Free-standing emergency departments could be the solution to keeping hospital services in rural areas

The tribulations of rural hospitals in Georgia, and the response, could signal a new direction for saving such facilities. Four rural hospitals in Georgia “have closed in the past two years, and
several more either have closed or significantly reduced services since
2001,” Bob Herman reports for Modern Healthcare. “Nationwide, more than two dozen rural hospitals have shut down
since 2013. For people in rural areas, a closed hospital means
they have to travel farther, sometimes hours, for care. And that could
mean life or death in situations such as cardiac arrest, car accidents,
workplace injuries and other emergencies.”

Republican-led Georgia, where officials have refused to expand Medicaid
under federal health reform, “has proposed a regulatory change that
some observers think could help rural hospitals across the country,”
Herman writes. Republican Gov. Nathan Deal said in March that “financially struggling rural hospitals can offer
fewer inpatient services and still keep their hospital licenses. In
essence, they can convert into free-standing emergency departments that
stabilize and transfer patients to bigger hospitals. Under Deal’s
proposal, these rural facilities also could offer other basic services
such as labor and delivery.”

Some people are critical of the idea. Brock Slabach, a senior vice president at the National Rural Health
Association, “said the financial sustainability of free-standing
rural EDs in Georgia as outlined by Deal would be low,” Herman writes.
Salbach told him, “Emergency departments
would be nice for access, but that doesn’t provide (insurance)
coverage. These rural communities are still going to be
having problems of paying for these services. We need to try to find a
way to expand coverage to these poor populations in a way that’s not
going to be called Obamacare.”

There are somewhere between 400 to 500 EDs in the U.S., Herman writes. Most “are
affiliated with a hospital or health system, serving as a feeder for
patients needing inpatient care. The EDs usually are within 20 miles of a
full-service hospital. More recently, for-profit ED companies have been
building in affluent suburbs, targeting privately insured patients who
see the EDs as more convenient than making an appointment with a
primary-care physician.”

The problem is that few are
located in rural areas, Herman writes. For urgent-care centers and
free-standing EDs to survive in underserved
rural areas the “operating model will need to adapt,” said Alan Ayers, a
vice president for Concentra, the urgent-care subsidiary of giant Louisville-based insurer Humana Inc. “They
will have to use mid-level clinicians including physician assistants and
nurse practitioners, reduce operating hours, and offer other
high-volume services such as primary care and occupational medicine.
That could help rural facilities offset the typically high fixed costs,
Ayers said.”

“Perhaps the most feasible solution for rural areas is a hybrid model,
mixing lower-level emergency care with primary-care services,” Herman writes. “An example
is Carolinas HealthCare System Anson in Wadesboro, N.C., a town of
5,800. In 2012, Carolinas HealthCare System—a large system based
in Charlotte, N.C., with $4.7 billion in annual revenue—decided to
overhaul Anson Community Hospital, a Hill-Burton facility with 125
staffed acute-care and nursing beds.”

“The system spent $20 million and
downsized the hospital’s inpatient capacity from 30 beds to 15,” he writes. “The new
facility, which opened in July, offers 24/7 emergency care in addition
to the limited number of acute beds. Carolinas officials said Anson’s
major innovation and attraction is that it uses a patient-centered
medical home model, offering residents access to primary-care providers
with the help of a patient navigator.” (Read more)