How a Small Idaho Hospital Could Set the Tone for Oregon’s Rural Health Care Reform

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Rural hospitals have been suffering a long decline. They are serving a decreasing and aging population with more expensive needs. However, these older patients have lower reimbursement rates under Medicare than private health insurance would provide.

The remaining working-age population relies more heavily on Medicaid than urban residents; Medicaid doesn’t fully reimburse hospitals, and it also increases costs for rural medical institutions they can ill afford. Rural hospitals face the same high cost of liability insurance as urban ones, but a smaller and dwindling patient base. They have trouble offering the greater pay necessary to attract medical professionals to rural areas, though this is sometimes supplemented by federal programs that offer student loan forgiveness to medical professionals that work in rural communities.

Whether due to insurance costs, low reimbursement rates or lack of professionals to man them, many rural hospitals have been forced to close emergency rooms or obstetrics wards if not close altogether. Thus, it is easy to see why rural areas have seen a wave of hospital closures nationwide and decline in the services the remaining ones can offer. However, a small hospital in rural Idaho is making a difference in its community and showing us a way such rural hospitals could remain open. Oregon lawmakers are paying attention. A fourteen-bed hospital in Butte County, Idaho is leading the way by adopting new medical technologies and showing how other rural hospitals could continue to serve their populations.

New Medical Technologies

Rural hospitals are increasingly using remote monitors to track patients. Electronic medical records stored in the cloud eliminate the hassle of maintaining paper-based records, while using a cloud-based service means the hospital doesn’t have to rely on an IT department to use EMR. When a rural patient does need to be transferred to another facility, their records are available immediately to other medical professionals through the cloud.

A side benefit of having digital X-rays and electronic medical records stored in the cloud is the ability to send scans to radiologists anywhere in the world. An expert located somewhere else in the world can easily review the files so that emergency room staff has a diagnosis in hours if not minutes. Companies like Rev1 Engineering are also designing medical equipment that offers the same diagnostic capabilities as traditional equipment but at a lower cost.

Telemedicine

Telemedicine allows rural hospitals to connect to experts worldwide, so they can consult with experts they cannot afford to keep on staff full time. Rural Oregon and Washington state have set up a program to allow rural veterans to consult with mental health professionals via telemedicine, allowing them to receive counseling in their homes or from equipment located in rural clinics. Doctors in small rural hospitals gain the ability to consult with trauma experts when dealing with the unfamiliar in emergency care.

Butte County’s hospital is pioneering the use of a remote pharmacist who reviews doctor requests and signs off on prescriptions remotely, while the hospital relies on technicians and students from nearby Idaho State University to fill prescriptions.

Hospitals in Washington are combining mobile robots and telemedicine to put remote physician specialists by the bedside of ill patients; more than a dozen rural hospitals in Washington state now use TeleStroke. Lincoln Hospital became the first critical access hospital to use a robot to manage care for stroke patients. TelePediatrics is a similar program under development to meet the needs of the youngest members of these communities at an affordable cost. Steps like this improve patient care by reducing the need for transfers to distant hospitals, while helping hospitals maintain the revenue these patients generate.

Nestled in the snowy hills of central Idaho, Lost Rivers Hospital only has one resident doctor and three beds in its emergency room. However, the tiny facility provides critical exams such as CT scans that are much needed in the community. The hospital nearly closed its doors in 2013 but was able to stay open due to changes in management and private funding. The 14 bedroom facility was restocked with new state of the art equipment, new staff and expanded services.

Brad Huerta, who is now in charge of the new hospital, focused on introducing new technologies in a bid to improve the facility’s efficiency. This has enabled the hospital to significantly cut charges and provide better services for the community.

Software-Based Solutions

A common statement in reference to any problem someone has is, “There is an app for that.” Due to the widespread availability of smartphones, the University of Texas Medical Branch (UTMB) and other research institutions have been doing exactly that. Apps to monitor and record patients’ heart rates, blood pressure and blood sugar while notifying an expert when something is outside of acceptable parameters are already on the market.

The lab on a chip technology reported on by Science Magazine in 2015 turns any smartphone into a mobile disease clinic using the Colorimetrix app. It is intended to diagnose serious disorders like HIV, malaria and tuberculosis without relying on expensive and bulky spectrophotometers. In 2017, an app came out that lets people measure their sperm counts at home. The uCheck app allows patients or nurses to test urine for two dozen different diseases. The ability to test for conditions ranging from preeclampsia to urinary tract infections in a matter of minutes without a costly lab is invaluable.

All of this is on top of community health workers being able to take a picture of a matter of concern and send it immediately to a healthcare professional for feedback.

Conclusion

New medical technologies are altering the healthcare industry, though rural hospitals reap the greatest cost savings. Telemedicine brings experts to rural hospitals, saving patients money and generating income for financially strapped rural facilities. An expanding array of apps allows patients and low-cost health workers to perform diagnostic tests in the patient’s home or small clinics while being able to consult with experts as required. Other apps and remote monitoring now enable patients to monitor themselves knowing that doctors will be notified if something is wrong. All of this is helping to reform healthcare in rural areas.

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