Rural Hospitals Serve Our Friends and Neighbors

We at University Hospitals talk a lot about providing care for our patients that’s close to home – with good reason. Life is hard enough when you’re seeking answers for troubling symptoms or undergoing treatment for a life-altering medical condition. Providing convenient access to care seems like the least we can do.

But in certain rural areas of our state and country, offering that nearby connection to care and expertise goes far beyond convenience. In fact, for many rural citizens, it’s a lifeline that can make the difference between a good health outcome and one none of us wants.

Two recent cases at UH Geneva Medical Center and UH Conneaut Medical Center, our federally designated Critical Access Hospitals in rural Ashtabula County, are?illustrative examples.?

We have branches of UH Seidman Cancer Center in both locations, providing local residents with biopsies, imaging, chemotherapy and infusions – services that not so long ago they had to drive many miles to access. It makes a difference.

Just a little while ago, a recently diagnosed cancer patient approached our Chief Medical Officer in the lobby at UH Geneva with a somewhat startling message: “I’m so glad you opened this facility, because if you weren’t here, I wouldn’t get treated,” he said. “I couldn’t do that to my family – I wouldn’t make them drive every day.” A cancer patient at UH Conneaut confided the same to the UH Seidman staff there.

The bottom line? For rural residents, travel looms large, as they try to balance the competing demands of seeking the healthcare they need and trying to continue on with life.

At UH, we see it as our job to help achieve this balance with our rural friends and neighbors.

It’s not a small number of people. According to the latest U.S. Census figures, the American rural population is growing, now numbering 20%. Ohio has the distinction of having the fourth-largest population of rural citizens in the U.S . We see this in our own service area. At UH, we serve rural patients not only at UH Conneaut and UH Geneva, but also UH Geauga, UH Portage and UH Samaritan medical centers.

These patients are by no means a monolith, but they have some unique needs and challenges in common. Reliable transportation can be hard to come by. Our Amish patients in Geauga County don’t drive cars, but our other rural patients also may sometimes need to make special arrangements to make it to doctor’s appointments. Lack of insurance, food insecurity and low income are other roadblocks many of our rural patients face.

In Ashtabula County, for example, 17% of families live below the poverty line, compared with 9% for all of Ohio.

To best meet these patients’ needs and unique challenges, we’ve made the decision to invest in them, their communities and our facilities. In an era when 150 rural hospitals closed from 2016 to 2021, we’ve decided instead to “double-down” with the rural healthcare we provide within our system.?

Just recently, for example, UH Conneaut added a new swing bed unit that allows patients to go directly from acute medical admission to skilled rehabilitation, providing them with physical, occupational and speech therapy to help them recover and regain their quality of life. The unit is occupying the space formerly used by orthopaedic surgery, which because of advancements in care no longer need their patients to stay a day or two in the hospital after a joint replacement. Critical access hospitals like UH Conneaut can utilize swing bed services so that patients can easily transition from acute to skilled nursing facility care without leaving the hospital. In the past few years, we’ve also added a Sleep Medicine Center, Wound Care Center and Pulmonary Rehabilitation Center at UH Geneva, elevating the quality of the care we provide to meet that community’s specific needs.

These new investments and services are first and foremost provided for our patients. But it’s always nice to get external validation that we’re pursuing the correct course. In recent years, UH Conneaut and UH Geneva medical centers?earned The Partnership for Excellence (TPE) Gold Achievement of Excellence Award. This is a Baldrige-based awards program and helps organizations using the internationally recognized Baldrige Excellence Framework. High-performing organizations are recognized based on performance through innovation, results and visionary leadership. The evaluation process included a three-day virtual site visit and more than 1,000 hours of review by a team of examiners.

