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Urban hospitals are seeing increases in Medicare rural patient admissions

As poor financial health forces hospitals to close in rural areas across the country, the remaining rural hospitals are experiencing a decline in patient admissions. New research shows that this is not because fewer patients are looking for emergency services. In contrast, these patients are more likely to be admitted to hospitals in urban areas, even if there is a hospital closer.

New findings from the UNC Gillings School of Global Public Health suggest that Medicare patients may overlook rural hospitals and travel longer distances to seek care in urban hospitals.

“There are a number of different factors that influence where someone goes to receive treatment, such as proximity, referral from a primary care provider, and differences in cost and quality of care between hospitals,” Hannah said. Friedman, a doctoral student in health policy and management, who is the lead author of a study recently published in Health Services Research. “Proximity may be offset by other considerations that drive people to seek more distant care, which could be contributing to the declining volume of the rural hospital that could eventually lead to closures.”

In the study, Friedman and Mark Holmes, PhD, professor of health policy and management and director of the Cecil D. Sheps Center for Health Services Research, examined hospital admission and service rate (FFS) data of Medicare between 2010 and 2018 to determine what kind of impact rural hospital availability had on revenue.

They found that rural areas experienced a 2% annual increase in Medicare patient admissions to urban hospitals by zip code. This equates to an estimated 16% increase over an eight-year period.

Although urban hospitals admitted more patients even though there was a rural hospital nearby, rural hospital closures also increased the likelihood of admission to an urban hospital. In addition, admissions to urban hospitals increased although the nearest rural hospital was incorporated into a larger health care system.

These results were consistent across the continent of the United States. Although rural hospital closures are more prominent in the southeast, the results suggest that patient priorities and referral patterns are changing or that rural hospitals across the country may be unable to meet all the needs of patients. Medicare patients in their communities.

Decreased admission rates will inevitably lead to more hospital closures, a worrying trend that indicates the need for rural hospitals to adapt to changes in patient care research behaviors.

“This trend may not be sustainable for hospitals that depend on pay-per-service models that depend on the volume of patients, especially hospitals that are already experiencing financial challenges. Some patients, such as those with complex conditions, probably should not “to be treated in critically ill hospitals due to the lack of facilities or specialists available to treat them. More can be done to make it easier for people to access this type of care,” Friedman explained. “Larger hospitals often have more resources to devote to quality improvement initiatives and other programs that can influence patients’ health outcomes.”

“Rural hospitals can provide high-quality health care,” he continued. “From an equity perspective, we want to ensure that people who go to rural hospitals have similar results to those who go further. For those who have to visit the nearest hospital due to cost-sensitive medical needs or at the same time, hospital closures can lead to reduced access and worse health outcomes. ”

Friedman suggested several ways to approach access issues. Independent emergency departments (EDs) can provide emergency care for weather-sensitive conditions without having any affiliation with a hospital. Similarly, the Centers for Medicare and Medicaid Services (CMS) authorized the creation of rural emergency hospitals (REHs), which provide emergency care 24 hours a day but not hospital care. Although CMS is still finalizing the rule for setting up REH, it says some hospitals may start to become REH instead of closing, which could preserve access to health care despite the loss of services. of hospitalization.

The research team aims to continue studying ways to ensure broad access to high-quality health care that meets the needs of communities. This will involve investigating factors that make patients more or less likely to overlook their nearest hospital and evaluating alternatives to hospitals such as the US or autonomous REHs.

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