Apr. 22—Patients hospitalized in rural hospitals were much less likely than those in urban facilities to have procedures performed during their hospitalization, and those patients who underwent operations tended to have fewer surgeries, according to new federal data.

The Centers for Disease Control and Prevention (CDC) reported Tuesday that 64 percent of rural hospital inpatients did not undergo surgery in 2010, compared with only 38 percent of urban hospital inpatients.

Additionally, the agency found that urban hospital inpatients were more than twice as likely to have three or more procedures performed as rural hospital inpatients.

“This could be due to the shortage of specialty physicians in rural areas, the lack of other staff skilled in surgery, or the absence of costly equipment needed for many surgical and nonsurgical procedures in rural hospitals,” the CDC authors wrote about the divergence in surgery practices. “Because of economies of scale, rural hospitals may forgo offering many procedures and instead choose to focus on patients needing basic inpatient surgical care and on patients needing medical, rather than surgical, treatment.”

Although 17 percent of U.S. population lived in rural areas, only 6 percent of the 51 million nonsurgical and surgical inpatient procedures performed nationally were in rural hospitals, according to the CDC.

The proportionately fewer procedures was a more extreme example of the rural-urban healthcare split identified in the CDC data, which also noted that rural hospitals cared for only 12 percent of all 35 million hospitalizations and 11 percent of the 168 million total hospital days of care.

Other differences among rural hospitals related to the age of their patient populations: The majority of inpatients in rural hospitals—51 percent—were older than 64, compared with 37 percent of inpatients in urban hospitals.

That differences in patient base also led to sharply different leading diagnoses between the two types of hospitals. Diagnoses that led among urban hospital inpatients were childbirth, cancer, and poisoning. Diagnoses that led among rural facility inpatients were dehydration, bronchitis, and pneumonia.

Similarities between the two classes of hospitals included the average number of diagnoses (7.9 in rural hospitals versus 7.4 in urban hospitals) and the average length of stay (4.5 days for rural versus 4.8 days for urban hospitals).

Previously Identified Trend

The CDC data on fewer rural hospital inpatient admissions and treatments echoed the recent findings of the Medicare Payment Advisory Commission (MedPAC), which reported in March that inpatient discharges declined 8 percent in urban hospitals and 21 percent in rural hospitals from 2006 to 2012. The drop in inpatient discharges was most pronounced for rural hospitals with fewer than 100 beds.

“This more rapid decline in discharges at the smallest rural hospitals is attributable in part to the movement of patient care from relatively isolated rural facilities to more centralized facilities,” wrote the commissioners.

MedPAC cited the examples of large shifts in market share from rural hospitals to urban hospitals with more specialized facilities that offer cardiac catheterization and stroke care centers.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.


Publication Date: Tuesday, April 22, 2014