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5 Ways Rural Healthcare Delivery Is Changing

By Doug Bennett, contributor

An alarming number of rural hospital closures over the last decade have triggered significant changes to the traditional “hospital as hub” model for rural healthcare delivery. According to the National Rural Hospital Association, over 90 rural hospitals have closed just since 2010, and one third of rural hospitals are at risk financially.

“Reduced inpatient volumes in rural hospitals—echoing nationwide trends—is more financially stressful for rural hospitals, which typically have more narrow profit margins,” said Margaret Greenwood-Ericksen, MD, MPH, an assistant professor of emergency medicine and health services researcher at the University of New Mexico.

“As a result, rural hospitals are considering new ways to deliver care, such as transforming into micro-hospitals, free standing emergency departments (EDs), or even 24/7 ambulance plus outpatient clinics,” Greenwood-Ericksen explained.

To make matters worse, one-third of the 67 rural hospitals that have closed since 2013 were more than 20 miles away from the next nearest hospital. This increased transit time for emergency services, especially in trauma cases, increases the risk of adverse outcomes and death.

“There is increased appreciation for addressing patient’s social determinants of health (SDOH), particularly transportation,” Greenwood-Ericksen noted. “But addressing SDOH’s can be more challenging in rural areas due to resource constraints and geographic challenges.”

In response to these dilemmas, rural physicians and hospitals are rising to the challenge and changing how they deliver healthcare to the communities they serve.

5 Emerging Trends in Rural Healthcare Delivery

1. Telehealth and telemedicine

Traveling long distances to access healthcare services is more common for rural populations. This often translates into more time spent away from work and greater related expenses. 

To help address these challenges, rural physicians and patients are increasingly relying upon communication technology advances to facilitate healthcare delivery. Patients can now play a more active role in managing their own health by using smart phones or tablets that enable fast, easy and routine transmission of diagnostic data back to physicians. 

In turn, busy physicians and specialists—who might be hundreds or even thousands of miles away—can use mobile devices to save time and reach more patients through virtual visits. Specialists can also provide expert consults to rural physicians who might not have the same equipment or expertise available at their location.

Because specialty practitioners are among those most likely to be impacted when rural hospitals close, 24/7 telemedicine services can literally be a lifeline for some trauma, mental health and substance abuse patients.

2. Consumer health technology

Recent advances in home health technology—including wearable devices such as mobile cardiovascular monitors, blood glucose meters, and GPS-configured inhalers that record when and where asthma attacks occur—enable rural physicians to monitor the health of patients who have chronic diseases without requiring routine long distance travel for the patient, their family or caregivers.

3. Consolidation of services

In small, often tight-knit, rural communities, patients are sometimes reluctant to seek care for issues such as sexual health, pregnancy, substance abuse and mental health. Co-locating primary healthcare services and behavioral health services in the same location can be an effective strategy to help alleviate patient privacy concerns. 

Perhaps one of the most dramatic changes occurring in rural healthcare delivery is the co-location of primary care and behavioral health with traditional emergency departments. 

According to a recent study of emergency department use by Greenwood-Ericksen and Keith Kocher, MD, MPD, “We found increased rural emergency department use, which speaks to the need to simultaneously bolster rural primary care, while identifying ways that rural EDs can serve as a support to primary care. This means rural hospitals will likely need to bring additional resources to rural EDs, such as care coordination and community health workers.” 

One recent policy proposal—the Rural Emergency Medical Center Act of 2018—advocates establishing a new Medicare designation for emergency medical centers that would enable small rural hospitals to maintain emergency and outpatient care without having to provide inpatient services.

4. Physician assistants and nurse practitioners to the rescue

The jobs of physician assistants (PAs) and nurse practitioners (NPs) in rural settings continue to evolve as the shortage of rural physicians grows.

Although 20 percent of Americans live in rural areas, only 11 percent of the nation’s physicians work there. This gap translates into physician assistants and nurse practitioners increasingly being called upon to provide services traditionally delivered by rural physicians.

Increased use of NPs and PAs can also make good financial sense for rural hospitals and practices with smaller personnel budgets.

5. School-based care for rural children

The Health Resources and Services Administration (HRSA) reports that rural communities are increasing access to services for students through programs that link school systems with local healthcare and social service programs. These programs are helping high-risk children and their families who may need assistance overcoming barriers to care, such as transportation or the ability to take time away from work for medical appointments. 

Behavioral health and primary care services that are associated with rural area schools can also enhance access to services for children and teens, especially if there is a concern about privacy in smaller communities. 

Each and every day, rural physicians, advanced practitioners, hospitals and communities across America confront a daunting number of challenges in a rapidly changing healthcare environment. The good news is that these types of new and evolving models of care can offer innovative solutions.

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