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Small town Healthcare- I Don’t Think PSLF or Tuition Free PCP Helps

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  • Avatar Tim 
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    Much has been made “more PCP” and “insurance “.
    The Medicare components:
    Facilities + provider + malpractice = Cost/reimbursement seems sound.

    Outpatient surgery centers and hospitals in today’s economics are costly. With low volumes, I don’t see more physicians or insurance solving the equation.

    I certainly don’t have a clue. To me it’s more like telephone, electricity and highways.If government needs to be involved it would be on the infrastructure side. I sure hate $100mm to train more PCP’s with no where to practice.

    https://www.npr.org/sections/health-shots/2019/05/14/722199393/no-mercy-how-a-kansas-town-is-grappling-with-its-hospitals-closure

    #214427 Reply
    Avatar snowcanyon 
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    Great article, thank you.

    I think PSLF and HPSP help to attract PCPs to town and allows them to stay, which is important for these really dysfunctional communities. The article makes it clear there will still be PCPs and a CHC in town.

    These small towns are delusional, though. The patients go to the big city but they still want a local hospital? 100% unsustainable. Not to mention how poor the outcomes are at these low volume facilities.

     

    #214450 Reply
    Lithium Lithium 
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    I read an article a few years ago about a similar hospital that closed in Nevada.  If you have driven through Nevada outside of Las Vegas or Reno, you know that you can go three hours without seeing so much as a house or a gas station.  So that community had no hospital within 2.5 hours.  People were dying of heart attacks and suffering brain damage while flying 100+ mph on the desert road.  Unless you are under 50 with no chronic medical conditions, it doesn’t make a whole lot of sense to set up roots in those communities.

    #214472 Reply
    Liked by Kamban, Zaphod, Tim
    Avatar SValleyMD 
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    It’s a complicated issue.

    The “low volume” argument is ridiculous imo. Sure you might get a couple crazy docs/surgeons biting off more than they can chew but the vast majority of guys are just as happy to get their complicated pts out of fudge to a major center. They can still provide a great service locally and just the mere fact that they’re there means they’re treating many that otherwise would get no treatment at all

    People that don’t live rural just don’t get it. It’s amazingg the amount of people (esp old but even young) that would rather die than travel 2 hours and try to navigate a big city/hospital. They just won’t do it. They can’t.

    These local community hospitals can triage and get these guys where they need to go

    The problem is these community hospitals are now a part of these national conglomerates (hca, lifepoint, iasis), that dont understand the communities and what it takes to recruit there and what it takes to make these hospitals thrive.. Then when the profit margins drop boom they close shop

    The best community hospitals I’ve seen are still ones run independently with heavy community involvement. They provide a lot of decent/good local jobs and you can find many incredible physicians that deal with issues and skills that few could do..

    #214508 Reply
    Avatar jz 
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    It’s amazingg the amount of people (esp old but even young) that would rather die than travel 2 hours and try to navigate a big city/hospital.

    Agree.  and  imagine an Amish child with appendicitis traveling 50 miles by buggy to a hospital.  better to keep the hospital at  15 miles.

    #214517 Reply
    Liked by hatton1, Zaphod, Tim
    Lordosis Lordosis 
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    People that don’t live rural just don’t get it. It’s amazingg the amount of people (esp old but even young) that would rather die than travel 2 hours and try to navigate a big city/hospital. They just won’t do it. They can’t.

     

    Click to expand…

    I have a hard time getting people to drive 45 minutes to our “big” city hospital.

    Obstetrical care is another concern.  One of our local hospitals closed their L&D so we get folks from 45-60 min away coming to us for obstetrical care and delivery.  If we did not exist they would need to tack another 30-45 minutes on the drive to the city hospitals.

    “Never let your sense of morals prevent you from doing what is right.”

