A Look at Alternative Models for Rural Hospitals
Rural hospitals are a valuable hub in their communities and provide much-needed care and support to the vulnerable populations they serve. Due to geographical and socioeconomic challenges that many rural communities face, we often see a higher rate of disparities, such as lack of a viable workforce, physician and other healthcare professional shortages, and a predominantly older, sicker population. Rural residents also tend to be poorer, and as a result, are often underinsured with high rates of chronic illnesses.
These issues, teamed with rural hospitals struggle to remain financially viable, perpetuate the struggle of providing quality care and further increase the gap in access to care.
Tennessee has experienced 16 hospital closures, with 13 of those being rural, since 2010 — the second highest rate in the United States. Of the 95 counties that make up the state, 82 percent are rural.
Due to the complex nature of rural communities and the ever evolving nature of healthcare it is important for rural hospitals to explore alternative strategies to help them continue providing care to their communities.
Tennessee Hospital Association, in conjunction with the American Hospital Association Taskforce Report, has focused on strategies to support rural hospitals in developing solutions to ensure they are financially viable and capable of providing care.
Global Budgeting
Global budget payments provide security for financially-strapped facilities by shifting reimbursement for health care services away from volume-based to value-based payments.
The global payment system also gives providers the flexibility to create customized plans that fit the unique needs of their patients, decrease the utilization of non-essential hospital services and increase the utilization of necessary hospital services.
Resources:
- Addressing and Reducing Health Care Cost in States
- Pennsylvania Rural Health Model
- Global Budget Process as an Alternative Payment Model
- Evalution of the Maryland All-Payer Model
- Toward a Global Budget for the U.S. Health System
Emergency Medical Centers
Emergency Medical Centers (EMCs) allow existing facilities to continue providing care on an outpatient basis. EMCs’ presence relieves rural hospitals’ burden of maintaining inpatient beds. This, in turn, allows greater financial viability for the hospital.
Resources:
- Emergency Medical Center
- The Emergency Medical Center Strategy
- Improving Efficiency and Providing Access to Emergency Care in Rural Areas
- Rethinking Rural Hospitals
- A Solution for Rural Acute Care Access
Addressing the Social Determinants of Health
Social determinants are age and environmental conditions in which people are born, live, learn and work that affect quality-of-life outcomes and risks. They often prevent individuals from accessing health care.
Determinants include:
- socioeconomic status
- housing
- literacy
- access to parks and playgrounds
- transportation and
- healthcare provider availability
Addressing these challenges through enhanced clinical-community linkages helps rural residents access healthcare. To provide the best possible care, providers identify social determinants to help craft specific solutions for their communities.
Patient screenings to identify unmet social needs, providing transportation assistance to medical appointments, and developing partnerships between health-based and community-based organizations are all ways that can help ensure quality care.
Resources:
- Social Determinants of Health: Know What Affects Health
- Developing Healthy People 2020
- Health In All Policies
- Social Determinants of Health
- Perspectives on Health Equity and Social Determinants of Health
- Beyond Health Care: The Roles of Social Determinants in Promoting Health and Health Equity
- Transportation and the Role of Hospitals
Inpatient/Outpatient Transformation Strategy
Many hospitals, especially in rural areas, have opted out of providing traditional inpatient services, such as in-house physical therapy services. And as a result, inpatient volume has steadily declined.
The transformation strategy allows hospitals to reduce inpatient capacity to a level that closely reflects the needs of the community and in turn, enhances the outpatient and primary care services they offer.
Resources:
- Rural Health Grants
- Value Based Initiatives for Rural Providers
- Rural Services Integration Toolkit
- Value-Based Strategic Planning Guide
- Critical Access Hospitals
- Re-envisioning Clinical Infrastructure
Urgent Care Centers
Urgent care centers function as medical clinics that are specially equipped to diagnose and treat non-life threatening illnesses and injuries. These centers often have on-site radiology and laboratory services, and operate in a separate location from a freestanding EMC or hospital-based emergency department.
This model allows existing facilities to maintain an access point for urgent medical conditions that can be treated on an outpatient basis.
Resources:
- Urgent Care Centers
- Is the Urgent Care Center the Right Strategy for your Community?
- Urgent Care Association of America
- Using Urgent Care Centers to Support Rural Patient Care Access
Virtual Care Strategies
Virtual care and telehealth give hospitals the ability to maintain providing care, often with immediate 24/7 access to healthcare professionals.
Participating hospitals can perform high-tech monitoring as well, and ultimately, deliver less expensive and more convenient care options.
Resources:
- Telehealth: Delivering the Right Care, at the Right Place, at the Right Time
- Telehealth Services
- Virtual Care Strategies
- Developing a Virtual Health Strategy
Rural Hospital/Health Clinic Strategy
To ensure and expand access, many rural hospitals are building strong partnerships with health clinics, including Federally Qualified Health Centers (FQHCs). These partnerships create integration of care (primary, behavioral and oral health) and allow for economic gain for the hospital and the center.
Resources:
- Effective Collaboration Between Critical Access Hospitals and Federally Qualified Health Centers
- Comparisons of the Rural Health Clinic and Federally Qualified Health Center Programs
- Creating Effective Hospital – Community Partnerships to Build a Culture of Health
- The Role of Small and Rural Hospitals in Effective Population Health Partnerships
- Building Clinical Partnerships
Additional Resources:
- Task Force on Ensuring Access in Vulnerable Communities
- Issues Letter
- Executive Summary
- Rural Chart Pack
- A Compendium of Case Examples
- Issue of Affordability
- Community Conversations Toolkit
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