Georgia Aims to Revive Its Rural Healthcare System

In 2014, Georgia officials realized the state’s rural healthcare system was in critical condition. In recent years, eight hospitals had closed or restructured services. Additionally, 15 hospitals were considered financially fragile. Most of Georgia is a federally designated medically underserved area.

In April of that year, Gov. Nathan Deal (R) created a Rural Hospital Stabilization Committee to identify solutions for the healthcare needs of the state’s 1.8 million rural residents.

“When a rural hospital struggles, a community struggles,” Deal said in a statement when he released the committee’s findings in February. “Back in April we stood at a critical juncture for some of our state’s rural healthcare systems, and this committee was just one of the paths taken to ensure that Georgians, no matter where they live, have the ability to receive adequate care.”

The committee, which included lawmakers, CEOS, healthcare professionals, business owners and local officials, released its findings in February 2015. Its main recommendation was to pilot an integrated “hub-and-spoke” model designed to ensure patients receive treatment in the most appropriate setting, and relieve the emergency department cost pressures that can lead rural hospitals to close.

Hub-and-Spoke Design

Four designated hospitals—Union General Hospital, Appling Health System, Crisp Regional and Emanuel Regional Medical Center—will act as the “hubs.” Each of these hospitals also has nursing home, home health and rural health clinic components.

The “spokes” will include:

• Smaller critical-access hospitals;
• Wi-Fi- and telemedicine-equipped ambulances;
• Telemedicine-equipped school clinics;
• Federally qualified health centers;
• Public health departments;
• Local physician offices.

“It’s the future spine of the Georgia healthcare system,” says committee member Jimmy Lewis, CEO of HomeTown Health, LLC, a network that includes the state’s more than 55 rural hospitals as well as other healthcare providers and best-practice business partners. “For example, having the ambulances equipped with telemedicine and Wi-Fi capability, we suddenly have 1,000 facilities of integrated healthcare delivery.”

The committee also recommended extending the reach of the spokes through methods such as health apps, social and community services, and mobile monitoring.

Pilot Program Goals

The program aims to prevent overutilization of the ED as a primary-care access point. The goals are to help healthcare professionals at all levels:

• Ensure each patient is being transported to the appropriate setting;
• Monitor chronically ill patients to help them avoid repeat trips to the hospital;
• Address frequent flyers to emergency rooms.

“The idea is that a med unit gets to a patient and, with their expanded capabilities on the unit through telemedicine, they will then be able to have a doc triage a patient there on the spot to decide if they need to be transported or just checked out,” says Georgia Rep. Terry England (R), who co-chaired the committee. “If they need to be transported, then the doc will be able to direct them directly to the facility that has the ability to treat them.”

Resources for Implementation

The committee focused on optimizing the use of resources already available throughout the state, including:

• 156 federally qualified health centers;
• 55 school systems with telemedicine-equipped school nurse programs;
• 20+ telemedicine-equipped nursing homes;
• 1,000 ambulances capable of being equipped with locator systems and Wi-Fi; many also have telemedicine capabilities;
• Skilled physicians who already serve rural patients.

“The most amazing finding was that we have more than 500 healthcare access points in Georgia, and few of them coordinate delivery with each other, so better coordination and communication is needed,” England says. “Another finding was that many are in severe financial distress and that there are some fairly easy fixes to help that, and we are now working to implement those. The idea is to lower the delivery cost by not duplicating many options and help hospitals be more efficient in handling patients—right patient, right place, right time. It’s about getting the patient to the right spot for their needs at the time they need it.”

The committee also requested, and the governor granted, $3 million from the state budget to be used at the four hub hospitals for hardware, software, program development, process improvements and training needs as well as the implementation, monitoring and evaluation costs.

“The $3 million from the state buys the telemedicine equipment for the four hospitals,” says Lewis. “For it to work, the four hospitals had to agree to chip in $50,000 each into the project and also ask the county where they are to put in $50,000. Managed care had to chip in a couple hundred thousand dollars. The chosen hospitals, counties and the CMOs all agreed to do it.”

Anticipating a Good Outcome

England says he cannot predict the cost savings but believes the pilot program, which is scheduled to roll out in July 2015, will lead to more efficiency.

“If the system becomes more efficient, it means more patients can be treated with the current dollars,” England says. “The providers should be able to be compensated for what they are doing, making their survivability better as well. My thoughts would be that the pilot rolls into a program smoothly and that it will not require a mandate, but become a best management practice for healthcare delivery not only for Georgia, but also for other similar states. A good model should not have to be mandated, it should be accepted by the industry.”

England says he believes Georgia’s new model for healthcare can work in urban areas as well, “if those hospitals are willing to work together.”

Lewis sees the potential for benefit in many parts of the healthcare system. “People testified that 60-plus percent of calls for EMS are for managing chronic diseases, frequent flyers, people who have figured out how to use the ER for all of their medical care,” Lewis says. “We had to figure out how to stop that. So we thought, what if we just buy SUVs and do something like Meals on Wheels, where they can check on a diabetic wound, provide monitoring devices and teach people with chronic diseases how to monitor themselves and also communicate with the hospital without having to actually go to the hospital. ER waits are long, and if we can improve that as well as improve care, we hope we are laying the groundwork to reduce hospital readmissions, hospital infections and frequent flyers.”

He also notes that fixing Georgia’s ailing rural healthcare system is an imperative. “If we don’t do this, we will have a third-world state in healthcare,” he says. “We don’t have the option to fail.”

Susan E. Sagarra is a writer, editor and book author based in  St. Louis, MO.

Take-Home Points

Georgia pilot program seeks to:

• Curb overuse of EDs to relieve financial strains on rural hospitals;
• Deliver care in the most appropriate setting via a hub-and-spoke model;
• Leverage existing care access points through better coordination 
• and updated technology.