Rural America's Health Care Crisis
Rural communities are facing a crisis that, while quiet, is threatening millions. As hospitals in these communities close and services are cut, many Americans are losing access to quality health care.
Since 2010, more than 80 rural hospitals have shuttered. The National Rural Health Association, a non-profit that advocates for rural issues, estimates that there are as many as 700 more rural hospitals at risk of closing in the next 10 years. Just last month, the county commissioners of Decatur County, Tennessee, voted to close the county hospital. And even in cases where these hospitals stay afloat, critical services end up being axed. Often, obstetric services are atop the chopping block: between 2004 to 2014, 9 percent of all rural counties lost access to hospital obstetric services.
This is why emergency air medical services are now so essential: They ensure Americans living in rural communities have access to critical care when accidents, strokes, and heart attacks occur. While new technologies such as telemedicine can connect patients and physicians in remote communities for general health care needs, air ambulances have become the last — and sometimes only — link to immediate, critical care in many parts of the country. When medical emergencies strike, it is imperative to access the right kind of care as quickly and safely as possible.
According to the American Congress of Obstetricians and Gynecologists, fewer than half of women living in rural areas are within a 30-minute drive of the nearest hospital, and only 88 percent are within a 60-minute drive. In Alabama, only 16 of the state’s 54 rural counties have hospitals providing obstetrical services. This means that many women must drive an hour or more just to deliver their babies or get access to basic prenatal care.
It wasn’t always this way. For instance, in 1980, 45 of Alabama’s 54 rural county hospitals offered obstetrical care. As hospitals continue closing their doors, rural communities will be farther and farther away from quality health care. If access to high-quality health care becomes more difficult for expectant mothers, they run the risk of unexpected labor, which can put both the mother’s health and that of her newborn in jeopardy.
Today, one in four Americans — or 85 million people — can only get to a hospital with a Level I or II trauma center in under an hour if flown by helicopter. That’s pretty significant when you consider the immediate and sometimes life-threatening health care needs of a stroke victim, or those suffering heart attacks or traumatic injuries. In these cases, timely and definitive care is a must. But in places like Carson, North Dakota, ambulance services shut down in late 2014 and there is growing fear among residents that the 1.6 thousand miles of Grant County, where Carson is located, will lose access to services altogether.
Unfortunately, like rural hospitals, access to emergency air medical services is under threat. The inadequate reimbursement rates for this service that are provided by Medicaid and Medicare (as well as by some private insurers) fail to cover a significant portion of the cost to operate these critical services. According to an Xcenda Air Medical Services cost study report, 70 percent of patients who are transported by helicopter during an emergency are covered by underpaying insurers or have no insurance at all, placing a significant strain on air medical services. Just as rural hospitals are closing, so are air medical bases.
Fortunately, Congress has before it a solution that would address this reimbursement shortfall, protecting access to health care. The Ensuring Access to Air Ambulance Services Act (S. 2121/H.R. 3378), drafted by a bipartisan group of lawmakers in both the House and Senate, would require the Centers for Medicare and Medicaid Services to: develop an accurate payment system based on the actual costs of providing air medical care; establish a mandatory quality reporting program; and improve transparency of costs among providers, patients, and insurers.
Passing this legislation will be an important step in ensuring communities across America maintain access to life-saving emergency air medical services, especially in rural areas that are now increasingly relying on these services. Fixing reimbursement rates will ensure people who are being forced to live farther and farther away from hospitals still have access to emergency care.
Let’s not add insult to injury. We must do everything we can to protect and preserve health care access across the country — air medical services are a critical component. They are not an option, but a life-saving necessity.
Dr. Suzanne Harrison and Dr. Kim Templeton are president and past president, respectively, of the American Medical Women’s Association (AMWA).