In the heart of California’s rural landscapes, Critical Access Hospitals (CAHs) serve as essential pillars of healthcare, providing lifesaving services to communities where medical resources are often scarce. At the California Telehealth Resource Center (CTRC), we understand the crucial role these facilities play in maintaining the health of rural populations. That’s why we offer a range of no-cost, unbiased digital health resources tailored to meet the needs of health professionals operating in these challenging environments. Through leveraging technology and innovation, CTRC is committed to helping CAHs overcome the geographical and financial barriers that threaten their ability to deliver care. This blog explores the profound impact digital health can have on sustaining CAHs and, by extension, the communities they serve, ensuring that no patient is left behind due to their zip code.
The Backbone of Rural Health Care
Digital health technologies offer a robust solution to a number of pressing challenges faced by Critical Access Hospitals (CAHs) in rural America. Established by the Balanced Budget Act of 1997, CAHs were designed to ensure healthcare availability in regions most susceptible to service gaps. California, with its vast and varied geography, is home to 34 CAHs that provide essential medical services across isolated rural counties, as reported by the California State Office of Rural Health.
These hospitals are essential in delivering comprehensive healthcare, including emergency, inpatient, and outpatient services, often serving as the first, and sometimes only, point of care for medical emergencies in their regions. They provide continuous, 24-hour care critical for managing life-threatening conditions and are equipped to offer inpatient care for situations necessitating overnight stays.
Despite their critical importance, CAHs face ongoing threats to their sustainability, such as workforce shortages, financial instability, and the logistical challenges of serving dispersed populations. Here, digital health innovations come into play, providing vital support. By integrating telemedicine, electronic health records, and remote monitoring technologies, CAHs can enhance their service delivery. This digital approach not only helps in managing chronic diseases and conducting routine follow-ups but also ensures that patients in remote areas have better access to specialist consultations without the need to travel long distances.
Digital health tools not only promise to bridge the gap in service delivery but also aim to stabilize the operational aspects of CAHs by improving efficiency and reducing overhead costs. This is vital for the sustainability of healthcare services in California’s rural landscapes, ensuring that residents receive timely and effective care regardless of their geographic location.
To better understand how virtual care can support our most critical providers, we will examine a recent collaborative initiative aimed at creating a sustainable care model for a rural hospital in need.
Two-Way Interactive Audio/Video Telehealth Supporting Rural Hospital Sustainability: Insights from the Telehealth Centers of Excellence
The partnership between the Telehealth Centers of Excellence (COEs) and Hampton Regional Medical Center (HRMC) exemplifies how two-way interactive audio/visual telehealth can support the sustainability of rural hospitals. The Telehealth COEs are an HRSA-funded collaboration with the Medical University of South Carolina and the University of Mississippi Medical Center. You can explore their resources here.
HRMC, a 32-bed not-for-profit rural hospital, faced significant challenges due to its proximity to counties that experienced hospital closures and its low inpatient occupancy rate. To address these issues, the COEs and HRMC developed a sustainable care model heavily incorporating telehealth.
Methodology and Telehealth Integration
The initiative, funded by the South Carolina Department of Health and Human Services, focused on both outpatient and inpatient care. Key components of the two-way audio/video telehealth program included:
- Outpatient Telehealth Services: Urology and hematology-oncology consultations were provided via telehealth, allowing patients to receive specialized care without traveling long distances.
- Inpatient Telehealth Consultations: Neurology, cardiology, infectious disease, and ICU consultations were conducted through telehealth. Tele-hospitalists, in conjunction with onsite advanced practice providers (APPs), rounded on all admitted patients daily and provided 24/7 pager coverage for any acute issues.
- Tele-hospitalist Rounding: This model ensured continuous and comprehensive care for inpatients, improving patient outcomes and operational efficiency.
Findings and Impact
The telehealth initiative at HRMC yielded notable improvements in several performance measures:
30-Day Readmissions:
- Notably reduced from 68 pre-implementation to 44, ranking HRMC #1 among similar-sized hospitals in the state for preventing 30-day readmissions.
