Rural Hospitals: The Forgotten Frontier Needs Advocates for a Better Model

Access to health care services is critical to good health, but rural residents often face barriers to health care that limit their ability to get the care they need.

Similarly, providers who also operate in rural areas face unique challenges. Consider that about 20% of Americans live in rural areas, but barely a tenth of physicians practice there—and a shortage of 20,000 primary care physicians is predicted in rural areas by 2025.

In addition, many rural areas lack the support of subspecialists, hospital physicians, or emergency physicians.

Adding to the challenges are rural hospitals is also having financial difficulties in light of expired COVID-19 subsidies and declining reimbursements: half of rural hospitals lost money in the past year, up from 43% the year before, and 418 rural hospitals have been identified as vulnerable to closure.

We interviewed Dr. Jay Anders, Chief Medical Officer at Medicomp Systems, who also hosts a show on HealthcareNOW Radio, to discuss why he believes rural hospitals are the forgotten frontier and need advocates for a better model.

Q. Why do you think rural hospitals are the forgotten frontier? Who do you see as the best advocates who need to step up?

A. Rural hospitals are often forgotten because they are small-scale operations that lack the resources to attract attention and invest in infrastructure, IT and staffing. Despite caring for a large portion of the U.S. population, rural hospitals are part of the “flyover zone” that is overlooked unless a major event occurs. Sixty million Americans live in rural areas – that’s one-fifth of the country’s population.

Because rural populations tend to be older, many have health problems, meaning a large percentage of America’s health care needs lie in this population. The care in these smaller, independent hospitals is usually more personal and patient-oriented.

The problem is that rural hospitals don’t have strong advocates. Doctors could possibly go a step further, but professional associations and hospital associations do not advocate this effectively. However, As interoperability advances, rural hospitals will gain greater visibility as they will need to share patient data with larger healthcare systems. This can make them part of the broader healthcare conversation.

If any group is positioned to be the best advocate, it is likely the federal government, through entities like the ONC, which is pushing for widespread health data sharing and interoperability. Typical healthcare organizations are unlikely to fill that role as an advocate for rural hospitals.

Q. Please discuss this “better model” you believe is needed to bring about change in rural hospitals.

A. A better model for rural hospitals involves leveraging newer, cloud-based technologies to access specialty care and ancillary services, even with limited budgets. With family close by, rural hospitals can focus on getting patients healthy enough to return home, which benefits patient psychology and outcomes. The telehealth capabilities developed during the pandemic may be especially valuable in rural settings.

These hospitals are increasingly being incorporated into larger healthcare systems. And when that happens, specialty care becomes harder to achieve as those patients are transported to the mother ship for treatment. What does that do?

If you have a small hospital and a general surgeon who wants to practice medicine in that smaller hospital, that’s not going to be possible because the workload is going to be so low because patients are being transferred to another facility.

As system consolidation occurs, rural hospitals are beginning to disappear as they are converted into a triage station where a patient comes in, stays for two days, and then is transported to another location to be cared for.

Rural hospitals face staffing challenges, especially when it comes to nurses. They struggle to hire and retain nurses due to competition from high-paying travel nursing agencies. Rural facilities also have limited healthcare IT budgets, impacting the functionality and innovation they have access to.

While some EHR vendors focus on the small to medium hospital market, their R&D is limited compared to the investments of larger players like Epic.

Rural hospitals often rely on access to smaller versions of systems like Epic from larger healthcare systems. However, this offers reduced functionality and little customization to meet their specific needs.

Most of their minimum IT budgets go toward staffing rather than robust healthcare IT capabilities. To help address this, government funding programs, similar to the Meaningful Use incentives, could be developed to make interoperability and other technologies more accessible and affordable to rural organizations.

Can technology help? Yes, in some ways. If interoperability is now accessible to all these rural environments, they will have a complete view of the medical record. Moreover, telehealth not only goes from a provider to a patient, but also from a provider to a specialist.

So technology can be applied in rural areas to enable access to that specialist. There is also technology available that remotely monitors seriously ill patients.

Q. You support initiatives that make healthcare IT more available and affordable for rural hospitals. Please provide some more information.

A. As EHR adoption reaches saturation, rural hospitals need ways to be more efficient with limited resources. Adding functionality to existing systems that immediately improves efficiency can deliver strong ROI and boost the bottom line.

For example, if a hospital were to implement technology that could reduce the workload of ICU nurses by 50%, nurses could spend more time delivering high-quality patient care.

The key is that rural hospitals need affordable access to these technologies. Ripping and replacing systems is not feasible, but adding functionality to increase efficiency and improve care delivery by providing quality data for decision making is a realistic approach. Technologies that exist on top of existing ones EHRs to streamline workflows and surface key insights can make a meaningful difference.

Q. Relatedly, you say it’s critical to give physicians technology that is easy to use, deploy and train, and that frees up doctors and nurses to deliver high-quality patient care. How can IT leaders at rural hospitals ensure this happens?

A. Rural hospitals often rely on off-the-shelf versions of complex EHR systems designed for large medical centers. These systems are difficult to use, implement and train, especially without the dedicated support staff that larger organizations have. The workflows are not optimized for rural environments, leading to inefficiencies.

To address this, IT leaders in hospitals nationwide must make their voices heard and push EHR vendors, both large and small, to deliver technology that is easy to use and drives efficiency. They must clearly identify inefficient workflows and demand better solutions. Rural hospitals are ignored and exploited from an IT perspective.

Emerging technologies such as ambient listening and AI tools can help, but come with additional costs that are challenging for rural hospitals to absorb, especially if they do not demonstrably improve efficiency at the point of care. Unless new technology saves doctors time, there is a risk the problem will worsen.

Ultimately, end users and hospital leaders must stand up for themselves, demand IT that supports their unique needs, and sound the alarm when systems fall short. Technology has the potential to be a game changer, but not if rural hospitals remain an afterthought. They deserve IT that helps them thrive and provide the best possible care for their communities.

Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
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