Keep rural hospitals in the game

Nearly 20 percent of America’s population lives in rural areas of the country, where access to health care facilities and services can be difficult. The Patient to Primary Care Physician Ratio In rural areas only 39.8 physicians per 100,000 residents, compared to 53.3 in urban areas.

Rural hospitals work hard to meet the health needs of the population they serve, but they have long suffered from understaffing, inconsistent patient volumes, and financial instability.

Since 2005, 181 rural hospital They stopped providing short-term, acute inpatient care, which affected their communities’ health outcomes, employment rates, and long-term population growth. While federal pandemic relief funds have helped slow the shutdown rate, that temporary assistance will soon end.

In 2022, the bipartisan Policy Center reported that 20 percent of the country’s rural hospitals — 441 out of 2,176 — currently face three or more financial risk factors that put them at risk. Risk of service downgrade or closure.

Several legislations are currently in place to protect rural hospitals from these financial stresses, including the American Hospital Association-backed Rural Hospital Support Act, which will address economies of scale for rural hospitals through the prospective payment system. Rural Hospital Rescue Act 2021 Permanent suspension of Medicare detention Extension of Medicaid Primary Care Payments for Rural Providers. The bill would also establish a national minimum wage index in the region to ensure that rural hospitals are fairly compensated for their services by the federal government.

While rural hospital leadership is unable to speed up the passing of these bills, here are several steps they can take now to boost their finances.

Understand the need for bidirectional patient movement

As the pandemic has shown us, the ability of the healthcare ecosystem to expand and contract to accommodate sharp increases in volume status is critical. Due to the lack of shared infrastructure, our healthcare system is not well equipped to match the right patients with the right resources at the best of times – which becomes an issue during a national healthcare crisis.

In rural communities, critical access hospitals and health clinics tend to transfer far more patients than necessary to regional facilities, in part due to inconsistent patient assessment processes.

Rather than playing a limited role in the ecosystem, large reception facilities tend to accept all patient transfers as a suitable destination for only certain types of emergency care. This open door policy has a ripple effect across the ecosystem, as it reduces the number of beds available for critically ill patients.

This disconnect has its roots in how urban and rural hospitals handle size. Urban facilities try to keep the average daily count (ADC), or the number of daily inpatients, at 95 percent or more of their total capacity.

By contrast, the ADC rate of rural hospitals is often flat at 30 to 40 percent of their total capacity, due to changing service offerings and declining populations in rural areas. According to the research, the average ADC (number of inpatients per day) in urban hospitals ADC outnumbers rural hospitals At a rate of 15 to 1. Beyond a pandemic, rural hospitals are rarely operating at full capacity.

These beds, available in rural hospitals, can greatly benefit the health care system when capacity is high. We must move beyond one-way transportation of critically ill patients to larger hospitals that provide specialized care while increasing patient numbers at scale. We should also embrace moving low-acute patients to smaller facilities. This bi-directional patient movement will help provide adequately sized patient care across the ecosystem.

Implementation of standardized assessment and decision-making

The first step in determining the correct volume of care involves standardizing the patient assessment process. The severity of the patient, or the severity of their condition, is the most important data in the decision to transfer. Assigning a numerical severity score that is easy for patients to understand gives care teams a quick shortcut to making decisions throughout their care.

Once the care teams have assessed the patient’s condition, they need clear guidance on how to make transfer decisions. By identifying best practices for specific circumstances, patient conditions, system and staff limitations, rural hospitals can equip their staff to make quick and efficient choices to conserve resources, reduce risks, and deliver patients to the best care environment.

Robust patient movement workflows can help care teams address gaps in care and staffing more efficiently – which could have a significant impact on revenue for hospitals with very slim margins.

Sharing patient movement data across facilities

The second step to determining the correct size of care centers is to collect, evaluate and share patient movement data across facilities. By tracking data such as patient severity, presumptive diagnosis, type of transport, destination, and outcomes, rural hospitals will have greater insights into how patient movement is working for their organization. For example, they may reveal the need to develop a particular subspecialty in order to treat patients with a particular condition more quickly. In the long term, they may decide that stroke patients are better off when they are transferred to a particular regional facility rather than another.

In the short term, sharing of patient movement data between dispatch facilities, transport vendors, and reception facilities simplifies transfers and improves patient safety. For example, when clinicians work with the same system, the degree of patient acuteness helps care teams understand the care required during transfer; Receiving hospitals can use the same result to report the bed position of the incoming patient.

Create mutually beneficial partnerships

Collaborative relationships between rural and regional facilities are essential to reduce inefficiencies across the continuum of care. Across the country, the trend toward greater collaboration around patient movement is growing. Through a mutually beneficial partnership, an academic medical center may be committed to receiving patients from five urgent care centers and three rural hospitals, while a particular rural hospital may be committed to receiving patients with low severity as well as a particular subspecialty.

Without a strong rural health care system, our nation’s ability to expand and contract with increases in demand would be severely limited. When hospitals work together, they can better ensure that no community is left without a rural hospital for urgent care.

Richard Watson It is an emergency medicine Physician.

image credit: Shutterstock.com


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