Morrow says that the case against ED utilization may be relying too much on data collected at urban hospitals and projected onto every hospital regardless of its size, status, or mission.
"The data we see from large urban areas if you apply it nationally would be a bad thing," he says. "So there is an effort to keep people out of the ED. OK, that may be true but in rural settings it is not such a negative. What is the alternative? Loading up rural America with primary care physicians?"
Morrow says ACO designers would be well served to re-examine the role that rural hospitals play in managing patient population health.
"They have had to do it because they have a more non-transient population base," he says. "If you are an ACO or a mother ship hospital in a suburban setting there is something to be learned from the rural hospital that is your feeder hospital. This generalization that rural hospitals are crap it doesn't play out in the data. They are doing what they do pretty well.