Improving emergency health services in rural areas

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Farm Forum

In a rural state like South Dakota where access to specialized medical care can be hours away, residents depend on critical access hospitals to help meet their health care needs. However, an increasing number of rural hospitals are finding it difficult to recruit physicians to these under-served areas of the country. For small hospitals with only a few physicians, current federal laws and regulations require regular on-call shifts that prevent a physician from leaving town. This is a lifestyle that many younger doctors are not interested in pursuing when urban settings can offer more flexible career options.

Federal regulations for some rural hospitals currently require a physician to be on-call and able to arrive to the emergency department within 30 minutes, even if an associate provider, such as a nurse practitioner or physician assistant, is already covering the emergency department. For physicians in small hospitals who see patients all day and then must be on call at night, this creates a “24/7” work environment that can be unattractive to physicians and unnecessarily drives up the costs of health care.

However, by utilizing technology that is already available in hospitals across South Dakota and the country, there is a solution that both improves emergency care and creates a work environment that can make it easier to recruit physicians to rural areas. I recently introduced the bipartisan Strengthening Rural Access to Emergency Services Act that, if passed, would allow eligible hospitals in rural and medically underserved areas to use interactive telehealth programs that can connect at any hour of the day to a board-certified emergency physician to satisfy the federal emergency room staffing requirements. This use of emergency telehealth technology in this capacity would be permitted when an associate provider, such as a physician assistant or nurse practitioner, is already on site at the rural emergency room.

Often, small rural hospitals are not prepared to deal with complex patients and will sometimes need to transfer patients to larger, specialized hospitals. Immediate access to a physician that specializes in emergency medicine via telehealth can help the rural hospital determine whether a transfer is necessary. This ensures that precious time is not lost waiting for the on-call physician to arrive. It also benefits the hospital ensuring that, when appropriate, the patient can remain at their local hospital to receive care. This allows the small rural hospital to be reimbursed for services, making it easier for these safety-net hospitals to keep their doors open.

As a member of the Senate Rural Health Caucus, I understand the importance of access to fast, reliable emergency medicine in rural hospitals and will continue to support initiatives, such as this, that will strengthen our rural health care infrastructure.