Research Alert: October 19, 2022

New Research Publications on Converting to a Rural Emergency Hospital

CORRECTION: This research alert was previously released with incorrect contact information. Please reach out to George H. Pink, PhD with questions about the following research.

Small Rural Hospitals with Low-Volume Emergency Departments that May Convert to a Rural Emergency Hospital (REH)

This study examines Critical Access Hospitals (CAHs) and Prospective Payment System hospitals, with no more than 50 beds, in rural areas that are eligible to convert to a Rural Emergency Hospital (REH). For this study, hospitals with low emergency department (ED) volume are considered to be most likely to convert to an REH. In comparison to hospitals with greater ED volume, the hospitals with low-volume EDs:

• Are more likely to be located in the Midwest, be a CAH, be government-owned, and not be affiliated with a system.
• Have lower acute inpatient volume and lower outpatient volume.
• Are more likely to own and operate their own ambulance service, are more likely to have a Rural Health Clinic or a skilled nursing facility, but are less likely to be affiliated with an air ambulance company.
• Have similar access to computed tomography scanner services but are less likely to provide magnetic resonance imaging services.
• Have fewer overall physicians with hospital privileges but a similar number of Advanced Practice Providers.

Key Considerations for a Rural Hospital Assessing Conversion to Rural Emergency Hospital

Based on findings from a literature review and consultation with practitioners, a conceptual framework and checklist were developed to organize and guide conversations about key considerations for conversion to an REH. The conceptual framework includes considerations across five key domains: feasibility, workforce, community, partnerships, and regulation. This findings brief provides a basic financial framework for considering the incremental revenues, costs, and avoided costs that may be expected if a hospital converts to an REH by eliminating inpatient care.

Additional Resources of Interest:

• More information about the North Carolina Rural Health Research and Policy Analysis Center
• More information from the Rural Health Information Hub's topic guides: Critical Access Hospitals, EMS and Trauma, Healthcare Access, Rural Health Policy