In Rural Hospitals We Trust

By Dr. Nancy W. Dickey

Health care and access to needed medical care are just a few of the many challenges of the last several months as the United States continues to struggle with the COVID-19 pandemic. Patients want and need to have their chronic conditions managed but are hesitant to seek care in traditional health care settings or risk of exposure to the coronavirus. Physicians and other providers want to ensure that their patients continue to seek and receive high quality care, but also want to minimize their patient’s risk for exposure.

Rural areas are generally socially distant due to their geographical location and population size. Residents of these areas also have a decreased likelihood of interchange with people who travel extensively. These characteristics have resulted in rural areas displaying a significantly smaller penetration by the coronavirus. This directly translates to fewer infected individuals and fewer opportunities for virus transmission. Therefore, small rural hospitals often see a much smaller number of possible COVID patients making it safer for others to seek care in local clinics and even the emergency department. It is important to recognize that COVID-19 data is dynamic, and as the pandemic continues some rural areas are beginning to experience increased transmission rates. Available community resources will be especially valuable to these identified “hotspots.”

COVID-19 has prompted rural hospitals to intensify communication and outreach efforts within their communities. Hospitals are regularly holding virtual town halls and providing timely updates and guidance on how people can stay healthy. Many rural hospitals are experiencing increased website traffic, wide-spread social media engagement, and hosting public “thank you” events for health care providers and staff. It is important to point out that these enhanced communication efforts and concrete actions do not solely apply during a period of crisis, but set the stage for continued growth and responsiveness specific to the community’s needs. Rural hospitals have a prime opportunity to continue to grow in their role as a trusted source of health information for their community through regular dialogue and updates, regardless of circumstance.

Rural hospitals must continue taking steps to solidify their viability and their future by tapping into the goodwill being generated within their community and utilizing opportunities for growth. For example, telehealth has long been a lifeline for rural communities to broaden access to care, but it has also been constrained by technology challenges and narrow regulatory restrictions. Medicare’s recent implementation of telehealth flexibilities allows telehealth visits to now be billed at the same rate as in-person visits, expands coverage area, and removes the audiovisual platform requirement for some visits. These steps translate to broadened access to safe health care during the pandemic, and likely beyond. While telehealth’s growth and expansion won’t solve rural hospitals’ many workforce challenges, it will improve patients’ local access to medical professionals for certain types of care.

As the pandemic has placed a burden on available beds in metropolitan areas, partnerships have grown between rural facilities that continue to have available beds and larger tertiary facilities. Some hospitals have responded by enhancing the level of care available at the rural facility through consultation with a tertiary partner – and that enhanced level of care will continue long after the pandemic has faded. The initiation of consultations between urban sub-specialists and rural physicians has led to increased understanding of the kind of patients who can be effectively and successfully cared for nearer home; that increased understanding and consultative support should also continue after the crisis has passed.

The pandemic has offered the opportunity for rural hospitals to be recognized for what they have always done best: bringing communities together to prevail in the face of seemingly insurmountable adversity. While not without significant challenges, COVID-19 is reestablishing many rural institutions as mission-critical resources and pillars of trust. It is a good time for local hospitals to remind their communities of the breadth and quality of services available in their own backyard – often a safer alternative to the larger city down the road.