Rural – Urban Differences In Health Care Quality Assessment

• Read the initial comments posted by your classmates and reflect upon them.
• Formulate one new comment of your own. It must be a logical and thoughtful response that synthesizes the comments of at least 3 classmates into one comment. Be sure to synthesize; do not simply reply to each of the 3 classmates or restate their comments.
• If the class is small, the discussion will be with your professor.
• NOTE: You are not required to cite sources and include a reference list for the second post if it is simply your opinion. However, if your opinion is based on facts (as it should be), it is good practice to strengthen your position by citing sources.

post 1:

Kelsey Adams posted May 27, 2021 10:23 AMSubscribe

According to The Medicare Resource Center, “ancillary services are medical services provided in a hospital while a patient is an inpatient, but paid by Medicare Part B (outpatient care) when the Part A (hospitalization) claim is denied because Medicare believes that it was unreasonable or unnecessary for the person to be admitted as an inpatient” (2021). Some examples of these services are but not limited to; diagnostic ancillary services, therapeutic ancillary services and custodial ancillary services. Diagnostic ancillary services include radiology and lab. Therapeutic ancillary services can include physical, speech and occupational therapy. Custodial ancillary services is usually in home health care. There are many services within these services but these are the main ones available to most people.

From my knowledge a rural area differs from an urban area because an urban area is largely populated and a rural area is smaller in comparison. I grew up in a rural area where the hospitals were about a 45 minutes from my house. There was a little specialized clinic about 30 minutes away but the main hospitals and urgent care offices were quite a bit away from my house so when we needed medical attention we had to travel. Living in an urban area you have a much quicker and easier access point to care. As for ancillary services, sometimes these services are not in the same location where patients are seen for medical care. Depending on the insurance carrier or recommendation from the documentation it could cause a burden.  For example, when I was in high school I was playing basketball and broke my ankle, I was rushed to the emergency room and once I was taken care of referred to 6 months of physical therapy after heeling. My hospital was in an urban area but because I lived so far away from everything I had to endure the travel. For major procedures or specialties it was more of a 4 hour drive which in some instances could hurt someone. A lot of employment doesn’t pay for time off for appointments so it could limit the duration of time a patient could have to get the treatment they need.

Some recommendations I would provide as a health care leader to lessen the disadvantages living in a rural area would be the delivery methods, access to care, and teleworking/telehealth.  I would of course canvas the area I am working and learn what works best for my facility/region. After some realignment and hard thought as a leader I would suggest the area consider “Community Paramedicine, a model of care where paramedics and emergency medicine technicians (EMTs) operate in expanded roles to assist with healthcare services for those in need without duplicating available services existing within the community” (Rural Health Information Hub, 2021). Having this throughout the community would vastly help the access to care. I also thinking having a line of communication like a hot line or a teleconference line for patients to be able to call a nurse with symptoms. There are many factors that need to be determined when considering adding certain things to a rural area and one of the main factors is money. There are many rural areas that have a lower income rate and this could cause a potential problem. Understanding the wants and needs of each area could be different depending on what is needed and where the focus is. Every area is different.

Rural Health Information Hub. Healthcare Access in Rural Communities Introduction. (2002-2021). https://www.ruralhealthinfo.org/topics/healthcare-access.

What are ancillary services? medicareresources.org. (2021, March 11). https://www.medicareresources.org/glossary/ancillary-services/.

Post 2:

Mateo Alba posted May 25, 2021 7:58 PMSubscribe

Ancillary services are the important services that completes the patient treatment or the provider’s diagnosis. There are three types of ancillary services, treatment, diagnosis and custodial. Some examples of ancillary services are Pharmacy, Laboratory and Radiology (x-ray). Treatment services provide the necessary modalities prescribed by the provider. Without it, the patient will remain sick or injured and possibly get worst. The diagnostic services are essential to confirm the provider’s diagnosis. It provides the treatment team a clear picture of what the best course of action or treatment plan for the patient.

Urban area ancillary services

Ancillary services in urban areas can be a very profitable business. Due to the demographics, cultural background, high tempo and social norms in an urban environment patients will always pay for the convenience of the location. As an example, services like Optometry, Pharmacy and Physical Therapy, can be found in or around the same parking lot of a big grocery store like Fred Myers, Super Walmart or Costco. It gives the patient the convenience of multitasking which in an urban environment is essential. Ancillary services that can be found in an urban area not only provides the basic services but also the convenience. If the patient requires special treatment or diagnostic modality, they can go to a hospital or treatment facility in their network within their local area. Additionally, Urgent care centers or clinics provides the majority of the ancillary services the patients needs. Again, it is a one-stop shopping and prevents the patient from sitting around for hours in the hospital. Majority of these services accepts most medical insurance which is great for the patient and good business for the services.

