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Value of Rural Hospitals Linked to ED Utilization

John Commins, for HealthLeaders Media, June 20, 2012

"We are able to document that people get seen quickly," he says. "It may cost more, but they get to see a physician faster than if they were in an urban setting and they spend less time in the ED. Maybe the rural ED has figured out how to solve for the lack of primary care access. That may not be a bad thing. It's just different from what everyone else is saying."

Morrow says that the case against ED utilization may be relying too much on data collected at urban hospitals and projected onto every hospital regardless of its size, status, or mission.

"The data we see from large urban areas if you apply it nationally would be a bad thing," he says. "So there is an effort to keep people out of the ED. OK, that may be true but in rural settings it is not such a negative. What is the alternative? Loading up rural America with primary care physicians?"

Morrow says ACO designers would be well served to re-examine the role that rural hospitals play in managing patient population health.

"They have had to do it because they have a more non-transient population base," he says. "If you are an ACO or a mother ship hospital in a suburban setting there is something to be learned from the rural hospital that is your feeder hospital. This generalization that rural hospitals are crap it doesn't play out in the data. They are doing what they do pretty well.


John Commins is a senior editor with HealthLeaders Media.

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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.