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The worrying state of rural medicine

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According to to an article in Becker’s Hospital Reviewa 2020 study from the Center for Healthcare Quality and Payment Reform found that 40% of all rural hospitals were in danger of closing immediately – even before the COVID-19 pandemic added to their woes due to large multi-year financial losses or a heavy reliance on local taxes or government grants. the state.

Almost every state in the United States has at least one rural hospital that is at risk of closing immediately. In 21 states, 25% or more of rural hospitals were at immediate risk, the report said.

More than 130 rural hospitals have closed in the past decade, and more than 600 more rural hospitals – more than 30% of all rural hospitals in the country – are at risk of closing soon. People could be directly injured if these hospitals are nearby.

The crisis of rural hospitals in the United States – six points of concern

  1. Rural hospitals in the United States are at risk.
  2. 600 or more rural hospitals are at risk of closing.
  3. The effect on the health and safety of the people served by these hospitals at risk.
  4. When a rural hospital closes, another has to pick up the overflow. If these are mostly Medicare, Medicaid, or simply uninsured patients, this increases the financial pressure on the other hospital.
  5. Most hospitals, with the exception of very large hospital groups, are poorly managed, lack adequate staff and management technology.
  6. One of the main causes of rural hospital closures is the poor reimbursement of private insurance.

Financing and insurance issues

Payments from private health insurance plans do not cover essential services in rural communities. Larger urban hospitals are seeing much higher reimbursements on patients with private insurance that covers offset debts on uninsured patients and patients with Medicaid. Small rural hospitals do not have this luxury. Many small, rural hospitals are paid less for services by private insurance plans than by Medicare or Medicaid, which state insurance boards should investigate. Hospitals that lose money year after year cannot maintain the adequate capacity needed to respond to emergencies.

Local hospitals have fundraising mechanisms from local tax revenue, grants, or grants from other businesses that help cover the shortfalls. Yet, as costs continue to rise, there is no guarantee that these mechanisms will be adequate.

In the United States, 892 hospitals – more than 40% of all rural hospitals in the country – are at immediate or high risk of closure. According to the report, the more than 300 hospitals at increased risk of closure have either weaker financial reserves or increased reliance on non-patient service revenues, such as local taxes or grants. of State.

Gaps in EHRs and Access to Patient Data

The top priority for most healthcare executives is patient care. This often leads organizations to prioritize direct patient care initiatives over indirect projects. Consequently, finance teams and back-office departments can become an afterthought. Although many organizations have EHRs in place to support their suppliers and other key stakeholders, the financial component is rarely a determining factor in this decision. This is unfortunate, as it leaves critical data trapped in EHR systems. Finance teams lack the tools and technology to do their job.

In general, health officials should partner with vendors and providers with proven industry experience, instead of your GP friend in the area.

During the pandemic, hospitals have received a lifeline in the form of funding from the CARES Act of 2020, with rural providers receiving additional support through the US rescue plan. the Rural Hospital Support Act presented to Congress last year offered additional relief.

Paradoxically, saving rural hospitals will cost less than closing them. Remunerate rural hospitals correctly would increase national health spendingbut only a tiny amount – 1/10 of 1%. Spending would likely increase even more if hospitals were allowed to close due to the greater health problems rural residents would experience if they lost access to adequate preventive care and prompt treatment.

Hospital misfortunes also affect urban hospitals

For example, two months after Wellstar Atlanta Medical Center announcement it would close for good, the hospital closed at midnight on November 11. 1 — his future, and that of the nearby hospitals he leaves behind, remains uncertain.

The closure of the 460-bed hospital has raised concern from local hospital leaders, community members, government officials and health equity officials. According to Atlanta Journal-Constitution, sixty-seven percent of the facility’s emergency room patients were African American. Without this, an important source of care for underserved populations will dissolve, leading to overcrowding in other nearby centers. hospital safety net.

From the medical center farm its emergency department on Oct. 14, leaving nearby Grady Memorial Hospital the only Level 1 trauma center in Atlanta, local emergency response times soared. Neighboring hospitals absorbed former patients from the Wellstar facility, creating a surge that led 80 percent of them to reach the capacity

my catch

This is “good news” for shareholders of large healthcare entities that are dumping “unprofitable” hospitals. There will be millions of people with inadequate health care, thousands of people who will sustain permanent injuries because they cannot receive immediate care for medical emergencies, and some of them will die. Or, on the other hand, when a small hospital closes, large healthcare systems capture patients who have nowhere to go, thereby increasing their revenue. The whole system is perverted.

Pregnant women in rural areas will not receive essential services. Unfortunately, these women will, in too many cases, give birth to children with preventable problems. Caring for these infants after birth may require intensive care and/or lifelong care at enormous cost to our nation — not just financial.

Before a rural hospital closes, a rapid emergency response system should be in place, with ‘relays’ for immediate stabilization and treatment before patients are transferred to hospitals. Pregnant women should receive care from advanced registered nurse practitioners and certified nurse midwives placed in small communities. Home visits should be an essential component of maternity care.

Our country is sending exploratory devices to the far reaches of our solar system and beyond. Amazon can deliver purchased items to mountain villages in Nepal, and telemedicine allows those lucky enough to own computers and pay for internet services to access providers 24/7. Billionaires can do “whoop towers” in space. But the average American living outside of urban areas lacks access to essential health services. Health is a human right, not a privilege. It is an intolerable situation. When will the United States, as a nation, wake up?