Inpatient Transfers:
- The number of total inpatient transfers decreased from 79 pre-implementation to 72 in FY 2022.
Average Daily Census (ADC):
- Increased from 7.23 pre-implementation to 9.49 in FY 2022, reflecting better utilization of hospital resources.
Case Mix Index (CMI):
- Improved from 1.22 pre-implementation to 1.41, indicating a higher complexity of treated cases. A facility that records a higher case mix index indicates it has managed a greater number of complex, resource-intensive patients. Consequently, this leads to higher reimbursement rates for the facility.
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- Coding accuracy
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- Documentation specificity
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- Patient comorbidities
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- Patient population
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- Annual updates to relative Medicare Severity Diagnosis Related Group (MS-DRG) weights
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- An increased score may indicate higher coding and documentation specificity.
Implications for Rural CAHs
The successful implementation of telehealth at HRMC demonstrates how digital health technologies can sustain and enhance the operations of rural hospitals. By leveraging telehealth, CAHs can:
- Improve Access to Specialty Care: Telehealth bridges the gap between rural patients and specialized medical services, reducing the need for long-distance travel and ensuring timely care.
- Enhance Patient Outcomes: Continuous monitoring and regular consultations via telehealth lead to better patient management and reduced readmission rates.
- Optimize Resource Utilization: Telehealth allows for efficient use of hospital resources, improving occupancy rates and the overall financial health of CAHs.
- Support Economic Stability: By keeping care within the community, telehealth initiatives can help CAHs maintain their role as significant local employers and economic contributors.
The HRMC telehealth initiative highlights the transformative potential of digital health technologies in supporting the sustainability and growth of rural hospitals. CAHs can adopt similar models to overcome operational challenges, enhance patient care, and ensure long-term viability.
Resources & More
Critical Access Hospital providers have a variety of resources at their disposal to enhance service delivery and operational efficiency. At the California Telehealth Resource Center, we pride ourselves on offering a comprehensive library of resources tailored to the unique needs of rural healthcare providers. However, beyond our offerings, numerous other opportunities exist, including vital funding opportunities. If you cannot find what you are looking for, please do not hesitate to contact our team at CalTRC@OCHIN.org for no-cost technical assistance.
Opportunities for Critical Access Hospitals
- The California Critical Access Hospital Network (CCAHN) is dedicated to strengthening California’s critical access hospitals through collaboration, resource sharing, education, and innovation, ensuring that these vital institutions can continue to serve their rural communities effectively.
- The Small and Rural Hospital Relief Program (SRHRP) provides grants to qualified small, rural and Critical Access hospitals for the purpose of funding seismic safety compliance projects.
- The Medicare Rural Hospital Flexibility (FLEX/CAH) Program supports small, rural hospitals at multiple levels—national, state, community, and facility—by addressing key health service challenges and modernization. This comprehensive program encourages states to develop rural health plans and provides funding for performance management, training, and technical assistance to improve healthcare quality, emergency medical services, and rural health networks. For any questions, you can reach out to Peggy Wheeler at pwheeler@calhospital.org or Lisa Geraty at lgeraty@calhospital.org
- The California Public Utilities Commission (CPUC) manages the California Teleconnect Fund (CTF), a critical program that offers discounted telecommunications services to qualifying entities across the state. The CTF offers eligible entities a 50% discount on selected telecommunications services, making high-speed internet and other critical services more accessible and affordable.
- The Federal Communications Commission (FCC) established the Rural Health Care Subsidy Program to improve the quality of care available to patients in rural areas by ensuring that healthcare providers (HCPs) have access to the same advanced telecommunications and information services as those who work in urban areas. It also seeks to reduce the cost of high-speed internet access and telecommunications services, which are critical for modern medical practices, digital health initiatives, and EHR management.
Conclusion
The resiliency of Critical Access Hospitals is a defining characteristic of these essential providers. By integrating digital health technologies and adopting sustainable models of change, there is a pathway to sustainability for these vital institutions. As the lifeline of healthcare in rural America, CAHs are crucial not only for the health of their immediate populations but also for the overall stability and vitality of rural communities across the nation.
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