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Regional health care model crucial for rural areas

For about 60 million Americans—nearly one in five—who live in rural areas, access to health care services is becoming increasingly difficult. Many rural facilities face a growing threat to their very existence as they attempt to deal with challenges presented by their remote locations, declining population, aging facilities, rising chronic diseases, growing workforce shortages and dramatic declines in government payments. And while health care reform is placing significant financial and operational pressures on all health care providers, stand-alone rural hospitals are hit particularly hard.

After World War II, Congress passed the Hill-Burton Act in 1946 to provide grants and loans for construction and modernization of U.S. health facilities. In return, these facilities agreed to provide reasonable services to people unable to pay and to make their services available to residents of their service areas. As a result, rural communities gained ready access to hospital facilities that could provide the health care they needed. These rural hospitals thrived through the 1970s.

However, in recent decades, innovations in fields of specialty care such as cardiology, neurology and orthopedics have shifted care to outpatient facilities and transformed hospitals into large intensive care units. As a result, rural hospital volumes gradually declined as patients sought specialized care not available in their own communities.

With these volume declines came decreasing financial reserves, as well as greater difficulties recruiting and retaining qualified medical staff and funding improvements in equipment, technology and clinical procedures.

With rural hospitals already in a fragile economic state, the Affordable Care Act’s demand for improved health, reduced cost and better patient experiences has put these facilities at great risk, making it nearly impossible to invest in the staff, technology and facility improvements required to meet the health care needs of their communities. As a result, many are left with three choices: closure (seen in our community with Lakeside Memorial Hospital), conversion to a non-hospital outpatient care facility or affiliation with a larger health care system.

At a time of unprecedented consolidation, rural hospital affiliations with larger health care systems help to revitalize rural health care clinically and economically by offering patients the best of both worlds.

First, these affiliations make it possible for rural facilities to provide convenient, in-community access to an expanded range of clinical and specialty services through a combination of on-site clinical staff, shared specialists and technology, satellite offices and use of telemedicine.

Second, when a level of care is needed above what is typically available in a rural community—such as cardiac surgery, neurosurgery and complex critical care—affiliations offer patients immediate and often lifesaving access to highly specialized physicians and clinical services from the larger health system’s tertiary care hub. For patients, this can mean the difference between life and death.

Kate’s story: Kate lives in Wayne County with her young family. Last August, a couple of months after giving birth to her son Elijah, Kate started experiencing chest pains.

While en route to her doctor, Kate lost consciousness. She was driven straight to the Newark-Wayne Community Hospital emergency room, where doctors immediately determined she had suffered a massive heart attack.

Lucky for Kate, NWCH is no longer a small, stand-alone rural hospital. It is a fully integrated Rochester General Health System hospital that happens to be in her community. From the minute she arrived at NWCH, Kate’s care was being managed by a collaborative, world-class team of local emergency physicians and top cardiac specialists from Rochester General Hospital.

Working together using a common electronic patient record and monitoring technology, these specialists rapidly evaluated and stabilized Kate and immediately arranged a Mercy Flight to airlift her to the RGH cardiac cath lab in 11 minutes; there she was diagnosed with a totally closed artery in her heart.

Kate spent an hour in the cath lab, having the lifesaving procedure required to remove the blockage, and then two days in the medical ICU, where she received the state-of-the-art hypothermia protocols to help her brain and body heal—protocols available only in the nation’s top hospitals.

Today Kate is fully recovered and enjoying a very active life. Her happy ending demonstrates the importance and impact of getting health care right for our small communities. By embracing a regional health care model, we can help ensure that rural health care facilities remain a vibrant, trusted and central resource for community residents, while also serving as an immediate gateway to lifesaving, specialized care when needed.

Mark C. Clement is Rochester General Health System’s president and CEO. This is the fifth in a series of articles examining health care reform that began in late 2012.

4/25/14 (c) 2014 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email rbj@rbj.net.


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