Healthcare access disparities for people living in rural America continues to widen. Despite increased awareness about the challenges these communities face, progress has been slow and there are no quick fixes. Patients often have to drive grueling commutes to see physicians and specialists, deterring many from seeking needed medical attention. Moreover, it is increasingly difficult to recruit physicians willing to work in isolated areas across the US. Rural hospitals are also financially vulnerable—80 rural hospitals have closed in the past six years—and if this closure rate continues, more than 25% are predicted to close in less than a decade, creating a potential national crisis.

Concerns are deepening after study findings published in the BMG (formerly the British Medical Journal) last week reveal that a substantial number of Medicare patients, approximately 10,000, die each year within seven days of being released from emergency departments, despite no diagnosis of a life-threatening illness at the time. Hospitals with the lowest admission rates, many of which are located in rural areas, experienced elevated rates of unexpected patient death.

These findings, coupled with an uncertain healthcare policy landscape under a new administration, are creating even more concerns about the fragile state of healthcare in rural America.

Study raises many more questions

The BMJ study findings raise questions that warrant further exploration—among them, concerns about the lack of resources at rural hospitals as well as sparse staffing and limited access to specialist consultations and diagnostic tools. The authors found that federal policies aimed at hospitals to reduce unnecessary emergency department admissions in an effort to cut costs could actually put patients at risk.

The study’s lead author, Dr. Ziad Obermeyer, an emergency medicine physician and professor at Harvard Medical School, told STAT, “There’s no doubt there’s a lot of unnecessary hospital admissions, but this study suggests there’s also avoidable harm from sending people home that shouldn’t go home.” Obermeyer continued, “It doesn’t seem that the deaths are due to random chance. There is something different going on in those low-admission-rate hospitals.”

Healthcare providers and patients in rural areas face different obstacles from their urban counterparts. Access is a big issue and was also discussed by advocates this week in D.C. at the National Rural Health Association’s (NRHA) Rural Policy Institute meeting. Dr. David Schmitz, president of the organization told STAT, “Rural America is facing an access to care crisis. Due to the closure crisis, medical deserts are forming across rural America, where populations are per capita, older, poorer and sicker.”  

With limited access to care proving to be a big issue for these rural communities, could digital health serve as part of a solution?

Supporting rural communities through technology

According to Politico’s coverage of this week’s Rural Health Policy Institute meeting, North Dakota Senator Heidi Heitkamp said that rural providers need to look beyond traditional brick-and-mortar services. That includes telemedicine and different payment models “that recognize admissions to hospitals may not be the ticket to real health care quality in their community.”

It’s evident that rural communities have unique needs and challenges. Technology is becoming more widely recognized as a beneficial tool to reach those who are not as accessible, and thus  more likely to be underserved. The BMJ study authors noted that geographic and socioeconomic factors of rural hospital care could factor into the study outcomes. For example, the authors point out that beneficiaries eligible for Medicaid can access taxi vouchers for follow-up appointments. However, for people in rural areas, transportation options like taxis and rideshares are far less available, making it less likely that a patient would schedule a follow-up appointment.

Telemedicine and other digital health innovations could provide a solution for this problem. Patients could check in with their care provider via video conference or by phone, text or email to determine if a trip back to the clinician’s office or hospital is necessary. Telemedicine is also well-positioned to help patients touch base with clinicians over questions or concerns. Given that many of these individuals face long commutes to the nearest health facility, telemedicine could prove extremely effective and useful. Additionally, patients may be more likely to pursue critical follow-up care or respond to symptoms before they become larger issues if connecting with a care provider is faster and easier.

According to Becker’s Hospital Review, a report by the Institute of Medicine for the National Academies found that “telehealth drives volume, increases quality of care, and reduces costs by reducing readmissions and unnecessary emergency department visits for rural communities. Through telemedicine, rural hospitals can serve rural patients at better costs and help cut down on the time it takes rural patients to receive care, particularly specialty care.”

While telemedicine can help lower the barriers to care access and help improve health outcomes, technology can also play a role in helping the supply issue of rural hospital staffing. Next week, we’ll explore this topic in more detail as we continue our examination of the rural healthcare crisis in America.