A few weeks back, I wrote about a study confirming the obvious: Long ambulance rides increase your risk of death ("The Nearest ED is How Far?"). I wrote that piece based on the premise that patients were still being brought to the nearest emergency department—it’s just that those facilities happen to be farther away in some instances because the number of EDs has decreased by more than 400 during the past 15 years. But what if people in your community were choosing to drive 30 minutes past your hospital's ED to go to a larger hospital up the road? This comment from a hospital employee in Missouri is not the first time that I have heard about patients risking their health to drive themselves to a hospital farther away than their local community hospital:
Wanted: privately insured patients. The article on the nearest emergency department sent my mind in another direction when you mentioned the patient with insurance using the ER when his physician was unavailable. I am employed at a small, rural, Medicare-dependent facility with only 30 beds, and because so much of our patient volume is from Medicare, Medicaid, and uninsured patients, there is a considerable lack of funds here most of the time. The idea of more privately insured patients is one that I wish could be promoted within the community—even through the county commissioners as being part of the importance of attracting new industry to our rural area. These businesses would hopefully be able to afford company insurance for their employees, thereby increasing the percentage of privately insured patients walking through our doors. We are about 35 miles from a larger facility and many patients bypass us when they need a hospital. Some even jump in the car and race to a hospital farther away in the event of a possible heart attack or other life-threatening emergency instead of coming to us or calling an ambulance that would bring them here (as the nearest facility). To them, "bigger is better." But what they don't realize is that the trip itself could kill them.
These next two letters are in response to my column, "Share or Else."
Need specialists? Try telemedicine. Attempting to get appropriate specialty physicians into rural areas has not met with success for a long list of reasons over many decades now. The 21st-century answer to this lies in adopting connectivity via electronic means, namely telemedical interventions up to and including eICU connections between a major center, clinics, practices, and critical-access hospitals.
While the initial system implemented in the early '90s in Georgia failed, the current system, established by our insurance commissioner continues to grow in utilization. This not only provides specialty-directed care in conjunction with the patient's physician, but removes expensive and time-consuming travel from the patient's burdens. Because these expenses are seldom covered by third-party payers, it is seldom mentioned in relation to the cost of healthcare. However, it is a real cost and limits care for rural patients.
Jim Hutchinson, MD
Joint recruiting. Your suggestion of having a joint recruitment effort with a traveling doctor is good. However, finding one who is willing to travel is quite difficult. Six months ago, we and a fellow hospital about 150 miles away shared the expenses of a recruiter whose focus is on our two communities. The advantage of this over using a recruiting firm rests with fear and economics. A recruiting firm knows that they have to sell the doctor to a client ASAP or lose him or her to another search firm. In essence, mentioning "rural" to a candidate looking for a big city or better climate is dangerous to the company’s economic health. Our recruiter does not care and has brought us mostly qualified candidates. While it is still a very tough sell, at least we get to talk to more folks and raise the odds of success.
Jamestown (ND) Hospital
I'd like to thank all the readers for their comments. Addressing workforce shortages and declining reimbursement will continue to challenge hospital executives, so I'd love to hear about what is working at your facility or about the obstacles that your facility is facing. Please e-mail me at firstname.lastname@example.org.