- Associated Press - Saturday, May 17, 2014

MONTEZUMA, Ga. (AP) - As rural hospitals struggle, Georgia is letting stand-alone emergency rooms treat people in the countryside who would otherwise have to drive far away when they break an arm, need stitches or have a baby.

The state agency that licenses medical facilities changed its rules this year to allow a rural hospital that’s failing or has already closed in the last year to scale back its operations and reopen as a freestanding emergency room. Before, emergency departments were only allowed at full-service hospitals that fulfilled criteria including having inpatient beds and other expensive requirements.

Georgia’s leaders backed the rule change allowing stand-alone ERs after three rural hospitals closed in 2013. Many are taking financial losses.

“A hospital closes now, particularly in a small, rural community, there’s nothing, nothing,” said Clyde Reese, commissioner of Georgia’s Department of Community Health. “So this is an attempt to have something, some service, some infrastructure left in a community so all the doctors won’t leave, so the EMS services won’t leave and follow the facilities.”

Many other states already allow stand-alone emergency rooms, but health care analysts say they aren’t aware of the model being pushed as a way to keep struggling rural hospitals from going under. Among the hundreds of stand-alone ERs operating elsewhere, many are in affluent suburban areas where patients can afford to pay the higher bills.

Moody’s Investors Service predicts hospital revenues will drop as government payments decrease, fewer patients are held overnight and private insurance plans pay less. Its analyst said more patients are choosing high-deductible plans. Those plans could discourage people from seeking pricey care and raise the risk they won’t be able to afford their hospital bills. While all hospitals face these problems, small hospitals have the least cash as protection.

About half of all states, including Georgia, have refused to expand Medicaid under President Barack Obama’s health care law, further adding to the pressure on hospitals.

“While Medicaid doesn’t pay as well as other payers, it’s better than nothing,” said Jennifer Ewing, a Moody’s analyst.

The challenges are evident in Macon County, an agricultural region in central Georgia with fewer than 15,000 residents. Unemployment remains at nearly 14 percent, and more than half of residents in 2012 had no health insurance or relied on the government to provide it.

Flint River Hospital had reported for years that it was saddled with unpaid bills and that it was underpaid by government-run insurance programs for the poor and elderly. It closed its emergency room last year, the only one in the county.

Macon County has doctors and an urgent care center, but it is missing an emergency room where people can go for around-the-clock care.

Among the new requirements for scaled-back ERs in Georgia, the facilities would have to offer 24-hour care and treat all uninsured patients. They could be no more than 35 miles from a full-service hospital. They would be required to have agreements explaining how they would transfer patients who need more intensive help to a hospital.

“They need a close facility,” said Dawn James, a counselor in Montezuma. “…. You’re having chest pains, we have to drive now at least 30 minutes. At least. And that’s if you don’t get behind a tractor or bus.”

James recently drove her friend, Delois Smith, to the nearest hospital after Smith suffered a stroke. Smith does not own a car and hesitates to call for an ambulance since has no health insurance. She wants the old emergency room back.

“They closed it down last year and it was like, ‘Where are we going now?’” Smith said.

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