In the US, rural emergency hospitals are beginning to establish a tiny presence.
A new kind of hospital is gradually gaining traction, particularly in the Southeast, whereas rural hospitals still face financial difficulties.
Rural emergency hospitals close all of their inpatient beds and offer round-the-clock emergency care in exchange for more than $3 million in government funds annually and better Medicare reimbursements. Although it makes it simpler for a hospital to remain open, experts claim that it doesn’t address every issue that arises in rural health care.
For the treatment of conditions like pneumonia or COVID-19 that necessitate hospital stays, people may have to go further. Residents in some of the towns whose hospitals have changed to the new name are unsure of the services they may access. Furthermore, rural hospitals are reluctant to make the switch because there’s no margin of error.
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Rural Emergency Hospital
Carrie Cochran-McClain, chief policy officer of the National Rural Health Association, called it “ironic” that the facilities that would require the greatest assistance cannot afford to take the chance. She brought up the necessity of giving up some perks and services, including a federal prescription drug savings program.
In January 2023, the government, which has a hospital classification system based on type, launched the rural emergency option. As of last year, according to the Sheps Center for Health Services Research at the University of North Carolina, just 19 hospitals nationwide were classified as rural emergency hospitals.
Hospitals in Nebraska and Florida have lately begun to investigate the option, and the bulk are in the South, with a small number in the Midwest.
The designation is aimed at a very specific population, said George Pink, deputy director of the Sheps Center’s Rural Health Research Program, and that’s rural hospitals on the brink of closure with few people getting inpatient care already.
Saving rural care
That was the case for Irwin County Hospital in Ocilla, Georgia, which was the second rural emergency hospital established in the U.S.
Weeks prior to converting, the hospital received at least $1 million in credit from the county so it could pay employees—money that county board of supervisors chairman Scott Carver doubted he’d see returned.
“We operate on a $6 million budget for the county, so to extend that kind of line of credit was dangerous on our part to some degree,” he said. “But… we felt like we had to try.”
Irwin County Hospital became a rural emergency hospital on Feb. 1, 2023. Quentin Whitwell, the hospital’s CEO, said it was an ideal candidate.
“We’re still finding out what some of the impacts are, given that it’s a new thing,” said Whitwell, who, through his company Progressive Health Systems, owns and manages six hospitals in the Southeast, most of which are rural emergency hospitals or have applied for the designation. “But the change to a rural emergency hospital has transformed this hospital.”
A combination of state programs and tax credits, plus the new designation, means the hospital has $4 million in the bank, Carver said. Simply put, the work was worth it to him.
Traci Harper, a longtime Ocilla resident, isn’t so sure. About a year ago, she rushed her son to the hospital for emergency care for spinal meningitis.
Because the new designation requires the hospital to transfer patients to larger hospitals within 24 hours, Harper’s son was sent to another in-state facility, and three days later he ended up getting the care he needed in a hospital in Jacksonville, Florida.
“That’s two hours away,” she said. “The whole time, I could have taken him there myself, but nobody told me that.”
‘Barely surviving’
Nebraska’s first rural emergency hospital opened in February in a city called Friend.
Warren Memorial Hospital had reached a breaking point: federal pandemic relief money had dried up. The city, which owns the hospital, had to start extending lines of credit so hospital employees could get paid. A major street repair project was even delayed, said Jared Chaffin, the hospital’s chief financial officer and one of three co-CEOs.
“Back in the summer, we were barely surviving,” said Amy Thimm, the hospital’s vice president of clinical services and quality and co-CEO.
Though residents expressed concerns at a September town hall about closing inpatient services, the importance of having emergency care outweighed other worries.
“We have farmers and ranchers and people who don’t have the time to drive an hour to get care, so they’ll just go without,” said Ron Te Brink, co-CEO and chief information officer. “Rural health care is so extremely important to a lot of Nebraska communities like ours.”
The first federal payment, about $270,000, arrived on March 5. Chaffin projects the hospital’s revenue will be $6 million this year—more than it’s ever made.
“That’s just insane, especially for our little hospital here,” he said. “We still have Mount Everest to climb, and we still have so much work ahead of us. The designation alone is not a savior for the hospital; it’s a lifeline.”
Rural troubles
Alliance Healthcare System, another of Whitwell’s hospitals and the fourth facility in the nation to convert, has found it challenging to hang onto that lifeline.
The Centers for Medicare and Medicaid Services reversed their judgment a few months after they were granted approval to operate as a rural emergency hospital in March 2023.
Less than an hour’s drive from Memphis means the hospital is not considered rural, according to government officials, as hospital CEO Dr. Kenneth Williams told The Associated Press. According to a CMS spokesman, the building was “inadvertently certified.”
Williams stated that although the hospital has until April to return to full operation, many members of the mostly retired town think it has already closed. The number of patients is at a record low. Williams is skeptical about the hospital’s survival in the event that federal funding ceases.
He stated, “Something had to be done because we might have been shuttered if we hadn’t become a rural emergency hospital. Do I feel bad about all the problems we’ve had that other hospitals haven’t had, for whatever reason? I’m not sure.
Despite the fact that Alliance seems to be among the few establishments that the conversion to a rural emergency hospital has badly affected, Pink stated that it is too soon to determine if the federal designation has been successful.
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