A stark healthcare crisis is unfolding in rural America as emergency rooms are overwhelmed by unpaid services, overcrowding, and deteriorating staff safety, according to a landmark study by the RAND Corporation. The 1986 EMTALA law, which requires emergency departments to stabilize patients or deliver babies regardless of ability to pay, has created a financial strain on hospitals, leading to closures and instability. States like Texas, Oklahoma, and Tennessee have seen a dozen or more hospital closures, with rural areas and urban poor neighborhoods increasingly bearing the brunt.
Dr. Randy Pilgrim, an ER doctor and chief medical officer for emergency room services company SCP Health in Atlanta, emphasized the severity of the crisis. He stated, “This RAND study is the first ever that points to this crisis, which is that the emergency departments and the care that patients receive in them usually is so critical that, especially for time-sensitive conditions that patients can have, just the fact that you have to travel as far as you might have to, or that even in some cases if a hospital is close to you, but it still doesn’t have the resources to operate efficiently.”
Nearly $5.9 billion in emergency services go unpaid every year, the study found. Overcrowding and spates of violence towards staff have exacerbated the problem. EMTALA is essentially an unfunded mandate in many cases, and lack of funding for hospitals that treat a large proportion of that uncompensated care — which tends to fall in rural areas or poor neighborhoods in cities — leads to the dual issue of higher patient volumes and more uninsured patients being seen.
Many hospitals outside of cities cannot fully account for the funding gap, Pilgrim said. “The economics of reimbursement for physician care play a huge role. … We need more physicians generally in America, and we need physicians to feel like they can and will go to where they are needed,” he said. “Physicians won’t go where they are needed if there’s not enough resources or reimbursement to attract them.” Rural hospitals characteristically pay less than higher-end urban hospitals and have fewer local resources. With hospital demand “higher than ever,” all of the above factors mean help is needed now. Pilgrim said he has met with HHS Secretary Robert F. Kennedy, Jr., and other top officials at the agency, to discuss the issue — and hopes Washington can help.
Pilgrim said, “Secretary Kennedy… did a beautiful job of listening to what we were saying about the impending crisis that would probably happen during this administration,” he said. “And he was concerned about it because he could tell that you can’t make patients healthy unless you have a healthy healthcare system for them to engage. So I’m very encouraged about what Secretary Kennedy and his staff are doing to try to make a difference on the pieces that they control.” He also said Congress must act, particularly as 10,000 Americans turn 65 every day and are therefore eligible for Medicare, which presents a different environment than separate Medicaid.
“That’s where we see more volume of patients, more complexity, and much more clinical demand. But if the reimbursement in Medicare doesn’t keep pace with that demand, once again, you’re in this vicious cycle where emergency departments will be at greater risk, starting with the rural and underserved areas and moving forward from there,” Pilgrim said. Some in Congress have banded together to advocate for healthcare-related issues, including members of the bicameral