Potential remedies for stubborn problems in rural health care

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Part 5 of a special report

The concept is not really new.

Stand-alone emergency rooms – affiliated with but not physically linked to hospitals – have emerged in many areas, typically in suburban or urban areas where large numbers of local residents have private insurance. They provide emergency medical services outside of a regular hospital.

Now federal health officials are making plans for something similar, but within a different framework.

Southwest Georgia Regional Medical Center in Cuthbert

“Rural emergency hospitals” are part of a bipartisan proposal that would replace full-service medical facilities in rural areas with stand-alone emergencies.

An REH would be managed independently, with an emergency service and, perhaps in some cases, some outpatient services. Federal health programs would pay more than standard Medicare rates for services at such a facility.

This is the basic idea that officials at Cuthbert and Richland are considering to replace their closed Georgian hospitals.

It is not clear from the proposal whether an already closed hospital could be converted to a REH. Yet it is an interesting potential remedy for rural communities struggling to preserve health care.

Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, said the rural emergency hospitals initiative “is a priority to be implemented.”

More insurance coverage

Other ideas – many of which have been put into practice – have been promoted to strengthen rural health care.

Most importantly, the 12 states that have long refused to extend Medicaid under the Affordable Care Act agree to do so. Most of these states are in the south, and Georgia is one of them. In that state, the expansion would mean up to 500,000 low-income uninsured adults would receive coverage under the federal-state program. Georgia has the third highest uninsured rate in the United States

States that have not extended Medicaid are shown in orange. Source: Kaiser Family Foundation

Dozens of people associated with rural health care told GHN that expanding Medicaid would be of great help in Georgia. They say it would mean more compensation for providers whose patients do not have health insurance or other means to pay. But Republican leaders in Georgia, citing the costs, rejected the expansion.

In Congress, an alternative to expansion has surfaced in the Democrats’ social spending bill. It would target low-income people in the 12 non-expanding states who don’t qualify for regular Medicaid but don’t earn enough to get discounts on the coverage they buy on the health insurance exchange. Under the plan, these people would be entitled to these discounts for four years, starting in January.

The fate of the bill in Congress is unclear.

Address supplier gaps

Among the other recommended steps:

Attract those who are likely to stay: Katie Metts, a nurse in a small town in Florida, is now considering becoming a doctor. She began her medical studies on the campus of the Philadelphia College of Osteopathic Medicine (PCOM) in Moultrie. When working as a nurse practitioner in Jacksonville, she said, “Sometimes we had patients from South Georgia. They would have complex illnesses. Often their results were not good. I wondered if they had good access to health care. ”

PCOM Campus in Moultrie

PCOM, with the new Moultrie campus, is targeting Southwest Georgia students in admissions, as well as those with connections to the area and those interested in practicing in underserved areas.

In an effort to bolster the state’s medical workforce, Macon’s Mercer University School of Medicine is only accepting Georgia residents as applicants. “We started to focus primarily on people from rural areas. Our hope is that they understand the need, ” said Dr Jean Sumner, Dean of the school.

One of Mercer’s recent graduates, Dr Justin Peterson, an obstetrician / gynecologist in Douglas, Coffee County, said he wanted to come home to practice because his family is there and “I wanted to give back. to the community that raised me. ‘ ‘

Shorter medical school: The Medical College of Georgia at the University of Augusta is shortening its medical degree program to three years, instead of four for students who want to work in primary care in rural or underserved areas. “It’s a really good deal,” said Scotty Hall, who grew up in the small town of Dexter in central Georgia. Scholarships are also available for tuition fees. The Peach State Health Plan, managed by Centene, contributed $ 5.2 million to the CWM program. Mercer offers a similar short program for medical students.

Loan repayment programs: A hospital in Tifton has repaid $ 100,000 in medical education loans from Dr Flavia Rossi, a pediatrician in the city. The terms of the deal required her to work at Tifton for three years, which she completed, but she stayed there “because I like it.” I like the small town life. ”

Dr. Michael Raines examines a patient at the Mercer Clinic in Plains.

Primary care clinics: Mercer has opened four primary care clinics in underserved rural areas, including one in Plains at the behest of the city’s most famous resident, former President Jimmy Carter. “Our goal is to go where there is no care,” said Dr Sumner. Another clinic is planned in Harris County.

Sumner

Diversified services: Miller County Hospital in southwest Georgia has accepted an influx of patients deemed “medically needy,” who are Medicaid-eligible for disability, into its nursing home. “No state nursing home would accept them,” said Robin Rau, CEO of the hospital, which also benefits from the services provided to these patients. “We took 200 to 300”.

Mobile clinic: Rau, of the Miller County Hospital, runs a medical clinic for trucks in neighboring counties that have lost their hospitals. It is equipped for telehealth, electrocardiograms, x-rays and laboratory work, and its staff consists of a nurse.

“These communities have asked me to help them,” said Rau. “I will not reopen their hospitals, I will not be able to staff an emergency room. But sending the mobile clinic to the areas that need it, she said, “I’m ready to lose money. “

The Arthur M. Blank Family Foundation provided funding for the writing of this article.

Read Part 1: Rural Georgia Community Collapses After Hospital Closes

Read Part 2: How Rural Health Care “Lags” in Some Communities

Read Part 3: The ripple effect when rural hospitals abandon delivery services

Read part 4: Health care gaps hamper some rural areas


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