Image by Else Siegel from PixabayPatients living in rural areas are having more difficulty accessing surgical care.
That’s according to a recently published research letter in JAMA, which explored barriers to surgical care for rural patients.
“Timely access to health care services is increasingly threatened for rural residents, with 151 rural hospitals closing between 2010 and 2024,” the JAMA letter explained. “Compared with nonprocedural services, provision of surgical care faces unique ongoing challenges related to the workforce, resources and centralization of procedures.”
With rural hospitals shutting down, it could be an opportunity for ambulatory surgery centers (ASCs) to step up.
As part of their work, researchers examined over 12 million Medicare beneficiary admissions between 2010 and 2020. The data included older patients who underwent 16 different operations, categorized as either low-risk or high-risk.
The results showed that rural patients are increasingly traveling longer distances to reach a hospital capable of providing the procedures they need.
“In Oklahoma, as in many parts of the country, patients are used to driving 2 hours or more for many types of surgery simply not available in rural areas,” Keith Smith of the Surgery Center of Oklahoma (SCO) told Ambulatory Surgery Center News.
SCO offers a wide range of surgical specialties, including orthopedics, podiatry, urology, gynecology, general surgery, oral surgery, and ears, nose and throat (ENT) procedures.
Among the research letter’s key findings was a rise in the percentage of rural patients traveling more than 60 minutes for surgery.
That proportion rose from 36.8% in 2010 to 44.1% in 2020. Low-risk procedures, such as gallbladder removal or hernia repair, saw an increase from 32.9% to 37.8%. High-risk operations, including aortic valve replacements and certain cancer-related procedures, increased from 53.9% to 59.2%.
At the same time, nonrural patients experienced much smaller jumps in travel times. These trends mean that the gap between rural and nonrural patients is widening over time.
“These findings suggest a persistent and growing disparity in travel for rural patients undergoing surgical procedures,” the research letter continued.
ASCs operating in rural areas face their share of challenges.
Rural areas often struggle to attract and retain skilled health care professionals, including surgeons, anesthesiologists and nurses, for instance. Rural ASCs have fewer potential patients in their catchment area, too, making it difficult to maintain high surgical volumes.
“ASC’s that are interested in attracting the attention of rural patients should consider posting all-inclusive cash prices online,” Smith said. “ASCs should also be sensitive to the likelihood that a large hospital system bears responsibility for the ruination of their once-busy and vibrant rural hospital and, therefore, the ASCs should take all steps in any marketing campaign to distinguish themselves from the price-gouging, often impersonal hospital systems.”
Physician ownership is also a factor, Smith said.
“I believe that access to care in rural areas would be much improved if not completely relieved if physicians were once again allowed to own and operate the rural hospitals where they work,” he said.
