Rural hospitals: Give up inpatient care for federal stipend?

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#6

Actually, I can see the efficiency in small hospitals being ER only, stabilize the patient, then transport to a large hospital for warehousing.

When I first retired, I considered moving to less congested areas. I started comparing ACA plans by city. Grand Rapids was almost as cheap as metro Detroit, but coverage in Kalamazoo or Allegan was significantly more expensive. Allegan is dinky, but Kalamazoo County is home to some 260,000 people, with two hospitals. You would not think Kalamazoo was “rural”, but evidence says, using either of them costs a lot more than hospitals in metro Detroit.

So, that was one more reason to stay here. As luck would have it, my doc is employed by Beaumont Hospital, so I have been registered on their patient web site for years. When the covid vax became available, Beaumont announced that they would be selecting eligible people from among those registered on their web site to be invited in for a jab. So many people tried to register, they crashed the site. Being already registered, I sat back. A few days later, I received an e-mail that, if I wanted to be eligible for the jab, confirm my contact info on the web site, which I did, A few weeks later, I received an e-mail invite to make an appointment. No huge line. No travel to the far side of the moon for a jab (my neighbors drove to somewhere in Ohio). “Big hospital” took good care of me.

Steve

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#7

Lots of things “could be”–but should be is a different analysis.

If “pay for what you use” is a supposedly valid claim, then a LOT of stuff would NOT exist much further than a moderate distance from any reasonably-sized city or town. Lots of stuff people expect to have would be available the same way the Pony Express functioned–at a range of about one oasis every set distance, defined as hours of travel that is a reasonable driving distance until a traveler might want/need a stop. That is why there are so many essentially “ghost towns” in the US–they were bypassed by more modern transportation because they were no longer needed as a stopping point in travel.

Most small farmers’ existences are VERY dependent on larger cities (not vice versa) because the smaller farms tend to specialize in products aimed at a niche market (organic, kosher, etc)–which really only exists in a large/major distribution system. People who seek those products can be found in a sufficient quantity in large markets to justify the farms’ multiple market niches/specializations.

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#8

Right on target, Goofyhoofy. I agree 100%. Wish i had more recs.

Part of the problem with supporting rural hospitals is declining population. Lower birth rate and mechanized farming have greatly reduced population. In rural Missouri typical population density was 30/sq mi in 1900 in the day of the horse. In 2010 some counties were down to 8/sq mi. And as baby boomers die we seem headed for 2/sq mi.

Part of the problem is physicians who specialize and prefer to serve in cities. Public health service could offer scholarships in return for agreement to serve in rural areas for x years.

Worst case is public health medical schools to train more doctors.

Lack of insurance for the poor is also a problem. We need some form of universal health care. It will better fund rural hospitals.

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#9

This is already happening. Some rural areas will fund med school for a doctor who will commit a certain number of years to serving that area.

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#10

Ever watch “Northern Exposure”? That was exactly the scenario, Jewish guy from NYC has his med school funded by the state of Alaska, in return for him being the GP in a small town.

Steve

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#11

Right on target, Goofyhoofy and Paul.

Having lived for decades on the lightly populated (2020 census ~24,000) south Oregon Coast, we saw first hand the difficulties of doctor recruitment/retention: (1) when a Physician has a spouse who expects to have professional employment and; (2) when a couple also expect to have modern educational opportunities available for their children.

It is complicated…

Curry County, Oregon’s South Coast

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#12

A childhood friend of mine wound up doing something that, only I’m pretty certain it was a federal thing. He practiced in rural Utah and Colorado. He split his time between different small towns out in the boonies.

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#13

We are going through this already in Missouri. Audrain County recently lost their hospital in the county seat, Mexico, MO. Now patients must drive 60 miles or so to Columbia or Hannibal.

If you are expecting a baby, can you wait that long? Or do you give birth at home? Or move to one of those cities close to your due date?

I can’t believe this is adequate health care for new mothers or their babies.

And yes, in an emergency they can call an air ambulance. Fees can be high. And insurance coverage iffy. For a baby delivery, doubtful.

#14

Used to watch it regularly.

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#15

They are.

The issue is not removing the hospitals. The issue is funding them.

Bringing down the cost and improving the care is to transport in patients to larger complexes for treatment.

Treatments these days means machinery. That is expensive for only a few rural patients. Also we are discussing in essences a myriad of medical problems. Plus it means specialists who are not necessarily in rural places. Plus it means techs who are not necessarily in rural areas.

In patient treatments no longer mean in bed on the ward with little done for you.

It also means rehabilitation and physical therapy which may not be available in rural areas.

In other words in patient treatment in rural areas may be dismal. Malpractice not to send people to urban or suburban centers for care.

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#16

It doesn’t matter who owns the land. It takes people to manage and run them. These people need the rural hospitals/services.

