Rural Hospitals Often Safer, Cheaper for Common Surgeries: Study

Major complication rate lower for properly selected patients

By Mary Elizabeth Dallas

Tuesday, May 17, 2016

TUESDAY, May 17, 2016 (HealthDay News) -- Having a commonplace surgery -- such as a gallbladder removal -- may be safer when done in a rural hospital compared to a suburban or city hospital, a new study finds.

"This study gives credence to what rural surgeons long suspected -- that well-done rural surgery is safe and cost-effective," study author Dr. Tyler Hughes said in a University of Michigan news release. Hughes is one of only two surgeons at McPherson Hospital in rural McPherson, Kan., and a director of the American Board of Surgery.

Rural hospitals are also called critical access hospitals. They're the closest option for tens of millions of patients living outside major cities and suburban areas, the researchers said.

For the study, the researchers reviewed 1.6 million surgeries. They were performed at 828 rural hospitals or 3,600 larger hospitals. Specifically, the researchers compared outcomes for Medicare patients who had one of four common operations: gallbladder removal, colon surgery, hernia repair and appendix removal.

There was no difference between hospitals for the risk of dying within 30 days of an operation. However, researchers found the risk for developing a major complication after surgery -- such as heart attack, pneumonia or kidney damage -- was lower at rural hospitals.

The study also revealed that it cost Medicare about $1,400 less for the same operation at a rural hospital than at a larger hospital.

Patients who had surgery at rural hospitals were also less likely than patients in larger hospitals to use skilled nursing facilities after their operations, the researchers said.

The researchers noted that the patients operated on in rural hospitals tended to be healthier than those treated at larger hospitals, suggesting that rural doctors select low-risk surgical patients and send more complicated cases to larger medical centers.

Study senior author Dr. Justin Dimick said, "While it may make sense to travel to a higher-volume hospital for a few of the most complex operations, this study shows that having surgery locally is safe for many of our most common surgical procedures." Dimick is professor of surgery and leader of the Center for Healthcare Outcomes and Policy at the University of Michigan.

Hospitals are eligible for critical access designation by Medicare if they have fewer than 25 inpatient beds and are more than 35 miles from another hospital.

Currently, critical access hospitals are paid 101 percent of reasonable costs. Doctors who practice at these hospitals can also receive 115 percent of the usual payment for traditional Medicare patients. This helps rural hospitals to remain open, the researchers said.

The researchers added that many rural hospitals are facing the threat of closure. That's because national policies that set medical and surgical rates for these hospitals are under scrutiny.

The findings were published May 17 in the Journal of the American Medical Association.

SOURCE: University of Michigan Health System, news release, May 17, 2016

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