Coulter suggests that many rural hospitals could convert into emergency stabilization centers. "Instead of having inpatient beds, put in a cath unit in, put in a trauma unit. Have a trauma surgeon and a cardiologist in the house or on call 24 hours a day," he says.
"My bias is that many of these facilities could be converted to much more effective facilities for not really a whole heck of a lot of money."
The Affordable Care Act will place a renewed emphasis, and money, on chronic care treatment. Coulter believes that rural hospitals are a perfect source point. Instead of traveling longer distances for their more-frequent chronic care consultations, patients could drive to the hospital down the street.
"The emphasis is going to come particularly through the (Accountable Care Organization) concept. It's going to come from the perspective of case management," Coulter says. "There is finally some literature coming out showing that intensive case management really does prolong life. It is not necessarily cheaper in the aggregate, but it does improve quality of life."
This change in care models and emphases for rural hospitals will likely accelerate the consolidations that the sector has seen over the past five or six years. "We are going to see a lot of CHS and HCA and Tenet-type organizations are going to take over these small hospitals and they are going to figure out what the most profitable means to make the viable," Coulter says. "Then you have to ask is the most profitable the right thing to do?"