by Don Wood, Co-chair of the Joint Committee on Rural EMS Care (JCREC) and Director of the Utah Office of Primary Care and Rural Health
In recent years, rural hospitals have been closing at an alarming rate. More than 75 rural hospitals have closed since 2010, and the potential remains for more rural hospital closings. According to iVantage estimates, over 600 additional rural hospitals are at risk of closing in the future. These rural hospitals are going through or trying to prepare to go through the “transformation of healthcare delivery.” In short, this means that these hospitals are navigating challenges they have not encountered before. One example of this is the new concept of value-based reimbursement, which deviates from prior reimbursement methods that many rural hospitals are familiar with and accustomed to. While the reimbursement details may not be completely ironed out at this point, the concept is being accepted and expanding, resulting in the program being piloted in many different locations.
Although urban hospitals may be dealing with many of the same issues, they do not have to contend with issues based on EMS access to the same degree as rural hospitals. Consider this scenario: A rural hospital closes and the next closest hospital is 75 miles away. Because there is no other healthcare provider in the area, the EMS agency becomes the default healthcare provider. Patients who used to go to the hospital now call EMS for care, treatment, or information. Many patients who are sick or injured require the higher level of care that only the hospital can provide. The duty now falls on the EMS agency to transport those patients to the next closest hospital, even if it is 75 miles away. The long trek to the hospital now takes EMS personnel out of their normal service area for longer periods of time. Without enough trained personnel and/or additional vehicles, the access to EMS can be stressed beyond its limits. In some situations, the EMS agency closes operations because of that stress. This now places the burden of access to EMS on the next closest agency, which may be, again, several miles away.
The transformation of rural healthcare delivery from volume to value/quality has significant repercussions not only for hospitals and patients, but also to the economies of those rural areas. Although there are questions still unanswered about the transformation, EMS agencies should be part of the conversation and discussion in all rural areas. While there are many new ideas, models, and methodologies being identified every month on how this transformation will ultimately look, this may not be a one-size-fits-all conclusion.
For access to EMS, telehealth is looming on the horizon. Telehealth will not only impact the delivery of EMS services in the future but will also have significant impact on hospitals, both on their inpatient and outpatient populations. For EMS, telehealth technologies have the potential to change both the treatment in the field for patients but also for transport decisions and destinations. EMS agencies should be forward-thinking in their future planning when addressing access to care in the rural areas. Concepts that were simply ideas a few years ago are being implemented at rapidly progressing rates today. One such concept is that of community paramedicine. While the original concept has morphed into many different models, numerous agencies have adopted a version of the concept that has allowed their agency to locally address EMS access to care. Those agencies that have implemented such a service are also participating in the transformation of rural healthcare delivery.