May 4, 2021
Critical Access Hospitals (CAHs) serve as cornerstones of rural communities, providing lifesaving care and important community employment. In fact, about 18% of the US population is served by critical access hospitals (1). As a part of their designation as a CAH, critical access hospitals are usually located at least 35 miles from the next nearest hospital (2). Rural communities serve a different overall patient demographic compared to their urban counterparts, giving CAHs a unique patient population with unique needs. All of this in combination with their isolated locations causes CAHs to face challenges particular to them while remaining essential to our society.
One of the biggest challenges CAHs face is workforce shortages. Recruitment and retention rates at CAHs are very low, especially considering how big of a population they serve. Because of their small size, CAHs typically lack in-house specialists and patients often have to be transferred to bigger hospitals causing CAHs to lose vital revenue opportunities.
One specialty where workforce shortages are particularly acute and alarming for rural patients is mental health care. More than 90% of psychologists and psychiatrists work exclusively in metropolitan areas, leaving more than 60% of rural Americans living in an area with mental healthcare professional shortages (3). This leaves rural citizens with very few options and access to mental health care treatment.
Another major problem relating to workforce shortages is low patient volume. Because CAHs exist in small rural towns with low population density, CAHs struggle to scale to cover the high fixed operating costs. This in combination with the frequent transfers that occur often cause CAHs to struggle financially, historically causing dozens of facilities to close and leaving major gaps in rural healthcare coverage.
Fortunately, as technological innovation occurs and medicine continues to advance, telemedicine offers CAHs exciting, effective solutions to expand their care possibilities and best treat their patients. With today’s telehealth video conferencing capabilities, specialists located elsewhere can call in to virtually treat patients. Physicians can access real-time patient test results, monitors and more, all while being able to see and talk to their patient. This allows CAHs to effectively treat and retain patients and increase their collections. For patients, it allows them to still receive high quality care while staying in the comfort of their beds at their community hospital by making stressful, risky transfers unnecessary.
Returning to the problem that rural Americans face in accessing mental health care, virtual visits via at home video conferencing are an effective way to treat patients for their mental health needs. Telehealth virtual visits give rural patients the opportunity to seek treatment from the comfort of their homes without having to go anywhere. For mental health care providers, the vast majority of which live in metropolitan areas, this enables them to treat patients without the geographical constraints that typically exist or having to travel far to see patients. These virtual visits are not exclusive to mental health care and can be used as effective ways to treat patients when in-person visits are not required.
On top of offering CAHs a chance to improve their care quality and abilities, telemedicine also offers CAHs an opportunity to save money. A University of Iowa study conducted at nineteen rural hospitals in the Midwest found that hospitals that used telehealth services to support their ER saved an average of $117,000 annually (4). They also found that the hospitals that switched to telemedicine ER services found it easier to recruit and retain physicians because the telemedicine services allowed physicians to have a better work-life balance.
Telemedicine offers critical access hospitals exciting solutions to persistent problems they have faced for decades. The opportunity to decrease transfers and keep patients at their community hospital allows for patients to receive convenient, quality care, and helps CAHs stay in business. Additionally, telemedicine can connect rural patients with mental health care providers and other specialists so they can easily access treatment in their home without having to travel far from home to find care. The opportunities between telemedicine and critical access hospitals are endless, but both concerned with one common goal: helping provide the highest quality care to patients.
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