Rural safety-net hospitals seeing ED use increase faster than cities, report suggests

Emergency department visits are growing at a faster pace in rural areas than in urban settings, according to a study published in JAMA Network Open.

For the study, researchers from the University of New Mexico in Albuquerque and the University of Michigan in Ann Arbor examined ED visits recorded in the National Hospital Ambulatory Medical Care Survey from 2005-16.

During the study period, researchers found rural ED visits grew from 16.7 million to 28.4 million. In comparison, urban visits increased from 98.6 million to 117.2 million. Rural ED visit rates increased by more than 50 percent during the time period from 36.5 visits to 64.5 visits per 100 people. That outpaced urban ED visits, which grew from 40.2 visits to 43.8 visits per 100 people.

"These findings demonstrate several important and concerning implications for rural population healthcare delivery," the researchers said. "Increased ED use may reflect a deteriorating primary care infrastructure, greater fragmentation of care, and worsening disparities for several traditionally disadvantaged groups, including those with Medicaid and those without insurance."

Study authors also noted that by 2016, almost one-fifth of all ED visits occurred in a rural setting. In addition, rural EDs are also increasingly serving a larger portion of disadvantaged populations.

"Rural EDs are increasingly serving as safety-net hospitals, potentially further destabilizing their budgets because they generally operate in the traditional fee-for-service model. To improve the health of individuals in the rural United States, improved Medicaid reimbursement and innovative payment and delivery models that integrate EDs into local health are delivery systems may prove successful," the researchers concluded.

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