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What can be done to save rural imaging?

by Valerie Dimond, Contributing Reporter | December 04, 2020
Business Affairs
Eric Friedberg
From the November 2020 issue of HealthCare Business News magazine

Rural healthcare providers in the U.S. have been under tremendous strain for a long time. The pandemic has only exacerbated some of those challenges. We spoke to Eric Friedberg, the American College of Radiology’s chair for the General, Small, Emergency, Rural Practices Commission Network Planning Committee to find out what the situation looks like today, and what’s being done to fix it.

HCB News: We know that rural providers have been struggling for years. What was the situation like prior to the pandemic?
Eric Friedberg: Prior to the pandemic, rural America — which comprises nearly 20% of the U.S. population (> 60 million people) — was facing a crisis in care due, in large part, to rural hospital closures. Per Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, over 130 rural hospitals have closed since 2010, and 174 have shuttered since 2005. Prior to the pandemic, even those rural hospitals that remained viable were experiencing high rates of financial distress, and many of them (some estimated as many as 20%) were near bankruptcy.

In particular, the economics of providing diagnostic imaging and interventional services to rural patients at a level of care on par with that provided in urban areas have always been challenging. Imaging centers require capital-intensive investment and ongoing operations costs to provide the necessary equipment, technology, staff, and facilities to the patient population they serve. Rural populations are dispersed over larger geographic areas than urban populations. Smaller numbers of patients who are more commonly uninsured or underinsured are primarily served by rural imaging centers. These centers do not have offsetting reductions in costs to make up for the differences in revenue the higher volume urban imaging centers tend to generate for similar services. Because of these challenges, many critical access and rural hospitals are unable either to obtain or maintain higher-end imaging equipment, such as CTs and MRs, or to meet demand for interventional services. Historically, funding from outside sources, both government and private, has been inadequate to overcome the financial impact of falling reimbursements and increasing costs driven by regulatory, legislative, socioeconomic, and other factors.

HCB News: How has the COVID-19 pandemic impacted access to imaging in rural areas?
EF: The pandemic has only exacerbated the already substantial challenges of providing high- quality health care in rural areas. The implementation of precautionary measures by imaging facilities in response to the pandemic significantly drove costs up, while concurrently decreasing patient throughput. Rising costs and falling revenues, superimposed upon diminished cash reserves, precipitously increased financial pressure on these centers. Those fortunate enough to receive loans/grants have fared better than those that did not. Nevertheless, 15 rural hospital closures have occurred to date in 2020.

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