Access to care for rural Americans continues to wain and people die because of it. Is there hope to end the trend and breath life back into that part of our system of healthcare?
CNN recently published a compelling story about a troubling crisis in America...the continued erosion of already limited access to care for Americans living in rural areas. They branded it the hospital desert. Credit to CNN for bringing at least some light to this issue. Highlights about the situation from the story:
- Nearly 30 million Americans don’t live within an hour of a trauma center.
- Residents living in 16% of the mainland United States are 30 miles or more away from the nearest hospital.
- Accidental deaths are 50% higher in rural areas compared to urban areas, largely due to distance from an ER.
- Since 2010, 81 rural hospitals have closed in the United States.
- Another 673 rural hospitals are vulnerable to shutting down.
- Financial problems are driving the closures.
An interesting perspective from Jessica Thompson, a rural resident and Registered Nurse, stood out as she responded to a common criticism rural Americans hear: "I've been told multiple times that's what I get for (choosing) to live in rural Nevada and that really upsets me, because that isn't the choice I made. I was born in a hospital and I had a hospital my entire life up until two years ago," she said.
Another noteworthy fact in the story: a bipartisan group of congressman have proposed a bill to change Medicare rules to allow emergency and outpatient services without requiring inpatient beds.
To realistically pursue a solution to the problem we need to first understand what’s behind the financial challenges. While the specific problems behind the challenges vary depending on geography, there is a common theme to consider:
Being remote makes everything harder in an already difficult business.
Yes healthcare is more than a business. It’s a mission. It’s essential to life. Still, it must operate like a business from a financial perspective to keep the doors open. It’s been said, “no money, no mission.” Nowhere is that truer than in the healthcare of rural America.
So why does being remote make everything harder?
Technology makes everything easier just about everywhere, right? Not exactly. Key advances in technology are slower to reach rural areas because they aren’t profitable until they become largely commoditized. Secondly, rural populations, by design, are slow to adopt new technology (often for financial reasons) even when they conceivably make life easier. http://hppr.org/post/rural-areas-still-lag-behind-digital-technology-adoption. So how does that translate to healthcare? Slow adoption is a cultural attribute inherent within both the population of a rural community and the part of them providing care. New technology delivers tremendous value to the delivery and management of care. But it also requires investment, which brings us to our next point.
Statistically, rural areas are declining in earnings since 2007. https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/income/. Also, earnings are 25% lower in rural areas compared to urban and suburban areas. Unfortunately, the cost of care doesn’t give rural areas a break because they have a weaker economy. Trends in the cost of care continue to outpace the means to pay them across all communities. The result for rural communities is an amplified negative impact, meaning it’s harder to achieve a healthy P&L.
Rural populations are shrinking, meaning they lose more residents than they add each year. https://www.ers.usda.gov/topics/rural-economy-population/population-migration/. That makes it difficult to attract and retain the right staff. Too often, in lieu of the right people because they simply aren’t there, less qualified people are recruited or positions remain open. This all-too-common scenario amplifies other costs such as temp staffing, efficiency deficiency, training, and overwork of core staff. The impact of staffing challenges has a tremendously negative impact to any rural hospital P&L.
While regulatory efforts are often initiated as a means to protect the people, the people end up suffering anyway. There are so many regulatory requirements in operating a hospital that make the cost burden nearly unbearable. With respect to rural communities, officials in the last few decades have not been sensitive to their unique cultural attributes...those being the aforementioned. Changing requirements like the bipartisan congressional group is attempting to do with legislation is good, but these communities need more meaningful attention from CMS and other payer entities. Fortunately there are organizations like the National Rural Health Association fighting the good fight to help educate our lawmakers while supporting rural providers of care in their operational needs.
Yes, being remote does make everything harder. But you cannot take the remote out of the rural. Can rural Americans survive the crisis of fleeting access to care; this hospital desert? That remains to be seen. Although there are many headwinds for rural healthcare providers, there are advocates like the NRHA and other organizations close to the crisis providing valuable solutions that are proving to work against the unfortunate growth of this hospital desert.
We at MedAssist have the opportunity to work with many rural community healthcare providers. There are some great stories of triumph in the face of certain defeat. One that stands out is Aspen Valley. You can read about their story here.
Authored by Jerry McKenzie, former hospital CEO and current Director of Community Hospital Programs for MedAssist.