Understanding Why Rural Health is in Trouble: Part II

Understanding Why Rural Health is in Trouble: Part II

A day in the life of a critical access hospital illuminates the various issues such facilities currently face.

EDITOR’S NOTE: This is the second installment in a three-part series about the daunting challenges currently faced by rural healthcare providers.

Rural hospitals are closing and reducing services at an alarming rate. In the first article of this series, some of the closure statistics were presented, along with additional information.

The challenges faced by all hospitals, but especially rural hospitals, are multifactorial – and not just financial in nature, but often due to lack of adequate reimbursement for services provided and egregious denial rates from commercial payors. One key factor is also staffing, nursing, and professional services shortages.

But the reasons go beyond staffing and reimbursement services. Some of the other challenges include the following:

  • Difficulty in finding a physician, especially specialists such as those in cardiology, neurology, orthopedics, ophthalmology, and more;
  • The need to transfer patients to higher levels of care for some of the above-mentioned specialties, reducing census numbers and the need to board these patients until a bed is available;
  • Poor patient disease management and non-compliance that may be associated with low health literacy and perceptions of health – issues related to the Social Determinants of Health (SDoH);
  • Inability to adequately respond to major trauma, except to stabilize for transfer to a higher level of care, and the availability the services to transfer;
  • Frequent readmissions; and
  • Lack of patient resources in rural areas.

Most of these will be covered in greater detail in Part III of this series.

We all are fairly well aware of what goes on in urban hospitals, but to totally understand what goes on daily in these rural hospitals requires realizing their challenges, especially with staffing. In addition, for critical access hospitals (CAHs) and Medicare patients, the average length of stay (LOS) may not be greater than 96 hours. Here is a rundown of those daily activities, specific to a three-day period in a CAH.

  • Emergency Department – over a three-day period it averaged 12-17 patients each night, up until the early morning hours, with many of these patients being quite complex.
    • Some of those patients are boarders waiting for transfer to the proper floor or to a higher level of care (keep in mind that even though they are boarders, they must still receive care);
    • Some patients in need of critical care are just dropped off in the ED lobby;
    • Cardiac workup, hypoglycemic workup;
    • STEMI requiring intubation;
    • Social admits resulting from patients being unsafe for discharge, all the way to patients or families not wanting to leave;
    • Need for hospice care; and
    • Patient boarding with meningitis, falls – there is not enough staff to transfer them to the medical-surgical unit.
  • OB – most of these hospitals do have OB units; otherwise, patients might need to travel 25-50 miles to deliver their babies.
    • There is still need for transfer for babies requiring NICU;
    • Generally, the hospital is aware of how many expectant mothers are due, but that is only if the mothers sought pre-natal care; and
    • Need for inductions.
  • Medical-Surgical Units – since CAHs have a maximum census ability of 25, when the census is full, it results in boarders and the need for prompt discharges.
    • This does occur in urban hospitals also; it is not unique to CAHs;
    • Need for extra nurses to care for boarders in the ED if not enough discharges;
    • May need to care for critically ill patients waiting for transfer to higher level of care;
    • High number of patients detoxing from alcohol abuse;
    • Post-op patients, if appropriate surgeons are available, routine surgeries are taking place; and
    • Delays in specialty consults like cardiology and neurology that do not arrive timely from outlying hospitals or are only available certain days of the week, almost never on weekends.

As you can see, the challenges that rural hospitals face daily eventually can and do affect their survival in our ever-changing healthcare environment. This is why such hospitals are so necessary for the healthcare of their regions, and their presence must be preserved.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

John Zelem, MD, FACS

John Zelem, MD, is principal owner and chief executive officer of Streamline Solutions Consulting, Inc. providing technology-enabled, expert physician advisor services. A board-certified general surgeon with more than 26 years of clinical experience, Dr. Zelem managed quality assessment and improvement as a former executive medical director in the past. He developed expertise in compliance, contracts and regulations, utilization review, case management, client relations, physician advisor programs, and physician education. Dr. Zelem is a member of the RACmonitor editorial board.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →