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Value of Rural Hospitals Linked to ED Utilization

John Commins, for HealthLeaders Media, June 20, 2012

Lower costs for rural care
The study says cost per Medicare beneficiary is 3.7% lower overall for rural vs. urban beneficiaries, which would represent about $7.2 billion in annual savings if the average cost per urban beneficiary were equal to the average cost per rural beneficiary. Medicare already benefits from $2.2 billion of lower beneficiary costs for care delivered to rural beneficiaries vs. urban.

"When we look at Medicare costs per beneficiary for inpatient outpatient and physician care the cost per beneficiary we see rural costs are 2.7% lower than urban costs," Morrow says. "That doesn't include just the costs incurred in the rural setting. That is cost assigned to the beneficiary. So when the patient goes to Boston for a hip replacement those costs are assigned to his home, not where he had the care."

Access to physicians
In addition, the study found that in rural hospitals physician services payments are 18% lower, and hospital service payments are 2% lower, but outpatient service payments are 14% higher for Medicare beneficiaries. Morrow says that may be due largely to the use of the emergency department for non-emergency care.

"The big issue in rural care that people are stuck on is the access issue," Morrow says. "People talk about there not being any primary care and some of the evidence in our study points to the fact that people go to the rural emergency department during normal daylight business hours at a much higher rate than at all hospitals. We also see the severity level of patients in the rural EDs being lower than that of patients attending any emergency department. That supports the idea that in rural America people use the ED for primary care."

Efficient ED care
Morrow agrees that the ED is an expensive option for non-emergency care. But he says his study found that rural ED patients see a physician 30% faster and spend about 33% less total time in the ED than urban ED patients. In addition, rural ED visits result in less than half the hospital admissions than in other national benchmark reports of all hospitals.

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1 comments on "Value of Rural Hospitals Linked to ED Utilization"


Roger Downey (6/20/2012 at 4:54 PM)
Yes, patients in rural areas treat their local hospital EDs as a primary care destination. The reason those small EDs don't see serious health problems is because residents know they don't have access to specialty care at them. The Copper Queen Community Hospital, a small acute care, critical access facility in Bisbee, Arizona, had that reputation: people knew it could treat the minor ailments, but for serious problems they had to make the 85-mile trip to Tucson. That began to change in late 2009 when the Copper Queen embarked on a telecardiology program. Before that time, patients who presented with cardiac symptoms were flown to Tucson via emergency helicopter where they would undergo evaluation for two or three days. Cost: $10,000 for the helicopter flight and $10,000 for the hospital stay. Once the telecardiology program was in place, patients presenting at the ED were assessed by a Tucson cardiologist via videoconference. Six months after the program began in December 2009, the hospital had dealt with 36 cardiac patients who would all have been flown to Tucson. Because they had telemedicine visits with the Tucson cardiologists, only nine of the 36 were flown there, saving the healthcare system more than $500,000 in transport costs. Most of the other nine were kept for observation in their hometown hospital and released with a heart monitor and/or medication. The telemedicine assessements also saved their relatives the inconvenience of traveling to and from Tucson, meals, lodging costs, etc.