When someone’s life could have been saved in five minutes, why are we letting them die in 30? Shocking perhaps, but sadly, this is something people in communities throughout the country are all too familiar with when their local hospital closes.
With over 135 hospitals having closed in recent years, and another 200 at immediate risk of closure–including almost 30% of all rural hospitals in the country–we hear about this all too often. But few of us know what that actually looks like to the impacted families on the ground, to the ones that are literally “dying on the side of the road,” to quote a local ambulance service manager.
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Take, for example, Pickens County, Alabama, where their local 56-bed hospital, Pickens County Medical Center (PCMC) closed in March 2020. This left the entire county without emergency medical services or an acute care hospital within 30 miles, and regular waits for life-saving care from EMS of more than 3 hours.
As in the many similarly impacted communities around the country, ambulance services in Pickens County now treat cardiac arrests differently. Instead of immediately transporting patients, local EMS now work cardiac arrests in the field for 30 minutes; if there’s no change, they call it a “death in the field” because they know they cannot get the patient to a hospital in time for life-saving care. Thirty miles to the nearest hospital is an often insurmountable distance to travel when you typically only have minutes to act.
This is happening in our own backyards – not in a developing country, not in a war zone, but in average communities across the U.S.
Health equity depends on local hospitals
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As the Pickens County Coroner noted, the survivability rate for county residents has noticeably decreased in the last few years. This mirrors the landscape around the country, where for the last decade, we’ve seen Americans in urban areas living longer, on average, than Americans in rural areas.
We know that when a local hospital closes, the entire community suffers–not just the patients who die unnecessarily. The downstream impacts include less access to preventative care, diagnostics and treatment, with poorer health outcomes for remaining residents; local businesses and healthcare professionals leaving, leading to further closures of remaining medical facilities like pharmacies and nursing homes; and worsening unemployment, tax base, and economics for the community at large.
If we truly want to achieve health equity (and the associated economic benefits) for all Americans, keeping local hospitals open should be a priority for all of us. Government agencies, payers, health systems, local communities – everyone should be looking for innovative ways to solve this problem, which ultimately boils down to money. How can local hospitals increase revenue and reduce costs so they can keep their doors open?
Keeping local hospitals open means solving for physician shortages
There is no one-size-fits-all answer, but getting more physicians to work in these communities is one of the critical pieces of this puzzle. With more physicians, including specialists, providing care locally, hospitals can attract and treat more patients locally, and recruit and retain staff more efficiently, thereby both increasing revenues and reducing costs with one fell swoop.
However, we’re facing a severe physician shortage in this country, and it’s hitting certain areas harder than others. Only 1% of doctors in their final year of medical school say they want to live in communities under 10,000, and only 2% want to live in towns with fewer than 25,000. And this is not just a rural America problem, it’s an American problem: nearly 46 million people − 14% of all Americans − live in areas where they currently face a significant shortage of health care services, and physician shortages in particular will impact both marginalized rural and urban communities. These impacted hospitals support over $220 billion in economic activity nationwide.
It’s a vicious cycle: understaffed hospitals create more burden and burnout for the staff that is available; burnout leads to more open positions that can’t be filled; too many open positions force hospitals to cut coverage and access to care; coverage cuts mean hospitals are unable to treat as many or as complex patients, losing revenue and exacerbating the very issues that ends up in a hospital closure to begin with. And as we saw above, when local hospitals close their doors, the entire community suffers.
With telemedicine, we already have a proven solution
We need more physicians to work in places where they don’t necessarily want to live, and telemedicine is the obvious, proven, and only scalable solution.
As more hospitals have embraced telemedicine, we’ve seen facilities that were previously on the edge of collapse step back from that. Clinically, we’ve seen telemedicine dramatically reduce transfers and readmissions; improve patient throughput; reduce wait times and cost to treat; help local facilities attract and treat more complex patients locally; and generally increase patient satisfaction with their overall healthcare experience.
Telemedicine’s resulting financial impacts on hospital and community economics are priceless: improving both revenues and profits for hospitals as more patients are brought in and treated locally, and more ancillary revenues are kept in the local health system; and lower cost of care burdens for the community at large, financially, emotionally, and operationally.
With the addition of virtual specialists, particularly in the most commonly needed fields of neurology, cardiology, psychiatry, and infectious disease, hospitals around the country, regardless of location, are able to address two of the biggest threats to their ability to keep their doors open. Hospitals can take action today to implement comprehensive telemedicine programs and attract and treat more complex patients locally (thereby increasing their revenues), and recruit and retain remote permanent staff more cost-effectively (thereby cutting outsize operational costs associated with locums and traveler staff, helping, at least in part, to right-size budgets running in the red).
Telemedicine changes the staffing paradigm
While it is by no means a panacea, providers have clearly shown a willingness to support rural hospitals through telemedicine. As one busy Infectious Disease specialist in Ohio told me, “I love rural medicine, but I want to raise my kids in a larger city, with the access and exposure to a broader variety of experiences and opportunities that brings. Practicing remotely allows me to work in and help these smaller communities without living there.”
Hospitals that have embraced telemedicine are thus able to keep their doors open and offer additional services to their communities. One rural hospital in central Florida now offers neurology, cardiology, pulmonology and psychiatry via telemedicine, helping them achieve a coveted 5-Star rating from CMS. Today, when EMS responds to a patient experiencing a heart attack in their community, they not only have a hospital to go to locally, but they are confident their hometown emergency room can provide the care that patient needs. And when every minute counts, this local hospital is saving more lives–and their virtual specialists are playing a key role.
We all inherently understand that in today’s America, where you live determines how well and how long you live. But no one should have to accept “deaths in the field” as just the way things are, and especially not when dealing with an otherwise treatable health issue. Telemedicine gives us the opportunity to bring care to where it is needed most, helping local communities throughout the country keep their local hospitals open and their communities healthy and well. Every life saved as a result of virtual care is a win, and there’s nothing holding us back except our own inertia.
Photo: pablohart, Getty Images
With a mission to improve access to great healthcare, Meena Mallipeedi started AmplifyMD, a leading telehealth company, to address the critical shortage of specialists across a wide variety of care. Of the 6000 hospitals in the US, over 50% have clinical specialty shortages in three or more critical areas and over 90% have shortages in at least one. With 1/3 of hospital visits requiring a specialty consult, AmplifyMD's telehealth platform actively fills the void of infectious disease, pulmonology, hematology/oncology, cardiology, neurology, psychiatry, nephrology specialists that has cost the healthcare system over $17B annually and hard hit hospitals improve care locally.
Under Meena's leadership, AmplifyMD's arsenal of dedicated doctors have made a significant impact on patients, clinics and medical facilities - lessening readmission rates, transfer rates, treating complex cases, supporting staffing shortages, helping patients to avoid unnecessary tests and treatments, reducing wait times, and more by providing access to specialists whenever and wherever they need it.
Prior to starting AmplifyMD, Meena was at Bain and is a graduate of Stanford University.
