This seems a rational option and is worth consideration and our involvement. An emergency physician who is an ACEP member sits on the governor’s committee, and the Georgia College of Emergency Physicians is engaged as well.
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ACEP Now: Vol 34 – No 01– January 2015Emergency Physicians Need to Be Part of the Discussion
EMTALA, sufficient reimbursement, alternative sources of care, follow-up care, access to specialty consultation, EMS, workforce, and telemedicine are all part of the discussion. It is irrational for us to sit on our hands and await solutions from others without our input. The emergency medicine community should consider access to rural emergency care as a priority advocacy agenda item.
I do agree with Mr. Emanuel on one point: this is an opportunity for telemedicine. The application of telemedicine to rural emergency care should be explored, developed, and tested, particularly in remote and rural areas. Issues with fair payment and licensure requirements for telemedicine services need to be resolved. The ACEP Telemedicine Section was formed in 2011 during the ACEP Scientific Assembly in San Francisco. It is maturing, growing, and working to shape emergency telemedicine for the future.
It seems to me that EMS also plays a heavy role in rural emergency care delivery. How can it be leveraged to improve access? What limitations does it face, and how can these barriers be overcome?
I know emergency physicians care about people and do so regardless of race, gender, age, ability to pay, and wherever they may happen to live. It is our (ACEP’s) obligation to advocate for access to care for rural and remote areas.
We should be aware that public-policy developments may have unintended consequences impacting rural hospitals and our ability to deliver emergency care. Policy makers need to be fully educated about the unique issues and problems faced by rural hospitals and their importance not only to the health of their populations but to the economic vitality of their communities. The value of rural America to the rest of the country must be recognized, and all Americans deserve the same access to emergency care, recognizing emergency medicine as an essential public service.
Dr. Rogers is co–emergency department medical director at Coliseum Health System in Macon, Georgia, and ACEP secretary-treasurer.
References
- Emanuel E. Reinventing American Health Care. New York, N.Y.: Public Affairs; 2014.
- Buchmueller TC, Jacobson M, Wold C. How far to the hospital? The effect of closures on access to care. J Health Econ. 2006;740-761
- Gryzbowski S, Stofl K, Jude Kornelsen J. Distance matters: a population based study examining access to maternity services for rural women. BMC Health Serv Res. 2011;11:147
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2 Responses to “Rural Hospital Closures Leave Whole Communities Without Access to Emergency Care”
February 1, 2015
JGraykoskiThank you Dr. Rogers for raising this important issue.
1. Rural Critical Access Hospitals DO provide important local services for select patients. Not every elderly pneumonia patient should be transported 2 hours to a tertiary hospital. The scope of services needs to be clearly defined and funded.
2. Rural Critical Access Hospitals need systems of training and quality monitoring so that standards of care are met.
3. A nod of appreciation to ACEP Rural Section for endorsing Comprehensive Advanced Life Support training, a team based, evidence based training for rural Emergency Departments.
4. Regionally directed, adequately funded, paramedic staffed EMS is critical in addressing needs of rural communities.
5. The role of PAs certified in Emergency Medicine coupled with telemedicine is an effective and cost effective way to deliver emergency care in rural hospitals or free-standing EDs.
6. All rural hospitals should establish close collaborative linkages with tertiary facilities for referral, consultation, training and outreach.
ACEP and the Society of Emergency Medicine PAs need to lead advocacy efforts for comprehensive reform of rural emergency health care, based on the above points.
February 2, 2015
William RogersOne of the easiest ways to help save our rural hospitals is to encourage states that have refused to expand Medicaid to accept the generous subisdy offered by the Federal taxpayer (100% initially but never less than 90%) and expand the program so that all of the citizens of their state will be covered. The idea that americans who earn less than a thousand dollars a month dont deserve health care is hard to understand in a country that pretends to admire the actions of the good samaritan.