The Situation
Let’s start with some statistics. According to the ECRI researchers, more than 80% of U.S. counties lack proper access to healthcare services. That includes pharmacies, primary care providers, hospitals, trauma centers and low-cost health centers. “Hospitals are often the principal source of laboratory tests, imaging studies and primary care in rural communities; but, since 2005, 195 rural hospitals either closed or converted from inpatient services to other healthcare services (e.g., primary care, long-term care).” And it now appears that another 757 (34%) hospitals are at risk of closing, and nearly half of these are at immediate risk.
According to the ECRI publication, “these significant and pervasive barriers to healthcare put rural residents at higher risk for worse health outcomes and exacerbated disparities,” including the following:
- Delayed or forgone essential healthcare
- Higher mortality and chronic disease rates
- Poorer health behaviors (e.g., smoking, alcohol consumption, lack of exercise, weight management)
- Higher rates of suicide, mental health issues and substance use
- Poorer social drivers of health
- Lower life expectancy
Indeed, according to the research, “more than 60% of primary medical, dental and mental health professional shortage areas are rural.”
The Reason for the Situation
So the situation appears dire. According to ECRI, the problem seems to rest with the fact that costs of services are fixed but fewer patients are being served. This means that the average cost per care visit is higher in rural areas. “Private health insurance and federal reimbursement rates often do not compensate for this discrepancy, leading to nearly half of rural hospitals operating with negative patient service margins and higher debt-to-asset ratios.” The ECRI team goes on to assert:
Although local tax revenues and government grants exist, there is no guarantee that these funds will continue, cover higher costs, or offset losses on services to uninsured or Medicaid patients.
So, that leaves us looking for solutions.
Possible Resolutions to the Situation
The ECRI document doesn’t just outline the problem, it offers possible solutions. Here are just a few of the recommendations they list for dealing with this particular patient safety concern:
- Explore opportunities regarding provider types, models of care, federal and state programs, and health system or network affiliations to improve financial viability and preserve or extend health services.
- Expand telehealth and telepharmacy services.
- Consider establishing or expanding mobile health clinics for primary and preventive care, such as routine screenings and nonemergent diagnostics.
- Stay abreast of funding opportunities for facility improvements or financial stability, such as those gathered by the Rural Health Information Hub or through the federal Rural Health Transformation Program.
- Participate in rural health research programs or work with rural practice-based research networks to improve national understanding of rural public health and healthcare needs. The Federal Office of Rural Health Policy can help identify requests for proposals from federal and state governments, agencies, or other interest groups, as well as calls for study participants through academic institutions.
There are other measures that rural health providers can consider. The key is to be proactive. Given the downward trend in rural hospital survival, doing nothing is probably no longer an option for your facility. Begin now to develop a plan for sustainability. Your local rural community is counting on you.