At our hospital in Geauga County, the challenges are a bit different and require perhaps a bit more out-of-the-box thinking. To better serve our Amish patients at UH Geauga Medical Center, we’ve taken a bit of a “surround-sound” approach. A nurse specially designated to be a navigator guides Amish patients through their care decisions, while a financial navigator helps with their unique economic issues. To further cement our role as trusted partners in the community, we’ve also taken concrete steps to employ more Amish at UH Geauga. Waiving some relatively minor education and photo ID requirements for entry-level positions in food or environmental services has built a tremendous amount of good will.

A little further to the south, we’re also making significant investments in rural healthcare in Ashland County. Our hospital there, UH Samaritan Medical Center, is a leader in providing telehealth services for?specialty care – care that is often not readily available in rural communities? At the same time, UH Samaritan is boosting its recruitment of providers who have a special interest in rural healthcare. A recent addition, for example, is a young doctor who was actually born at UH Samaritan, completed her residency in rural health out of state and wanted to return to Ashland County to serve her community. Innovative time-sharing agreements for physicians are also creating a strong and substantial physician workforce at UH Samaritan from diverse specialties, including infusion services through UH Seidman and urogynecology. Beyond that, we’re investing in facilities. A newly upgraded cardiac catheterization lab at UH Samaritan is specifically designed to improve patients’ quality of care and provide a wider range of heart services closer to home. In fact, it recently achieved Level II status from the Ohio Department of Health, increasing the types of interventional and electrophysiology procedures that can be performed on-site, including balloon angioplasty and many others.?

This good work has not gone unnoticed: In recent years, UH Samaritan was?named one of the nation’s 100 Top Rural?& Community Hospitals by the Chartis Center for Rural Health, a leading provider of comprehensive advisory services and?analytics to the healthcare industry. And the hospital recently received an “A” grade for safety from the Leapfrog Group.

Of course, successes like this are sweet. But none of us can solve all the problems of rural healthcare on our own. Healthcare, after all, is a team sport, requiring the talents and hard work of every member of the community. To that end, we’re active in maintaining partnerships with like-minded individuals and groups and building new ones to advance our goals. In Ashtabula County, for example, we’ve partnered with the nonprofit Remote Access Medical to provide free medical, dental and vision services at a multi-day clinic since 2018. Over the six years, we’ve helped serve nearly 3,700 patients and performed nearly 1,000 medical exams – adding up to $3 million in care. At the same time, support from Sodexo and a grant from the Ashtabula Foundation helps fund our Food for Life Market? at UH Conneaut, where we’re assisting more than 100 individuals a month with healthy groceries for six months. At UH Portage, another recent recipient of an "A" safety grade from Leapfrog, a Food for Life Market also thrives with community support.

In the end, what makes all these efforts successful is that they’re uniquely tailored to meet local needs. Just as I as a physician prescribe unique treatment plans for my patients, hospitals, too, operate best when they provide just what the community needs. That’s our goal in these rural communities.?

That said, these are challenging times for rural healthcare. The American Hospital Association reports that 71% of the decline in U.S. community hospitals between 2017 and 2021 occurred among rural hospitals.

For those that have weathered that storm, providing care can be increasingly difficult. Beyond many being financially pressed, rural hospitals face out-of-date reimbursement rates, attacks on the 340B Drug Pricing Program that helps them serve vulnerable populations and uncertain federal funding for pressing infrastructure needs. Provider shortages are also an issue. Although we at UH have found creative ways to staff our rural hospitals in Ashtabula County, for instance, by working with the state to recruit international physicians using an Appalachian J1 Visa, challenges remain across the country. According to the AHA,?nearly 70% of the primary care health professional shortage areas are located in rural or partially rural areas.?

These obstacles may seem daunting, but we at UH are determined to prevail over whatever comes our way when providing care for our rural friends and neighbors.

Our rural hospitals are woven into the fabric of our communities, and these patients are counting on us to provide the high-quality care they expect and deserve.

This commitment to meeting people where they are -- and providing the healthcare and resources that will make the most difference in our patients’ lives -- is something that sets UH apart. We’re committed to advancing the science of health and the art of compassion in our rural communities well into the future.