Investment in rural hospitals and health infrastructure has lagged since 2014, a recent JAMA Health Forum study found.
Some organizations are attempting to reignite investment with a multi-pronged approach of improving rural facilities, boosting community partnerships and expanding virtual care.
HealthAlliance, part of the Westchester Medical Center Health Network, is set to open an expanded Mary’s Avenue hospital campus in Kingston, New York. The new facility was funded by New York State and WMC Health. New technology in the facility was funded through an agreement signed last year with the tech giant Philips that ensures a $500 million long-term strategic partnership with WMCHealth. Rural Hudson Valley communities will now be able to access the latest advancements, including Philips precision diagnostic, telemedicine and patient monitoring technology, according to the organizations.
“The HealthAlliance Hospital transformation involved a significant contribution in partnership with Philips, a world leader in health technology, imaging and monitoring, and that's largely what we're turning to them for is our imaging department,” Michael Doyle, M.D., HealthAlliance of the Hudson Valley executive director and chief medical officer, said in an interview. “We still have the leading edge, the newest technology, the newest equipment in MRI, CT, X-ray, fluoroscopy, ultrasound, all of that provided as part of a 15-year agreement that we have with Philips. That agreement also ensures that the technology stays up to date.”
For the HealthAlliance Hospital partnership, Philips will provide the latest connected patient monitoring systems, as well as diagnostic imaging technologies such as CT that can help lower radiation dose and innovations such as Compressed SENSE for MRI exams that enable patients to be scanned up to 50% faster. HealthAlliance Hospital also will offer the Philips Ambient Experience in the new imaging center, designed to create a calm and engaging experience for patients, family and staff.
Technology brings a digital lifeline to healthcare deserts
Philips has previously announced partnerships to address healthcare deserts including collaborating with Nuvo earlier this year to broaden maternity care access in rural areas.
Lack of financial stability has been blamed for the closing of 120 rural hospitals between 2010 and 2020 along with hospitals scaling back services. Once a hospital is closed, initial financial barriers to reopening tend to keep doors closed.
Rural populations comprise 15% of the U.S. population, according to data from the Centers for Disease Control and Prevention. Unintentional injury deaths are nearly 50% higher in these locations due to motor vehicle crashes and opioid overdoses, children are less likely to receive behavioral health support and access to quality, timely care is drastically lower, data shows.
Facility closures and limited obstetrics providers were recently highlighted by a March of Dimes report as part of the reason that a third of U.S. counties are maternity care deserts.
Through using Philips sensor bands during virtual visits, expecting parents in rural Colorado were able to connect to high-quality care without crossing county lines and mountain passes. Philips is now bringing more innovations to rural New York.
In October, the U.S. Department of Agriculture (USDA) acknowledged the lingering rural needs by announcing $110 million in grants to 208 organizations through the American Rescue Plan Act to improve health infrastructure in rural communities.
The HealthAlliance hospital expansion includes an emergency department, behavioral health triage area, family birth center with private rooms, advanced critical care capabilities and imaging supported by Philips.
The partnership with Philips, which Doyle emphasizes as a partnership as opposed to a vendor and client relationship, ensures that facilities maintain the most up-to-date technology at the rate of advancement.
“The partnership includes training and support for the equipment, so our staff stays up to date on changes in the technology,” Doyle said. “We’re engineering non-obsolescence. Part of the agreement is that we will keep the current best technology and best practices. That has a significant impact on the delivery of healthcare in rural locations and rural supported locations. Kingston itself was a city, but it has a large rural population and Ulster County standing beyond into the area that seeks its care here.”
Mary’s Avenue hospital campus will now provide patient monitoring systems to standardize care across urban and rural areas, including nearby Ulster country which contains one healthcare desert. Neighboring Greene County encompasses five healthcare deserts with shortages in hospital beds, pharmacies, health centers, hospitals and trauma centers.
HealthAlliance is leveraging telehealth technology to bring specialists into rural areas that otherwise would not have access to them. As one example, virtual care will be used to connect stroke experts with community hospitals, Doyle noted. When "time is tissue," he says, that expert can make a big difference.
Other specialties are being brought to rural areas, including tele-psychiatry implementation in K-12 schools and virtual trauma consultations in critical access care centers.
AI-enhanced remote patient monitoring is being used to predict and identify health emergencies in at-risk patients.
Expanding technology’s reach and efficacy with community relationships
The current goal for HealthAlliance is not to create a complex hospital campus in each corner of each county but harness the power of technology that already exists to create a lifeline between healthcare deserts and HealthAlliance. Through the WMCHealth Network, a whole host of experts can be easily tapped into with new Philips technology.
“If you look outside of the technology package, we have providers who go out into the community reaching folks who have health needs that aren't easily met,” Doyle said. “We maintain a critical access hospital in Margaretville because with the healthcare desert that exists in western Ulster County, we believe we have to meet that need. It's our mission.”
Patients living far outside HealthAlliance’s geographic range are now coming to its cardiac catheterization lab because local hospitals are unable to provide life-saving care due to patient volume and staffing shortages, Doyle said.
“Working closely outside of the network, outside of geographical boundaries and having relationships with other hospitals has been key to leveling and cross leveling, both within the network and outside of the network for patient care,” Doyle said.
The Affordable Care Act mandated in 2010 that tax-exempt hospitals conduct community needs assessments every three years and participate in community-level planning to improve outcomes.
However, the recent JAMA study written by authors affiliated with Harvard’s School of Public Health and Brigham and Women’s Hospital found that rural hospitals screened for a similar number of social determinants of health as urban hospitals but implemented fewer programs, interventions and community partnerships.
If Doyle had to suggest a playbook for hospitals serving rural populations, he would offer three primary areas of focus: emergency rooms partnered with larger facilities, substance abuse treatment and outreach and telehealth implementation.
Partnerships with community groups can be a vital tool for spreading the gospel of health, according to Doyle, and he emphasized the power of relationships with local health departments, law enforcement and even setting up booths at local events.
TimeDoc Health expands the reach of primary care
In addressing health issues prevalent in rural communities, the CDC emphasizes preventative screenings for cancer and high blood pressure, identifying support for families who have children with behavioral disorders and lifestyle alterations.
TimeDoc Health, a virtual care management company, partners with remote patient monitoring solutions to address chronic care conditions. Through the use of care coordinators, the company can supplement the support provided by primary care providers and help address the root of chronic conditions.
“Today we've got 10,000 Americans who are moving into Medicare every day and that's going to last until 2030 and primary care physicians are kind of increasingly expected to comprehensively manage those Medicare beneficiaries who have multiple chronic conditions including doing things for those patients that don't exactly have a clinical solution, like addressing their social determinants of health and trying to drive behavior change,” TimeDoc CEO Will Boeglin told Fierce Healthcare.
TimeDoc provides blood pressure monitors, glucometers and web applications integrated into primary care providers’ electronic medical record systems. Care coordinators then step in to serve as a virtual extension of care through phone calls and private messages.
TimeDoc works with 120 unique healthcare organizations comprised of over 100,000 patients. For teams with staffing shortages or in rural areas, they offer the co-source model by implementing their care coordinators. For larger teams, they offer a tech-only model.
“Our same care coordinators also provide a remote patient monitoring service,” Boeglin said. “A lot of the patients who need this have uncontrolled hypertension or diabetes and they can really benefit from using a blood pressure monitor or a glucometer on a daily basis because their condition is uncontrolled, and they need pretty close monitoring and medication titration.”
Remote monitoring data is brought into the primary care provider's EHR, placed into reports and analytics to see overall patient health and then used to flag providers and TimeDoc’s team if the patient is in danger.