With many rural hospitals failing across the state, Georgia may experiment with standalone emergency rooms.
Lawmakers made the change to allow freestanding ERs after three rural hospitals closed in the last year, with many others reporting financial struggles, the Associated Press reported. Under the rules, the standalone ERs must be open around the clock and treat all patients regardless of their insurance status, and cannot be more than 35 miles from a full-service hospital. They must also have in place agreements to transfer anyone who needs inpatient care.
"A hospital closes now, particularly in a small, rural community, there's nothing, nothing," Clyde Reese, commissioner of Georgia's Department of Community Health, told the AP. "So this is an attempt to have something, some service, some infrastructure left in a community so all the doctors won't leave, so the EMS services won't leave and follow the facilities."
The rural hospital financial crisis is not confined to Georgia, but is more acute in other states that did not expand Medicaid, according to the Wall Street Journal.
"We are in crisis mode," Maggie Elehwany, vice president of the National Rural Health Association, told the Journal. "We've got gale-force winds coming from one direction, the tide coming in from another and it's really hitting these small hospitals who operate at tiny margins."
Georgia Gov. Nathan Deal (R) has proposed "stepdown" hospitals earlier this year as a way to keep struggling rural facilities afloat. Meanwhile, studies suggest that rural hospitals operate more efficient ERs than their urban and suburban counterparts.
Hometown Health, a rural hospital lobby in Georgia, has expressed reservations about whether standalone ERs can succeed, citing data that suggests it would not be feasible in any area with fewer than 40,000 people. Flint River Hospital, located in Macon County, which has about 15,000 residents, shuttered its ER last year and converted to urgent care, but may reopen as a standalone ER, according to the AP.
However, others suggest that they may be worth it to subsidize freestanding ERs for full hospitals if it means regular referrals, according to the AP article.