 Americans. Rural hospitals face ongoing challenges with recruiting, increased competition and in some cases, a more challenging patient population due to the lack of primary care resources, advanced age and undiagnosed chronic conditions. Financially, these hospitals face greater threats from reimbursement and regulatory changes and uncertainty associated with value-based purchasing.

EmCare cares for more than 1.5 million patients in 170 rural hospitals around the country, and more than 3,000 clinicians dedicate their practice to this critical need.  In fact, nearly 30 percent of our clients serve patients in rural areas. But they are struggling; we’ve seen multiple client hospitals close and go into financial distress these past few years.

EmCare is committed to helping rural and community hospitals survive – and thrive – in these turbulent times. As such, we fully support the National Rural Health Association and its advocacy of the Save Rural Hospitals Act (H.R. 3225).

Introduced by U.S Reps. Sam Graves (R-Mo.) and Dave Loebsack (D-Iowa), the bipartisan bill will:

  • Stop the many cuts in Medicare reimbursement that rural hospitals have endured for years
  • Provide rural hospitals with new funding so they can provide quality primary care
  • Allow struggling rural hospitals to provide care that makes sense in their communities and receive fair reimbursement for emergency department and primary care

The Save Rural Hospitals Act will provide these hospitals with financial and regulatory relief to allow them to continue to care for rural residents who are older, poorer and have higher rates of chronic disease than their urban counterparts.

What You Can Do

The National Rural Health Association encourages you to contact your Congressmember and urge him or her to cosponsor HR 3225, the Save Rural Hospitals Act.

If you can, visit the district office, attend town hall meetings and invite your member of Congress to tour your rural facilities. Explain to them how important your hospital is to the patients you serve and the rural economy.

Since January 2013, more rural hospitals have closed than in the previous 10 years combined. If Congress doesn’t act now to prevent further closures, rural hospitals will be forced to lay off workers, cut wages, reduce services and close doors. Lives will be lost, and local economies will suffer. Let’s do what we can to reverse the tide.

Bill Yarbrough, Chief Executive Officer of EmCare Physician Services (EPS), joined the company in 1989 and has dedicated the majority of his career to 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.


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.