Rural hospitals are vital to their local economies. The National Rural Health Association claims that closing the 283 most vulnerable rural hospitals would eliminate 36,000 healthcare jobs and an additional 50,000 jobs in the community would be at risk. Those cuts would result in a $10.6 billion loss to the gross domestic product.
Clark said Page Memorial Hospital employs nearly 200 people and has a $40 million impact on the county.
Mueller said more primary-care and mental health providers are desperately needed in rural areas with shortages. “The high priority is everything related to the healthcare workforce,” he said. “That drives everything.”
Desperate for alternatives, some doctors and rural hospital administrators see telehealth as an option to access healthcare in rural areas. Dr. Michael Meza, who has been a family practice physician in north-central Idaho for 20 years, started incorporating telemedicine services when he saw his patients traveling long distances for specialty care, often after waiting months for an appointment.
To deal with the lack of psychiatric services and the fact that some of his patients have difficulty accessing specialty care, he created a telemedicine operation so that patients could receive timely care without taking days off work or school for travel. “It could be a godsend to some of these small hospitals and communities,” he said.
Telehealth services have unique barriers, though. Some rural communities do not have the high-speed Internet connection needed for videoconferencing. And some physicians are unwilling to make telemedicine referrals, he said.
Also, some organizations may have to reach across state lines to find a provider, which presents licensing, patient privacy and security challenges. Electronic health records need to be sharable with a variety of practices as well, Meza said.
Shannon Sorensen, CEO of Brown County Hospital in Ainsworth, Neb., said her hospital is in the black and meeting the needs of the community, but is struggling to cope with the increased regulatory burdens.
The closest hospital is 150 miles away, which means even by helicopter it takes an hour to reach other healthcare providers. The 23-bed critical-access facility is vital to residents who need preventive or emergency services, she said.
Sorensen called for getting rid of the 96-hour rule during a July congressional hearing; the rule requires a physician to certify that a beneficiary will be released or transferred within 96 hours of admission. If the condition is not met, the hospital faces nonpayment.
She also attacked physician supervision requirements for routine procedures and the two-midnight rule, which strictly defines inpatient hospital stays. “Having to focus on regulatory burdens interferes with the best judgment of physicians and other healthcare providers, placing them in a position where highly qualified local providers cannot provide care for their patients,” she told lawmakers.
In an interview, Sorensen said the regulations are arbitrary and a distraction for doctors who would rather focus on the health of a patient. “It's the world of medicine, not an exact science,” she said.
The hospital is small but has a lot of technical resources. Pharmacists and emergency doctors are available for consults at the push of a button and telehealth services are on-site, she said.
“We can't be everything to everyone. We recognize that,” she said. “We need to be really good at what we can do.”