Growing ED use in rural areas putting strain on safety nets, JAMA finds
Emergency departments in rural areas are busier than those in urban areas, which is putting a strain on safety net hospitals, according to a new JAMA study.
Rural ED visit rates increased more than 50% between 2005 and 2016 despite a 5% population drop in that time. The increase was a huge jump compared to urban ED visit rates, which saw only a slight increase, according to the report that reviewed National Hospital Ambulatory Medical Care Survey data.
Rural ED use grew across multiple patient populations, including Medicaid beneficiaries and uninsured patients.
The study results follow recent data from the Centers for Disease Control and Prevention that showed ED visits increased by nearly 10 million patients in 2016 compared to the previous year. Despite that increase, ED misuse is down. The percentage of emergency patients with nonurgent medical symptoms dropped from 5.5% in 2015 to 4.3% in 2016.
That's good news. Across the country, providers and payers are trying to educate patients on how to receive healthcare in the most appropriate place. Those efforts can lead to lower costs and less overcrowding in EDs.
However, the new JAMA report shows that more work is needed in rural areas, where EDs are often being used for nonurgent healthcare. This result could be connected to physician shortages, as well as "worsening disparities for several traditionally disadvantaged groups, including those with Medicaid and those without insurance," the study authors wrote.
"Rural EDs are experiencing important changes in utilization rates, increasingly serving a larger proportion of traditionally disadvantaged groups and with greater pressure as safety-net hospitals," they wrote.
One possible solution is greater use of telehealth, which could keep patients at home to receive appropriate care, while not flooding EDs. The study suggested another possible solution — improving Medicaid payments and integrating EDs into local healthcare delivery systems. Medicaid payments were 72% less than Medicare in 2016 and even lower than private payers, which can push some doctors to stop accepting Medicaid patients altogether.
The JAMA report also brings up more concern about the state of safety net hospitals. A group that represents about 300 such facilities warned in a recent report that the hospitals are struggling to keep up with uncompensated and charity care.
America's Essential Hospitals said pending disproportionate share hospital cuts slated for Oct. 1 will push those facilities to a "breaking point." AEH hospitals operated with an average margin of 1.6% in 2017, about half of what they had the previous year and well below the 7.8% average of other hospitals.