    #214525 Reply
    Liked by SLC OB
    CordMcNally CordMcNally 
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    Tough situation and I get both sides as I grew up in a small town. However, the residents are foolish to think that they ‘deserve’ a hospital. If everyone is going out of town and the hospital is hemorrhaging money, what did they think was going to happen? I don’t think there’s anything stopping them from taking a vote and voting on raising their own taxes so they can fund a hospital. I bet the big corporation that owns that building would sell it to them at bargain prices. Living in a rural area certainly has its pluses and minuses, however, one of the minuses is going to be convenience for easy healthcare access. That’s the way it’s always been and it will until a solution that makes fiscal sense comes around. That solution will certainly include tele-medicine.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #214526 Reply
    Lordosis Lordosis 
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    Obstetrical care is another concern.

    Click to expand…

    That solution will certainly include tele-medicine.

    Click to expand…

    I can imagine a doctor letting over the computer monitor “Push! Push!”

    “Never let your sense of morals prevent you from doing what is right.”

    #214534 Reply
    Liked by hatton1, Tim
    Avatar Anne 
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    It’s amazingg the amount of people (esp old but even young) that would rather die than travel 2 hours and try to navigate a big city/hospital.

    Agree.  and  imagine an Amish child with appendicitis traveling 50 miles by buggy to a hospital.  better to keep the hospital at  15 miles.

    Click to expand…

    The Amish will use ambulances when needed.

    #214546 Reply
    Liked by SLC OB, Tim
    Avatar Doc Spouse 
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    It’s amazingg the amount of people (esp old but even young) that would rather die than travel 2 hours and try to navigate a big city/hospital.

    Agree.  and  imagine an Amish child with appendicitis traveling 50 miles by buggy to a hospital.  better to keep the hospital at  15 miles.

    Click to expand…

    The Amish will use ambulances when needed.

    Click to expand…

    We live in Amish country and rarely a day goes by that I don’t see entire families visiting loved ones who are admitted.  Ambulances and combustible-engine taxi services seem to be acceptable when it comes to health care.

    I found this essay on Amish and healthcare pretty interesting.

     

    #214561 Reply
    Liked by SLC OB, Tim
    Avatar snowcanyon 
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    It’s particularly fiscally difficult to keep small-town OB units open: https://www.politico.com/magazine/story/2017/10/03/meadows-medicaid-rural-hospitals-pregnant-women-dying-215671

    Tough call because low-volume OB hospitals have much poorer outcomes, just like low-volume anything else. Alaska has addressed the rural obstetrics by having pregnant patients board near a hospital for their last few weeks of pregnancy.

     

    #214567 Reply
    Liked by Tim
    hatton1 hatton1 
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    Tough issue.  I see both sides.  Some patients are just not comfortable driving in a bigger city.  Some patients value proximity over anyone other metric.  OTOH I am aware of some really bad OB outcomes from small rural hospitals.  Telemedicine I suppose could be used for some prenatal care but not an actual delivery.

    #214643 Reply
    Liked by Lordosis
    Avatar ScubaV 
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    Somewhat off-topic, but I wonder what will happen to a lot of these small towns when there’s no economic foundation for them to exist.  I remember reading a sad story about some town in Ohio where the only real revenue-generating industry was related to coal and the corporation was pulling out because it wasn’t profitable anymore.  No one could sell their houses, and one family that managed to do so and get work elsewhere eventually came back because they missed their family and friends.  Of course, now they’re struggling with money.

    One of the hospitals I go to occasionally is pretty rural and some of the spots I drive past look like they belong in a post-apocalyptic movie.  I wonder how they survive and I suspect in some cases they don’t.

    #214648 Reply
    Hank Hank 
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    We’ve gone from 83% of the American labor force working in agriculture circa 1800 down to 2% of the workforce, yet we produce far more food far more cheaply.

    While exurbs are popular, I don’t see most truly rural locations becoming populous and affluent any time soon.

    #214700 Reply
    Avatar burritos 
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    It’s amazingg the amount of people (esp old but even young) that would rather die than travel 2 hours and try to navigate a big city/hospital.

    Agree.  and  imagine an Amish child with appendicitis traveling 50 miles by buggy to a hospital.  better to keep the hospital at  15 miles.

    Click to expand…

    Great, I suspect the primary issue is who is going to pay for this?

    #214705 Reply

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