It was a big loss to the state of Georgia when four rural hospitals closed over the course of two years. The closures gained state and national attention, and started a much needed conversation among rural health care leaders: How to help a rural community after a hospital closure. “Four hospitals is a lot to lose in our rural communities,” said Charles Owens, Executive Director of the Georgia State Office of Rural Health.

In May 2014 Georgia enacted regulations that would allow a closed rural hospital to be reopened as a freestanding ER department within 12 months of the initial closure.  The facility would need to be located in a rural county within 35 miles of a licensed general hospital, be open 24 hours/365 days a year and provide non-elective surgery and emergency treatments. Freestanding ERs must also maintain a license through the Healthcare Facility Regulation (HFR), and cannot house a patient for more than 24 hours. To date, no closed hospitals have reopened as freestanding ERs.

Owens is a member of the governor appointed Rural Hospital Stabilization Committee. The committee meets publicly to discuss the freestanding ER model and consider the pros and cons, as well as additional opportunities to bring health care resources to rural communities.   “We are evaluating what it takes to operate a freestanding ER and what the patient levels would need to be to sustain itself,” he said. “We are evaluating reimbursement and regulations and are also developing recommendations for communities to consider.” In addition to the committee, Owens has also been appointed the Rural Hospital Point of Contact for Georgia’s rural hospitals to assist them in addressing any challenges they are facing.

There are multiple challenges associated with reopening a closed hospital as a freestanding ER, primarily generating sufficient payment to establish sustainability. “Otherwise, in Georgia, a local subsidy would be required,” Owens said. “So the major obstacles are lower volume, poor payer mix, indigent population, severely poor health status, and the high cost population to be served.The models across the US that are currently in operation are either in urban commercial markets or otherwise are heavily subsidized by demonstration project funding, state or local funds. “

According to Owens, a freestanding ER is preferable to an urgent care facility in some communities due to “community perception and the potential for available diagnostics and other ancillary support if the community can support the added costs.” Additionally, urgent care facilities are restricted by Certificate of Need in most states.

Owens is happy to report that one CAH in south Georgia is not only thriving, but expanding.  Miller County Hospital in Colquitt recently started construction on the 6,500 square foot Miller County Dialysis Outpatient Clinic. The 1.1 million dollar facility is slated to open in January 2015. “Miller County Hospital is one of our growing Critical Access Hospitals as they proactively plan to meet the local needs of their communities they serve and expand services to meet those needs which creates sustainability for their health system,” Owens said.   ” Currently residents of Miller County are driving over 70 miles roundtrip 3 times per week.  Now they will have local access, which will greatly improve the quality of their lives, reduce transportation time as well as costs and also create jobs.”


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