12 Challenges for Public, Rural Hospitals

Cheryl Clark, for HealthLeaders Media , October 1, 2010

3. Provide a large amount of unreimbursed or under-reimbursed care, with 32.8% covered by Medicaid or uninsured, compared with 21% for private NFP facilities and 23.7% for all community hospitals.

4. Have a higher percentage of patients from the lowest income zip code, 34.5% compared with 25.7% for private NFP.

5. Likely to be in rural areas, with two out of three located in areas of low population, with even lower occupancy rates, 47.2%, compared with 60.7% in metropolitan areas and 59.7% in what the report calls "micropolitan," or small or medium sized towns.

6. Less likely to be part of large multi-hospital system compared with private NFP facilities, 26.1% compared with 61.1%. And only 21.5% of rural public hospitals were in multi-hospital systems.

7. Less likely than private NFP hospitals to have an approved medical teaching residency program than private NFP facilities.

8. Less likely to have a hospitalist on staff, with 28.5% compared with 50.3% for private NFP hospitals.

9. Public hospital stays are longer, 4.8 days compared with 4.6 for both private NFP and all community hospitals.

10. More likely to require mechanical ventilation, 29% compared with 2.6% and 2.7%.

11. Offered fewer "high technology" services, such as trauma, medical surgical ICU, neonatal ICU, CT or MRI, cardiac catheterization, cardiac surgery or transplant services. For example, while 27.5% of private NFP hospitals and 22.4% of all community hospitals offer cardiac surgery services, only 13.9% of public hospitals did.

12. Have fewer patients with a high severity of illness than private NFP and all community hospitals.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.

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