The Urban Migration
Rural hospitals have always faced their own unique challenges, including restricted access to capital, limited service lines, and difficulties attracting staff. And there may be more on the horizon that's cause for concern.
According to the American Hospital Association, of the 54 million people served by rural hospitals, 9 million are Medicare beneficiaries. It’s a fact that will be paramount in coming months as Medicare cuts loom.
Add into that the growing need to become more technologically sophisticated to support patient expectations (along with mandates) for electronic health records, in addition to a growing demand for telemedicine.
But even as rural facilities work to either stand their ground or consider affiliations/consolidations with larger providers, what if the patients have already made up their minds? What if the critical access hospital a mile from their house isn’t as attractive to them as the modern, technologically advanced mega-hospital just an hour’s drive away?
A recent study from the BlueCross BlueShield of Tennessee Health Institute, "Patterns of Care in Tennessee," sheds light on this being a very real scenario.
The institute set out to examine patterns of patient care in the state, specifically looking at where Tennesseans were going for medical care—diving in with the assumption that geographic proximity would be a significant influence on that choice.
However, as it turns out, the researchers were wrong.
Study results show that rural community members on average willingly traveled 22.6 miles farther away than their closest healthcare facility, with 43.4% of 20,536 people making that choice to migrate.
So what does it mean? The study says a few things:
- Distance is no longer the barrier it used to be when many rural facilities were originally built. In the case of an emergency, for example, a helicopter can take a patient to a more urban locale within minutes.
- As healthcare becomes more reliant on sophisticated technology, the even playing field that once existed between rural and urban facilities is beginning to shift. Rural hospitals don’t have the capital to make the large IT investments that urban hospitals can.
- Larger hospitals are able to take on more patients because they have beds already on a fixed-cost base, so accepting referrals only results in limited staffing costs.
Of course, this is just a snapshot of what’s happening in Tennessee. But certainly facts here ring true for rural facilities across the country.
As healthcare designers, it’s imperative to acknowledge the issues rural facilities are facing and to either join them in making their facilities places where local patients want to be, or be instrumental in successfully assimilating them under a new affiliation, establishing new brands while preserving local identities.
We’ll be exploring the challenges and celebrating the accomplishments of rural healthcare facilities in our October issue of HEALTHCARE DESIGN, including an article on the pros, cons, and design/construction ramifications of affiliations and mergers, and our Showcase feature on a new addition at Community Hospital in McCook, Nebraska.
In the meantime, use the comments section below to share your thoughts and insights on the challenges facing rural hospitals and, subsequently, the future of their facilities.