- Patients forced to drive 30 minutes or more to a nearby emergency department after a closure near them risk negative health outcomes, particularly when the next closest facility is considered a high-occupancy hospital, according to a new study in Health Affairs that examines more than 1.1 million patient encounters across 3,720 hospitals between 2001 and 2013.
- The study also examines how those nearby hospitals with a high occupancy influence health outcomes and treatment when a nearby facility closes or opens. The study focuses on time-sensitive illnesses such as heart attacks and unintentional injuries.
- "The high sensitivity to ED closures at high occupancy bystander hospitals is especially concerning, as our data also show that high-occupancy hospitals are disproportionately treating large shares of black patients," the study notes.
Hospital closures are a real risk for many Americans, particularly those in rural areas who are forced to drive further for care. More than 100 rural facilities have closed since 2010, and many more are on the brink. Two hospitals along the Ohio River said recently they are joining the list next month.
Emergency room closures outpaced any openings that occurred around the country, according to the Health Affairs report. On average, about 69 emergency departments closed each year during the study's 12-year period. At the same time, about 38 openings occurred each year.
The study explains that the largest effects occur when driving time increases by 30 minutes or more.
The authors believe that because of these results, both utilization and distance from a nearby ER should be considered when stakeholders are considering whether to open or close an ER.
After nearby ERs closed and forced patients to increase their driving time by 30 minutes to a high-occupancy hospital, the study found increases in the mortality rates measured at 30 days, 90 days and one year. On the other hand, when an ER opened and significantly reduced that driving time by 30 minutes or more from a high-occupancy hospital, mortality rates fell.
Hospitals everywhere have seen more care shift from their walls to outpatient settings, cutting off some revenue opportunity for smaller facilities. Outpatient services grew from 11.1% of all care visits to 12.9% between 2009 and 2017, according to a recent study.
One growing option for rural patients is telehealth, which could prevent the need for some emergency visits. The Federal Communications Commission recently reformed its Rural Health Care Program to make it easier for rural hospitals to get broadband access in an attempt help providers and patients in medically underserved areas.