May 05, 2020
There are multiple benefits to living in rural areas in the United States. Less pollution, lower crime rates and a more affordable cost of living are just a few. Maybe that’s why about 46 million (20%) United States residents live in rural counties compared to approximately 175 million who reside in the country’s suburbs and 98 million in urban core counties.
One drawback to living in a rural community is more limited options for healthcare services. Although people who live in rural areas deal with the same health problems as their counterparts in more populated regions, they typically don’t have the same access to state-of-the-art medical facilities. As the Rural Health Information Hub notes, rural residents are more likely than their urban counterparts to have chronic diseases. Many have to travel a fair distance to reach a specialist or a bigger, more technologically-advanced hospital. Some can’t afford this travel, which can result in lower utilization of preventive care.
Rural healthcare doesn’t just affect patients. According to the Rural Health Information Hub, rural hospitals provide a higher percentage of care in outpatient settings and are more likely to offer home health, skilled nursing and assisted living, all of which have lower Medicare margins than inpatient care. Plus, these facilities rely more heavily on reimbursement from public programs, whose payments can fall short of costs.
There are 1,821 rural community hospitals located in the U.S., about half of which are critical access facilities. While these hospitals handle more than 21.5 million emergency visits annually, the patient-to-primary care physician ratio in rural communities is only 39.8 physicians per 100,000 people. For comparison, in urban areas, it’s 53.3 physicians per 100,000 residents. This doesn’t take into account the predicted physician shortage.
The physician shortage in the U.S. is predicted to be up to 121,300 by 2030. It is already an issue for rural areas, where approximately 77% of counties are experiencing shortages of primary care doctors. According to one study, hospitals and health systems will probably come up against higher costs for labor as a result of bigger compensation packages to combat the shortage.
Fortunately, there are efforts being utilized to lessen the negative effects of the physician shortage in rural areas, while also improving care for residents in those communities. Not surprisingly, a major one involves technology.
Telehealth, sometimes referred to as telemedicine, employs telecommunication technologies such as remote patient monitoring, video conferencing, mHealth (mobile health) and more to assist providers in remotely delivering healthcare services. Not only does it enable those living in rural areas to receive a higher quality of care, but it also reduces costs and promotes continuity of care through real-time communication, responsive concern and reduced admissions.
Physicians employed by rural hospitals can connect virtually with their colleagues at larger health systems, allowing them to better diagnose a serious health problem or offer more extensive options for treatment. A study by Deloitte found that 90% of physicians agree that virtual care is beneficial in terms of increased access, communication, and satisfaction. Maybe that’s why provider adoption of telehealth has increased by 340%.
More than half of U.S. hospitals have implemented a telehealth program, and about 60% use remote patient monitoring services. Statistics from the American Hospital Association show that 76% of hospitals in the U.S. were connecting with patients and other practitioners through telehealth. For states delivering telehealth services, the most common priority populations are healthcare and public health providers.
In addition to better access to healthcare education tools and improved mental healthcare, advantages of telehealth include:
Another benefit is patient engagement. Though some patients report the resolution of their healthcare concerns at 64% through in-office appointments, those who made use of telemedicine visits noted their concerns were resolved 85% of the time.
Unfortunately, only about two percent of residents and fellows and seven percent of doctors already practicing prefer to live in a rural area. However, the U.S. government and some states have enacted programs to lure physicians to practice in rural areas.
The Health Resources & Service Administration (HRSA) maintains that doctors who complete rural rotations, while in medical school and through residency training, are more likely to practice in such settings. One study found that physicians who participate in training in rural areas are two to three times more apt to practice in one. In 2019, the Resident Physician Shortage Reduction Act of 2019 was presented to Congress, with the goal of increasing residency slots.
The NHSC Loan Repayment program offers doctors who work at a high Health Professional Shortage Area (HPSA) score facility up to $50,000 in loan repayment with additional assistance if they expand their service there, past two years. The aim of the program is to encourage doctors already working in a rural area to stay there. It is also used as a tool to bring physicians to communities in which they might not otherwise serve. Through the Centers for Medicare & Medicaid Services (CMS) HPSA Bonus Payment Program, doctors who provide services covered under Medicare to residents of geographic HPSAs are eligible to receive a 10% bonus payment.
On a state level, Alaska is a designated HPSA because of its lack of in-state medical schools. Its sole medical residency program is the Alaska Family Medicine Residency (AFMR). Therefore, a state loan repayment program is provided by the Alaska Health Workforce Coalition to qualified physicians. Texas Tech, in Lubbock, lets medical students progress into their first year of residency instead of their fourth year of medical school through its accelerated family medicine track, with the goal of training and retaining rural providers. As a result of the program, the number of physicians in family medicine in the Lubbock area has increased.
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