Rural area ancillary services

Ancillary services in a rural community can be isolated and austere. They are normally very limited, operating with bare essentials and sometimes none existent. These services are normally collocated within the medical clinic and with limited hours of operations. Since the services are limited, patients tend not to use them or just make do of what they have. For example, patients will travel long distance just to get their medicine.

Disadvantages of patients living in rural areas

It is a challenge for the patients and the providers. From the patient side, it can be frustrating because the time and distance it takes to travel to the medical facility. Limited hours of operations and services they offer, sometimes it is better making the effort of traveling to the urban community just to get the services they need. That means spending time and money which can be hard for the families. From the provider side, it is also a challenge. The issue are volume and cost to operations. Even though the rural providers would like to get the state-of-the-art diagnostic or therapeutic machines and the highly trained staff to operate it is not cost-effective. Rural areas normally do not have the patient load compared to the urban areas. Therefor, the providers must balance on what type and volume of patients they normally have, what modalities or treatment they can perform and the cost to business operations.

Recommendations to providers in rural areas

One recommendation which has been validated during the current COVID 19 pandemic is the use of telemedicine (Weisgrau. 1995). From the basic primary care patient visit to specialty appointments like allergy, dermatology appointments. Also, it is currently being used effectively by the military and the Veterans Healthcare system for mental health services. It was initially used in the Philippines and Iraq (Chen. 2016).

Invest in basic diagnostic equipment that is portable, easy to use, can conduct multiple test and cost-effective like the i-STAT-1 Handheld Blood analyzer (Abbott. n.d.). It will save lives and good for business.

Lastly, keep it simple and basic. Always remember to goal of healthcare (even in the most austere environment) is the same…save lives (U.S. Army. 2020).

References

Abbott. (n.d.). i-STAT-1 Point of care Blood analyser. Retrieved May 25, 2021, from https://www.pointofcare.abbott/us/en/offerings/istat/istat-handheld

Chen, M. (2016, November 7). Lessons on Bringing Surgical Care and Telemedicine to Iraq Kurdistan. Linkedin. Retrieved May 25, 2021, from https://www.linkedin.com/pulse/lessons-bringing-surgical-care-telemedicine-iraq-kurdistan-chen

U.S. Army. (2020). Army Health System FM 4-02 [PDF].

Post 3 :

Jaydin Davis posted May 28, 2021 7:39 PMSubscribe

Ancillary services are medical support services offered to primary physicians. They are the services offered by hospitals and medical institutions, other medical and nursing services. Ancillary services are divided into three categories: diagnostic services like laboratory tests, therapeutic services like hospice care services, and custodial services.

Access to medical services is the main problem facing the rural population. The same applies to ancillary services, where the main difference between rural and urban is access. The services are usually provided in different areas in rural areas. Rural hospitals are usually smaller in size than urban hospitals (Hatten & Connerton, 1986). The size leads to the geographical disbursement of ancillary services. Patients have to travel for distances to obtain ancillary services. Spasojevic et al., (2015) articulated that rural folks are more likely to travel more than 15 minutes to obtain medical services.

Rural consumers of medical services living in rural areas are at a disadvantage when receiving ancillary services. The services are disbursed in different places making access to the services a problem. The charges for ancillary service in rural areas are higher than in urban areas. Ancillary services follow a pattern where medical services are charged higher (Hatten & Connerton, 1986). This increases the cost of medical care for the patients in rural areas.

One way of improving access to health care services and ancillary services in rural areas is through better remuneration of physicians and providers of ancillary services. This will make the services in rural areas more attractive, attracting more professionals, and improving access. Medicare payments to rural physicians should be increased. Studies have shown that lower payments to physicians in rural areas may be why rural areas are not attractive to professionals.

References

Hatten, J. M., & Connerton, R. E. (1986). Urban and rural hospitals: how do they differ? Health care financing review, 8(2), 77–85.

Spasojevic N, Vasilj I, Hrabac B, Celik D. (2015). Rural – Urban Differences In Health Care Quality Assessment. Mater Sociomed. 2015 Dec;27(6):409-11. Doi: 10.5455/Msm.2015.27.409-411. Pmid: 26937222; Pmcid: Pmc4753384.