Sixteen percent of Americans – over 51 million people – live in an area defined as rural. But while many of these Americans are insured, they face significant hurdles to access healthcare services compared to their urban counterparts.
With regulatory and quality requirements rolling out and reimbursements threatened, critical access hospitals (CAHs) and community hospitals are fighting to remain financially viable in order to continue to serve their patients. Without these facilities in rural communities, overall community healthcare and economic conditions will decline.
The right technology is finally starting to reach these remote areas, so that these hospitals can stay competitive, financially healthy and stabilize as pillars of their communities.
The rural landscape
In 2017, a community hospital in Patrick, Virginia closed, forcing its 19,000 residents in the surrounding areas to drive up to four hours for medical care, and more than 45 minutes to reach an emergency healthcare facility.
Since 2010, we have seen 83 closures according to North Carolina Rural Health Research Program and more are expected. The strains causing these closures and consolidations are unique to rural executives.
Beyond keeping up with technology and quality programs, CAHs and community hospitals are dealing with shrinking patient populations and aging populations with significant travel restraints. Hospitals are also losing revenue due to patient transfers, resulting from physician shortages and limited access to specialists. There is also the juggling act of keeping pace with better-funded and well-staffed urban hospitals.
The effects of downsizing, too, are unique to rural communities. Many rural hospitals serve as the community’s largest employer. When the aforementioned hospital closed, 100 residents lost their jobs. In Washington, Gray Harbor Community Hospital sited “low volume and continued reimbursement reductions” as the reason it laid off 24 percent of its leadership team. Serving 70,000 residents, Gray Harbor now works under advisement of consultants to keep their doors open and maintain all patient service lines.
With hospital closures, rural communities face a significant loss of jobs, which in turn impairs economic growth. It is unlikely that new businesses will expand to cities without adequate healthcare for employees.
Rural providers are looking at the latest in technology and methodology to combats these striking closures, with a highlight on three primary areas:
Swing beds
To address financial stability, many rural hospitals are restructuring their facilities to support swing beds as one approach to drive revenue. This makes use of otherwise empty beds - helping offset hospitals’ fixed costs while decreasing the Medicare costs per inpatient day.
Swing bed care begins immediately following a patient’s discharge from a minimum three-day hospital stay. While some swing bed patients need extensive physical rehabilitation or intravenous antibiotics, others may need hospice or end-of-life care. It makes sense for this care to be as close to home and family as possible.
Cloud quality
Technology also remains a crucial component to achieving profitability and helping rural healthcare executives overcome their identified top concerns of ensuring access to care for their patients, attaining new value-based care goals and quality measures, and combating growing physician shortages in rural America.
By understanding what’s available – and without a large IT department staff of additional budgeting, can offer community hospitals critical insight on care and quality to remain competitive. Cloud based electronic health records, for example, can often be implemented quickly and with little start-up costs. This will enable the rural hospital to almost immediately start tracking and acting on quality programs with automated information and reports.
For instance, real-time quality measure tracking can provide needed insight into ensuring the delivery of evidence-based standards of care. Or, icons on nurse and physician documentation screens can queue the user that a particular field is used for reporting organizations such as CMS. With each measure directly correlating to reimbursement, EHRs can positively impact a hospital’s financial plans.
Telehealth
Further, rural hospitals are looking to telehealth to fill the gap when faced with physician shortage or decreased availability of specialists. When asked if telehealth is viewed as a resource to tackle these shortages, Jason McCauly, regional administrator for Jane Phillips Nowata Health Center, Sedan City Hospital shared, ““I think that the options provided by telehealth are not being fully realized yet. One major item that we are excited about is the potential impact that telehealth could have for patients who present to our emergency department with stroke symptoms.”
McCauley further explains, “Telehealth will allow us to have a patient receive a quicker evaluation and consultation by off-site neurology staff who are located in a larger, urban stroke center.”
We’re almost halfway through 2018 and for rural executives, the opportunity is bright to remain competitive. With more access to technology and remote clinical support than ever before, rural communities have the opportunity to build better access to quality healthcare for their communities, including clinics, specialists, emergency care and hospitals. And do all of this without having to undergo a financial burden.
Baha Zeidan is founder and CEO of Azalea Health, an integrated healthcare software company serving rural communities