Rural hospitals: The forgotten frontier needs advocates for a better model

Access to healthcare services is critical to good health, yet rural residents often encounter barriers to healthcare that limit their ability to obtain the care they need.

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

Furthermore, many rural areas also lack the support of subspecialists, hospitalists or emergency physicians.

Adding to the challenges, rural hospitals are also struggling financially in the face of expired COVID-19 subsidies and declining reimbursements: Half of rural hospitals lost money in the past year, up from 43% the previous year, and 418 rural hospitals have been labeled 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 in need of 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-budget operations that lack the resources to gain attention and invest in infrastructure, IT and hiring. Despite taking care of a large portion of the U.S. population, rural hospitals are part of the “flyover zone” that gets overlooked unless a major event occurs. Sixty million Americans live in rural settings – that is one-fifth of the country’s population.

Because the rural population is typically older, many have health issues, which means a large percentage of the U.S. healthcare needs are in this population. The care at these smaller, independent hospitals tends to be more personalized and patient oriented.

The issue is that rural hospitals lack strong advocates. Physicians could potentially step up, but professional associations and hospital associations aren’t effectively advocating for them. However, as interoperability progresses, rural hospitals will gain more visibility since they’ll need to share patient data with larger health systems. This may make them part of the broader healthcare conversation.

If any group is positioned to be the best advocate, it would likely be the federal government through entities like the ONC that are pushing for widespread health data exchange and interoperability. The typical healthcare organizations are unlikely to fill that advocacy role for rural hospitals.

Q. Please discuss this “better model” you see needed to effect change in rural hospitals.

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

These hospitals are increasingly being incorporated into larger health systems. And when that happens, specialty care starts to get harder to reach because those patients will be transported to the mother ship to be treated. What does that do?

Well, if you have a small hospital and a general surgeon who wants to practice medicine in that smaller hospital, they won’t be able to because the caseload is going to be so low because patients are shipped out to another facility.

So, as system consolidation occurs, rural hospitals start to disappear because they are converted into a triage station where a patient comes in, stays for two days, and then is transported somewhere else to be cared for.

Rural hospitals face challenges in staffing, particularly with nurses. They struggle to hire and retain staff nurses due to competition from high-paying travel nursing agencies. Rural facilities also have limited budgets for health IT, impacting the functionality and innovation they can access.

While some EHR vendors focus on the small to midsize hospital market, their R&D is constrained compared to the investments made by larger players like Epic.

Rural hospitals often rely on getting access to scaled-down versions of systems like Epic from larger health systems. However, this provides reduced functionality and little customization to fit their specific needs.

Most of their minimal IT budgets go toward personnel rather than robust health 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 for rural organizations.

Can technology help? Yes, in a number of ways. If interoperability is now accessible to all these rural settings, they’re going to have a complete picture of the medical record. Also, telehealth is not just from a provider to a patient, it can be from a provider to a specialist.

So, technology can be applied at the rural setting to allow access to that specialist. There’s also technology available that monitors critically ill patients at a distance.

Q. You support initiatives that make health IT more readily available and affordable for rural hospitals. Please elaborate.

A. While EHR adoption is saturated, rural hospitals need ways to be more efficient with limited resources. Adding functionality to existing systems that directly improves efficiency can provide a strong ROI and benefit their bottom line.

For example, if a hospital implemented technology that could help reduce ICU nurses’ workload by 50%, it would allow the nurses to spend more time delivering quality patient care.

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

Q. On a related note, you say it’s critical to give clinicians technology that is easy to use, implement, and train, and gives doctors and nurses more time to deliver high-quality patient care. How can rural hospital IT leaders make sure this happens?

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

To address this, IT leaders at rural hospitals need to speak up and push EHR vendors, both large and small, to provide technology that is easy to use and drives efficiency. They need to vocally identify inefficient workflows and demand better solutions. Rural hospitals are getting ignored and taken advantage of from an IT perspective.

Emerging technologies like ambient listening and AI tools can help, but they come with added costs that are challenging for rural hospitals to absorb, especially if they don’t demonstrably improve efficiency at the point of care. Unless new tech saves clinicians time, it risks making the problem worse.

Ultimately, end users and hospital leaders need to advocate for themselves, demanding IT that supports their unique needs and calling out 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 enables them to thrive and provide the best possible care for their communities.

Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him: [email protected]
Healthcare IT News is a HIMSS Media publication.

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