Pilot program hospitals
- Union General Hospital, Blairsville
- Appling HealthCare System, Baxley
- Crisp Regional Hospital, Cordele
- Emanual Medical Center, Swainsboro
Gov. Nathan Deal unveiled a plan on Monday to shore up Georgia’s rural hospitals, a faltering system in which patients sometimes risk death or disability because they can’t get to the doctor or hospital in time.
Deal is calling for networks of regional hospitals, wifi-equipped ambulances, community health centers and school clinics to take pressure off of rural hospitals. But it may be too late to save some hospitals that are already on the verge of closing.
Eight have closed since 2001. Another 15 are considered “financially fragile,” with half a dozen scrimping to survive from one day to the next, according to a report released Monday by Deal’s rural health stabilization committee.
The group is proposing to help ease the burden on the emergency departments at Georgia’s smallest rural hospitals by turning larger regional hospitals into communication hubs that will direct patients to the most appropriate places for care.
“This is not going to be simple. This is going to be hard,” said Jimmy Lewis, a committee member and CEO of HomeTown Health, which works with rural hospitals. “We have to figure out how to transform health care particularly in rural Georgia and save hospitals wherever we can.”
Small-town hospitals have been pummeled in recent years by a mix of falling populations, declining reimbursements, more government regulation and a pool of patients who are generally older, poorer and sicker than those in metro areas. The resulting financial turmoil threatens access to life-saving care for thousands of Georgia’s 1.8 million citizens who live in rural areas.
Nearly two-thirds of rural hospitals lost money in the most recent year they reported financial data to the state, according to an analysis conducted earlier this year by The Atlanta Journal-Constitution. Twenty-one suffered budget shortfalls for five years running. Only seven made a profit each year.
The AJC also documented instances in which patients died or suffered permanent disabilities because they were too far away from health care providers that could have treated them.
Last April, Deal brought together hospital executives, lawmakers, business owners and health industry experts to tackle the problem following a spate of hospital closures.
The Rural Hospital Stabilization Committee is now proposing a “hub and spoke” model that relies heavily on telemedicine and other advanced technology to better enable medical providers to work with each other.
“Just as a medical emergency can’t wait, neither can we wait to act upon these recommendations,” Deal said in a statement.
The report points out that Georgia already has 55 school nursing programs and more than 20 nursing homes with telemedicine technology. Some 1,000 ambulances across the state have wifi and locator systems, with many also having telemedicine capability.
Telemedicine enables school nurses, emergency medical technicians, doctors and other rural providers to connect with specialists in metro areas hundreds of miles away. Doctors using telemedicine can, for example, instruct EMTs not to stop at a smaller hospital if what a patient needs is a larger regional facility as soon as possible.
The committee’s proposal will be tested at four regional hospital hubs: Union General Hospital, Appling HealthCare System, Crisp Regional Hospital and Emanuel Medical Center. The governor said he plans to include $3 million in the state’s fiscal 2016 budget to help fund the program.
Still, the committee’s proposal contains no easy fixes, and any long-term changes will almost certainly be too late for hospitals suffering the most.
“The committee’s work wasn’t about short-term solutions,” said Deal spokesman Brian Robinson. “It was about building sustainability so we can provide access to health care in all corners of the state.”
The report also urges lawmakers to preserve the “certificate of need” regime that regulates the number of hospitals.
And it recommends expanding the duties of nurse practitioners and physician assistants. Such a move could give them broader leeway to write prescriptions and perform procedures once exclusively reserved for doctors. Even seemingly small changes to those regulations can lead to big fights at the Legislature.
State Rep. Sharon Cooper, R-Marietta, who chairs the House’s health committee, said she was concerned about the proposal to expand the scope of practice for nurse practitioners and PAs.
“There are not enough nurse practitioners and physician assistants in the same places where there are not enough doctors,” Cooper said. “We have a dearth of trained medical workers across rural Georgia.”
State Sen. Chuck Hufstetler, R-Rome, said though he supports the plan, he’s concerned that it still doesn’t address the underlying problem that “these facilities are absorbing billions in unpaid care that they have no choice in.”
He’s one of a few Republicans who support expanding Medicaid under the Affordable Care Act. The governor and other Republican leaders have long refused to expand the program, saying the state can’t afford it.
“Until we find a way to unlock the dollars available to address this, I am afraid we will continue to lose hospitals in our state,” said Hufstetler. “Obviously, if our Georgia hospitals suddenly had half their uninsured covered, the hospitals’ financial picture would improve drastically.”
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Georgia rural hospital closures since 2010
Source: North Carolina Rural Heatlh Research Program
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