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#17

3.2 million dollars doesn’t seem like that much money to me for a hospital. But then again the long term care of patients is what really hurts profits. Patients who come into the hospital for a few days usually don’t eat up a hospitals resources like a sick patient who is in the hospital for a month. Also, the way insurance is set up, the longer a patient is in the hospital, the lower the hospital profits on the payments…doc

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#18

Actually, it matters a lot. Corporations are able to hire people to work on the land the business owns. So providing health care to employees is a cost the corporation carries–or else they do not have good employees. The good employees get hired away and go elsewhere because health care is something of significant value to them.

Small farms can not afford to hire many workers because they only profit by having the small farm owner do a major share of the work and then get paid via farm profits–if any.

#19

Well, no.

I agree entirely for the patients who need high-level care: urgent cardiac catheterization/angioplasty; high-risk OB; chemotherapy; emergent neurosurgery.

But a lot of community hospitalizations fall short of this.

Grandpa’s COPD flares. Two days of IV antibiotics, respiratory treatments, general tuneup and home.

Great-grandma is acutely confused. Ooops, she has a UTI. IV antibiotics, careful hydration and nursing, home (or previous care facility) by Monday afternoon.

Hunter Bob is brought in because he got lost/ran out of gas and is modestly hypothermic. Or, maybe he veered into a ditch, rolled his truck, hit his head. Overnight and home.

Dad has chest pain after shoveling snow. EKG and labs in ER are equivocal. Overnight monitoring and re-check labs; probably home in the morning with a cardiologist evaluation next week.

Teenage Tom does something stupid involving alcohol/drugs/his truck and fortunately needs only overnight observation and not ICU care while he comes down.

Sarah didn’t take her seizure meds, again, and spent too long outdoors until she was picked up. IV fluids for the kidneys, get seizure meds back on board, home in 48 hours

Aunt Edith got her chemo in the big city Wednesday, and is due back next Wednesday. It’s no Friday night and it’s snowing hard. She has a low-grade temp and feels rotten. She might well need a 100-mile transport back to the major medical center…or, she might not. Or, the roads might not be open, and the helicopter grounded.

You get the idea.

A country as rich as ours should be able to provide adequate rural health care for its people.

And, as far as the “I’m sick of their whining”…well, me too. (See my previous rants re: overheard conversations at the Redneck Cafe) (Kidding! Those were before the Great Purge)

But seriously: as a smarter, better man than I once said, “We are not enemies, but friends. We must not be enemies. Though passion may have strained, it must not break our bonds of affection.”

–sutton
who is not a fan of his species’ susceptibility to propaganda. Even the ones of average intelligence

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#20

The comment is about the need for rural services. It doesn’t matter who you are working for, yourself on a family farm or a corporate farm. The need for rural services is there.

#21

True, but the level of services does not have to be a hospital. Perhaps a clinic with 2-4 staff (<–there is the major ongoing cost), 1-2 beds for a couple people needing to recover from something simple, and not much more. Thus, it would require an affiliation of some type with a larger system that would be able to justify those costs over a much larger group of patients (i.e. perhaps affiliated with corporate employer(s) in some way).

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#22

It was said mostly tongue in cheek, but yes, when you look at the most anti-government, radicalized, and easily manipulated segment of the population you’ll find that it correlates nicely with the most rural parts of the geography.

It would be nice if someone would point out (to them) how they benefit from the government services that they decry. I do realize that is a fool’s errand because they don’t want to think about or be informed of it, and silo themselves to make sure their prejudices are not confronted.

It seems to me the only way to get through to them would be to remove those services in toto, although I would not seriously advocate that because, as others may have noticed, I have human feelings for others, even those with whom I disagree.

There is, however, a limit to the resources available via taxation (which they complain about) - as well as my patience. I would rather provide them some form of adequate health care than rural airports, but I don’t get to make that call. (I believe that rural health care can be provided for most care at a fraction of the cost of trying to equip every small hospital in Montana with a multi-million dollar MRI scanner or other high-cost super-specialized technological wondermachine.)

And yes, I like my food. I’m also aware it takes a small fraction of the number of people to produce it as it used to, and that number continues to decrease. That doesn’t mean they shouldn’t have anything in the way of medical resources, but there should be some semblance of reasonability of cost.

OK, but yeah, mostly it’s a rant about ingratitude. It’s not politics at all, it’s reality.

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#23

The article does say the stipend is for rural hospitals and doesn’t mention clinics which suggests that these facilities will have to meet a certain level of care…doc

#24

A rural “hospital” does not have to be anything like an urban “hospital”. We see that in govt all the time. Same word used, but not even close to the same thing when used in a different situational context.

#25

How were casualties handled in Iraq? Sticks in my mind the guys were stabilized in Iraq, then evaced to Ramstein, or to the US. Were there hospitals with hundreds of beds, giving the full course of treatment, and rehab, in country?

Steve

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