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The Critical Role of Rural Hospitals

Posted on Tue, Jun 23, 2015
The Critical Role of Rural Hospitals

Rural hospitals play a critical role in the overall healthcare system. 


Rural hospitals face ongoing challenges with recruiting of physicians and staff, the lack of easily accessible onsite training and development programs; inaccurate community perceptions often leading to patient migration to larger hospitals for care of even basic medical problems; and in some cases a more challenging patient population due to the lack of primary care resources, advanced age and undiagnosed chronic conditions. Financially, with tight budgets and lower ability for revenue & service line growth than their more urban counterparts, these hospitals face greater threats from reimbursement and regulatory changes and uncertainty associated with value-based purchasing.

According to the National Rural Health Association (NRHA), rural hospitals serve an estimated 62 million Americans, representing approximately 20 percent of the 318 million people in the U.S. Often rural communities have a disproportionate share of the elderly, uninsured and patients with significant health challenges. While not always easy,  rural hospitals find a way to provide these Americans quality care close to home.

The following article features a number of common questions about the state of rural healthcare answered by an EmCare clinical leader. Dr. Jeff Slepin, Executive Vice President and Regional Medical Director for EmCare’s community hospital division. 

Q: How would you describe the role of rural hospitals in providing critical services to the community?

A: Rural hospitals deliver high-quality services efficiently and affordably, and help keep patients close to loved ones during episodes of care.  They provide competent, compassionate community-based care for the general medical and surgical needs of their patient populations. Often, in small communities, the caregivers in the hospital  are neighbors helping neighbors.  As in larger hospitals, providers focus on patient-centered care with continuous quality improvement and strive to create an outstanding patient experience.

Q: How has the role of rural hospitals changed over the past decade?

A: Rural hospitals face many of the same challenges as their urban, tertiary, and academic center counterparts, including population health concerns, new laws and regulations and reimbursement.  Over the past 15 years of working directly with rural hospitals, I have seen a more sharpened focus on how these facilities address the needs of their communities

While rural hospitals are prepared to manage most emergent and urgent care needs, they have also become very competent at managing the traditional scope of general medical and surgical problems, and have become a focal point of entry of patient who require more advanced services by forming relationships that efficiently and seamlessly connect patients with higher level treatment facilities that can deliver specialized care.    These referral relationships are symmetrical and strive to assure that upon their return to the rural community their ongoing relationships with local primary care physicians and the hospital are preserved.
 
Q: What market forces most impact the direction your hospital must take to keep up with the healthcare needs of this community?

A: Hospitals are in a constant battle to keep up with health trends including the aging population, acute exacerbations of chronic conditions (including diabetes, cancer, respiratory, and cardiovascular disease) changing demographics, decreasing reimbursement, increasing costs, physician shortage, and aging infrastructure.  To maintain their viability, rural hospitals strive to recruit new providers and improve current or establish new service lines (such as medical or surgical subspecialties),

Q: How do rural hospitals compare to larger urban hospitals for service?

A: Service excellence and positive patient experiences are key benefits of lower-volume rural facilities. They are often better positioned to provide more personalized service because nursing and ancillary staff have more time to spend with patients thereby improving the patient experience.  Satisfaction scores and performance on the HCAHPS survey are in line with those of  larger hospitals. Patient safety and clinical outcomes are also keeping pace with larger facilities, including comparable rates of readmission and hospital-acquired conditions.

Q: What are the advantages for patient and families?

A: In terms of convenience, compassion, personal attention and communication, rural hospitals provide patients and families a competent and desirable alternative to care at venues that requires even 20 or 30 miles or more of travel.

Q: What do you think is the most common misconception about rural hospitals?

A: The most common mistaken belief about rural hospital that they are little more than first aid stations and unable to care for more complicated patients.  Based on analysis of transfer rates in our client base, most rural hospitals are able to handle more than 90% of the patients who present to the Emergency Department.

Indeed many rural hospitals provide the full spectrum of family medicine, internal medicine, general surgery, pediatrics and obstetrics/gynecology service lines.

Transfers are arranged only when requested by the patient or medically necessary, i.e. the patient has a condition for which the hospital does not have the capacity, capability, or resources to manage the patient and any reasonably foreseeable complications that may develop.

Q: What should a patient expect if they must go to a larger urban health system?

A: While at times this is necessary to get the specific services and treatments at higher level facilities, the disadvantages, including travel time and expense (fuel, hotel, meals), potential of lost wages, and the emotional challenges of  leaving a family member alone for extended periods of time, and perhaps  less access to the medical staff for the patient’s family, are outweighed by the benefits of tertiary care when indicated.

Q: In addition to improving access to immediate and convenient care, what are the other benefits of rural hospitals?

A: Like their urban counterparts, rural hospitals provide a community education and outreach, often more focused to the specific needs of a smaller population.  Rural hospitals are often among the largest employers in the area.  Having a dedicated community hospital in the local area is one of the elements that improve the likelihood of more people and businesses in considering relocation to a rural area.

Nearly 30% of EmCare’s clients are rural, lower-volume or critical access hospitals. Supporting rural hospitals by bringing competent and committed physicians into these communities is one of EmCare’s greatest achievements.




Dr. Jeff Slepin



References and related articles for further reading:

Healthland. (n.d.). Fighting for Rural Hospitals. Retrieved from Healthland

Health Research & Educational Trust. (2013, June). The role of small and rural hospitals and care systems in effective population health partnerships. Chicago, IL: Health Research &Educational Trust.  

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