So there’s good news and bad as I read the above article.
Good news: at least the feds are trying to think of a way to keep rural hospitals afloat.
Bad news: for all that I applaud an attempt to reduce cost and give flexibility, the problem these days is not just having a place for patients to be seen for emergencies. It’s having a place to admit them, or transfer them, when serious illness or injury occur.
Even before COVID and certainly during and since, small rural hospitals face some monumental challenges.
Their patient populations tend to lack primary care and have high baseline levels of illness, often untreated. They also tend to be complicated by high levels of mental illness and substance abuse. In addition, people are using emergency departments more than ever right now, urban and rural, and the sicker are sicker than ever in my recollection.
Their rural location and small size means that specialists are unlikely to be in the community, so complicated patients in need of higher levels of complex care have to be transferred.
Their rural location, coupled with weather and EMS shortages mean that transferring those patients is often next to impossible if only from a logistical standpoint.
The regional referral centers, the places patients would be sent from rural hospitals for more advanced care, are themselves completely full and typically not accepting transfers at all except for a few special situations which I have listed before: peds, OB, trauma, heart attack and stroke.
The above being true, very sick patients will be stuck in the Rural Emergency Hospital with emergency physicians trying to manage complex illness and injuries for hours to days without help. Holding patients in this manner has been shown to be unsafe. Without question it will lead to bad outcomes and lawsuits.
Many physicians, even very seasoned physicians, are becoming uncomfortable working in small, rural places. When transfers or admissions were possible it was challenging. Now that transfers or admissions are much less likely to happen (and patients sicker) these sorts of hospitals are soul-crushing and terrifying places to work, no matter how passionate the staff.
So in summary, nice idea but not likely to alleviate the current crisis.
Back to the drawing board?
Edwin
Rural Emergency Hospital Concept Won't Help
I was squawking about this before COViD. For years the regional hospitals would send representatives out to the smaller rural hospitals saying “send us your more challenging patients “. As small rural hospitals could not keep up with updating equipment and services due to their lack of funds, they closed more services and became “critical access hospitals “, which I have heard referred to as “pack and ships”. Now our system is in dire straits because there (as predicted 35 years ago) are not enough resources, and here we are...
Ed Leap for Surgeon General!