"There are a handful of critical access hospitals, some in recreational areas, that, even though they're small, have developed robust orthopedic surgery programs," O'Neill says.
Unfortunately, geographic location is not a fix that other financially struggling critical access hospitals, in more depressed regions of the nation, can make.
Additionally, those hospitals with positive operating margins tend to have more patients than those with lower operating margins, and perform more surgeries. Again something that may not be easily duplicated in very remote regions of the country, where daily CAH census may hover in one digit.
O'Neill noted that many CAH facilities in California and the rest of the country also serve as the diagnostic imaging centers for their regions.
"They're not just the only hospital in town. But also, they're the only source of major diagnostic technology in town as well. If something were to happen to the hospital in those communities, area doctors and clinicians would lose basic clinical diagnostic capacity too," O'Neill says.
Yet critical access hospitals in California and across the country are at a critical juncture. They have more trouble obtaining debt financing, even as they face daunting tasks of adopting electronic medical record systems.
Additionally they treat a population that is "more likely to be unemployed, lack health insurance, be diagnosed with chronic conditions (e.g., diabetes and heart disease), and be less likely to receive medical exams for common procedures than other Californians," the report says.
I'm not sure what factors threaten critical access hospitals in other parts of the country, but it's a good bet that they too are struggling. And it's also a good bet that expanding their patient base and adding on services like orthopedics are unlikely remedies to their financial problems, given the small populations and the large geographic regions they serve.
But without a doubt, these facilities are the only real lifeline for critically ill patients in these areas.
Where rural healthcare in America comes from is a question that may be lost in the halls of Congress and the offices on K Street. But for one in every four hospitals in the nation, it is not lost at all.