Rural residents are 5x more likely than city dwellers to live in an “ambulance desert” where the nearest ambulance station is at least 25 minutes from their home. In raw numbers, that means about 2.3 million rural Americans are at heightened risk in emergency situations. Even the best hospital can do only so much for a patient who lost precious minutes during the so-called “golden hour.”   More than 80% of rural counties have at least one ambulance desert, and the problem is especially acute in the West, where small populations are spread over large areas. South Dakota, for instance, cov ..read more

Vulnerable rural providers have been converting to the new Rural Emergency Hospital status at a rate of 1.5 per month throughout 2023, the first full year of the program. That might not qualify as a groundswell, but 18 volunteers for a new and untested reimbursement model is still notable.   This is a model we’ve been closely following since it was first introduced, so the one-year anniversary seemed like a good time to assess. As a quick review, Medicare offers two major financial incentives to rural hospitals that opt for REH status: Outpatient services are reimbursed at 105% of the OP ..read more

With rural communities facing a crisis in accessible healthcare, lawmakers in North Carolina have committed funds for an independent, statewide analysis of more sustainable delivery models. Read about RHI's historic opportunity in the press release below. Raleigh, NC, September 22, 2023 – North Carolina’s new budget was approved today by the General Assembly, and Gov. Roy Cooper issued a statement that he would allow it to become law without his signature. The budget makes strong investments in healthcare, including a $2.5 million appropriation for creating “effective models of sustainable he ..read more

Congress has been working for years to solve the problem of hospital closures in rural America, and the result is an alphabet soup of special hospital types that qualify for higher Medicare payments: CAH, MDH, LVH, SCH, and most recently, REH.* I’m glad that Washington recognizes the need to do something, but all those good intentions are being undermined by two more little letters: MA, or Medicare Advantage. As the Congressional Research Service pointed out in an April 2023 study, only traditional Medicare is required by law to pay higher rates under the various rural hospital designations ..read more

It’s the economy, stupid. Campaign strategist James Carville coined that dictum in the 1992 presidential campaign, helping Bill Clinton upset George Bush amidst a deep recession. Three decades later, the phrase still holds true for understanding public attitudes toward hospitals and health systems. Based on a survey of 1,000 consumers nationwide, our friends at Jarrard have released an important new study on public perceptions of finances and healthcare. Jarrad partner Isaac Squyres, an RHI contributor, gave us a look at the rural data and offered his analysis. “The study indicates money is th ..read more

State lawmakers across the country are debating legislation to authorize Rural Emergency Hospitals, the new federal model launched by Medicare on Jan. 1, 2023. We believe there's a lot riding on these state authorizations, so we decided to see if the REH Conversion Calculator could help quantify the urgency. We started with Arkansas, where an authorization bill has already passed the House and awaits consideration by the Senate. Arkansas has 28 Critical Access Hospitals that would be automatically eligible for REH conversion if allowed by state law. Based on recent financial and operational d ..read more

After years of study and planning, Medicare officially launched its new Rural Emergency Hospital (REH) model on Jan. 1. Experts can debate the model’s strengths and weaknesses, but for rural hospitals facing financial disaster, it all boils down to this question: Would an REH conversion improve the odds of keeping our doors open? Unfortunately, there’s never been a quick and easy way to know what the numbers look like in a specific community ­– until now. Rural Healthcare Initiative is pleased to introduce a first-of-its-kind data analysis tool for rural hospitals weighing an REH conversion ..read more

At a New York City awards ceremony on Dec. 5, 2022, the Rural Healthcare Initiative was recognized by the Financial Times for "originality, leadership, and impact" in socially responsible business. "Awards don't always mean a whole lot, but this one is important to me," says RHI co-founder Bob Wilson, a partner at Nelson Mullins Riley & Scarborough. "It affirms not just our concept for addressing the needs of rural community healthcare in a holistic manner, but also it recognizes the looming crisis of access to healthcare, keeping healthcare local. I hope that we can shine a light on the ..read more

If you looked up “rural county” in the dictionary, you just might find a map of Daniels County, Montana. With 1,661 residents spread across 1,426 square miles, Daniels was named the most rural county in the continental U.S. in 2000, according to the Index of Relative Rurality. Surrounded by farmland that stretches to the horizon in every direction, Daniels Memorial Healthcare Center (DMHC) is a nonprofit, 25-bed Critical Access Hospital. As the second-largest employer in the county, DMHC enjoys strong community support and an active volunteer board, led by Paul Kanning, a fourth-generation fa ..read more

Within a matter of days, the U.S. Department of Health and Human Services will issue its Final Rule allowing small, rural hospitals to convert to a new Medicare provider type – the first such change in a generation. Rural Emergency Hospital (REH) status could help stem the rising tide of hospital closures by allowing under-utilized facilities to close their inpatient beds while receiving $3+ million a year in federal payments for sustainable outpatient services. Some early studies of the REH model predicted that only a few dozen hospitals were likely to make the switch, but interest appears t ..read more