Like free-standing EDs, however, urgent-care centers often cherry-pick their locations based on socio-economics and rates of commercially insured residents, according to statistics from 2012. Only 11% of urgent-care centers are in rural areas.
For urgent-care centers and free-standing EDs to survive in underserved rural areas, Ayers argues the “operating model will need to adapt.” They will have to use midlevel clinicians including physician assistants and nurse practitioners, reduce operating hours, and offer other high-volume services such as primary care and occupational medicine. That could help rural facilities offset the typically high fixed costs, Ayers said.
Perhaps the most feasible solution for rural areas is a hybrid model, mixing lower-level emergency care with primary-care services. An example is Carolinas HealthCare System Anson in Wadesboro, N.C., a town of 5,800.
In 2012, Carolinas HealthCare System—a large system based in Charlotte, N.C., with $4.7 billion in annual revenue—decided to overhaul Anson Community Hospital, a Hill-Burton facility with 125 staffed acute-care and nursing beds. The system spent $20 million and downsized the hospital's inpatient capacity from 30 beds to 15. The new facility, which opened in July, offers 24/7 emergency care in addition to the limited number of acute beds. Carolinas officials said Anson's major innovation and attraction is that it uses a patient-centered medical home model, offering residents access to primary-care providers with the help of a patient navigator.
That's what rural Americans most need, experts say. Hospitals and EDs may not need to be as ubiquitous as they once were, but preventive-care providers ought to be. “What it really boils down to is, we need access to primary care in those communities,” Moscovice said.
Back in Richland, McLendon said he and community members are trying to come up with a plan to bring healthcare back into the area. Richland is in Stewart County, which ranked 158th out of Georgia's 159 counties for health outcomes, according to a 2014 study.
He estimates the town will need at least $15 million to build a new hospital, as well as overcome certificate-of-need hurdles. That's a long shot, he concedes. He would be satisfied with a facility that provides some emergency treatment and preventive-care services, which would take pressure off the town's primary-care doctor. “I'm determined to do something,” McLendon said.
Follow Bob Herman on Twitter: @MHbherman