A few weeks ago Lee County Hospital Authority ended negotiations with Florida-based startup Americore Health to re-open the county’s only hospital in a rural corner of southwest Virginia. Wellmont Health System had previously shuttered Lee County Regional Medical Center in 2013, citing a lack of patients and declining federal reimbursement for care services. LCRMC’s closure resulted in residents either traveling out-of-state or up to 55 miles to the next-closest Virginia hospital for acute services.
The Lee County Hospital Authority and the broader community’s efforts had intended to stem a growing trend over the last decade - rural hospital closures in America.
As with many trends in healthcare, rural hospital closures have ebbed and flowed. Between 2013 and 2017, the U.S. GAO reported that 64 rural hospitals closed - and that nearly half ceased to offer any type of healthcare services after closing their doors. This number of closures was reported to be more than double that of the previous five-year period.
Contributing factors for rural hospital closures have been widely studied by the GAO, The Henry J. Kaiser Family Foundation, analytics firms, and many others. Most generally cite decreasing patient volumes, unfavorable reimbursement rates, and business decisions related to market competition and unsustainable operating models as driving forces for the current trend.
The impact of rural hospital closures has also been examined - notable findings include reduced access to care, outmigration of healthcare providers from communities, and consumer decisions to delay much-needed preventative and chronic care services (perhaps miscalculating the opportunity cost of missing a day of work for a 30-minute appointment).
An area of this trend that I propose requires more study is the impact on pre-hospital emergency care. Emergency care is part of a community’s safety net of core services, and of equal importance as fire and police services. Without basic emergency medical services, reduced access to life-saving, evidence-based healthcare from paramedical professionals can have a significant impact on the severity of and mortality for acute and chronic conditions.
“Rural hospital closures put a burden on pre-hospital care providers and create increased wait-times for patients seeking access to emergency care. Prolonged transport times to more distant hospitals can also cause a community to be without qualified pre-hospital care providers should another emergency event arise,” reported Marc Wtulich, RN, EMT, former Captain and President of Vernon Township Ambulance Squad and Delegate to the 12th District EMS Council of New Jersey. One of Wtulich’s local rural hospitals had closed in 2012, predicated on similar conditions as outlined in studies cited above.
Likewise, the effectiveness of pre-hospital care transformation interventions in response to this trend warrant study, curation, and a national dialog on methods to enable spread. Some tactics that have been promoted or implemented include:
- Public investment in more robust ambulance services. After Mercy Hospital closed in 2015, the city of Independence, Kansas purchased two additional ambulances and hired more EMS personnel. The city of Fulton, Kentucky responded similarly after the closure of Parkway Regional Hospital that same year by supplementing emergency services with city and county funds.
- Opening and operating “Primary Health Centers” to shift focus towards outpatient and transitional care services. This model has been championed by the Kansas Hospital Association but would require licensure and reimbursement changes in order to become a viable option. KHA’s proposed model includes 24 hour-per-day, 7 day-per-week centers which would likely be equipped to handle common medical emergencies.
- Utilization of drone technology to supplement transportation of lifesaving equipment, medicines, and telemedicine capabilities to emergency scenes. According to Michael Van Poots, PhD, NRP, vice president of Harrisonburg Rescue Squad, Inc., in Harrisonburg, Virginia, “When a provider utilizes drones in EMS, improvements in response time, medical sample transport time, traditional aeromedical barriers, and access to emergency care are demonstrated. Advances in drone technology, improved reliability, and proliferation have made drones worth considering in EMS.”
- Expanding use of telemedicine in pre-hospital care delivery. There have been several anecdotal success stories of EMS utilizing virtual health to reduce unnecessary transports. Theoretically, a “treat and street” care model delivered by EMS personnel would reduce the amount of time these resources are tied up in non-emergent trips.
Read more:
The Commonwealth Fund (2017). The Impact of the ACA’s Medicaid Expansion on Hospitals’ Uncompensated Care Burden and the Potential Effects of Repeal. Retrieved from: https://www.commonwealthfund.org/publications/issue-briefs/2017/may/impact-acas-medicaid-expansion-hospitals-uncompensated-care
The Henry J. Kaiser Family Foundation (2016). A Look at Rural Hospital Closures and Implications for Access to Care: Three Case Studies. Retrieved from: https://www.kff.org/medicaid/issue-brief/a-look-at-rural-hospital-closures-and-implications-for-access-to-care/
iVantage Health Analytics (2016). Rural Relevance: Vulnerability to Value. Retrieved from: https://www.chartis.com/resources/files/INDEX_2016_Rural_Relevance_Study_FINAL_Formatted_02_08_16.pdf
relyMD (2017). EMS Telemedicine, An Aid for Rural Areas Impacted by Hospital Closures [blog]. Retrieved from: https://relymd.com/blog-ems-telemedicine-an-aid-for-rural-areas-impacted-by-hospital-closures/
U.S. Government Accountability Office (2018). Rural Hospital Closures: Number and Characteristics of Affected Hospitals and Contributing Factors. Retrieved from: https://www.gao.gov/products/GAO-18-634
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