Researchers in North Texas are calling for more insight into whether a federal program is improving access to care for rural communities.
Certain rural hospitals were able to convert to "Rural Emergency Hospitals" beginning in 2020. The designation allows hospitals to participate in a new federal payment program designed to provide financial stability and ensure access in rural areas.
Elizabeth Merwin, a nursing professor at UT Arlington, said researchers have questions about how the conditions of the program affect care.
"There's very little evidence or research-based information on the outcomes of the use of –or the switch to rural emergency hospitals," she said.
About 1,500 hospitals were eligible for the program based on the specific requirements.
Since the first hospitals converted in 2023, 40 have joined the program. Currently, Texas is home to four of those hospitals.
"In order to be eligible, a hospital had to be enrolled in Medicare," said Suzanne Daly, another professor at UTA's Center for Rural Health and Nursing.
Daly said there were also stipulations based on the size of the hospital and the designation it already had. When hospitals enter the program, they can't provide inpatient care.
The program "does potentially provide a lifeline" for struggling rural hospitals and preserving "a baseline of care," according to a recent paper written by the UTA researchers. The baseline focuses on emergency and outpatient care that "might ultimately be more profitable," the paper said.
Focusing on those services does mean losing vital inpatient services in rural communities, but keeping a source of care open in a community can be critical – especially with so many rural hospitals closing or facing a risk of closure.
Texas has seen 14 rural hospital closures in the past decade. More than half of the state's 154 remaining rural hospitals are at risk of closure.
The loss of care, including inpatient care, means patients may have to leave their communities to seek those services. Merwin said this can make transportation an even bigger hurdle.
"When you think of the size of Texas and the mileage between different communities, that's a particularly unique feature of Texas that we'll have to watch in looking at how these programs affect access and quality of care," Merwin said.
In addition, the program depends on rural hospitals having a relationship with larger facilities that are able to provide inpatient or specialized care – this can increase the strain placed on hospitals in non-rural communities.
"Whether or not these more urban hospitals are going to be able to absorb these patients is a really significant question," Daly said. "What kind of impact that might have on these hospitals that are more urban. Do they have the staffing for it? Do they have the beds for it? I think that's a big unknown right now."
The researchers said there are a lot of questions they're interested in exploring further. Merwin said there are a lot of opportunities to examine the issues facing rural communities and the health care industry as a whole.
"We have been in discussions about designing a study that would include interviewing some of the leaders and providers in the rural hospitals in Texas," Merwin said.
She said the research could help explain how rural health leaders determined whether or not they converted to the new program or not.
Despite the lack of data and analysis, Merwin said rural health care leaders are focused on making decisions that are in the best interests of the communities they serve.
"While we don't know a lot about outcomes at this point, they're an attempt at a solution …to contribute to improving rural health care," Merwin said. "I'm grateful when there are opportunities to consider different ways to improve rural health care."
Abigail Ruhman is KERA's health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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