Member Research and Reports

Member Research and Reports

Iowa Study Finds Tele-ERs Save Money, Improve Physician Recruitment in Rural Hospitals

A new study from the University of Iowa finds rural hospitals that use telemedicine to back up their emergency room health care providers not only save money but find it easier to recruit new physicians.

Dr. Marcia Ward, study author and professor of health management and policy in the University of Iowa College of Public Health, says the results suggest that expanded use of tele-emergency services could play a key role in helping small, rural critical access hospitals maintain their emergency rooms.

[Photo: Dr. Marcia Ward]

“The study finds that expanding options for provider coverage to include telemedicine in some rural emergency departments has noticeable benefits,” says Dr. Ward, whose study was published Dec. 3 in the December issue of the journal Health Affairs. “This supports the viability of critical access hospitals at risk of closing and leaving their communities without local emergency care.”

Many of the nearly 1,400 rural hospitals in the United States are struggling to provide health care services generally because of declining population and rising costs. One of those services is emergency medicine, as emergency rooms are expensive to operate and, until 2013, were required to be staffed with a physician on site or on call 24 hours a day. As a result, Dr. Ward says many rural hospitals are unable to staff their emergency rooms (ERs) with doctors trained in emergency medicine. Instead, they’re covered by family physicians from the community who share ER coverage along with their regular clinic and hospital practice.

However, in 2013, a Medicare rule clarification allowed rural hospitals to fulfill their on-site staffing requirements using an advanced practice provider, such as a physician assistant or nurse practitioner, as long as they have remote access to a physician using a telemedicine link. To measure the impact of that rule change, UI researchers analyzed 19 rural hospitals in the Sioux Falls, South Dakota-based Avera Health network. Seven of the hospitals took advantage of the Medicare rule clarification to back up their ER providers with telemedicine doctors who work at the hub hospital in Sioux Falls.

The spoke hospitals were located in Iowa, Minnesota, North Dakota, South Dakota, and Nebraska.

Key findings from the study include:

Dr. Ward also is director of the College of Public Health’s Center for Health Policy and Research and conducted the study under the auspices of the university’s Rural Telehealth Research Center.