How Patterns in ED Use by Urban & Rural Patients Influence Hospital Finances

These trends in ED use and payer demographics may help your emergency physician group better plan for patient healthcare needs within your budget. 

Hospital Finances

Emergency departments in rural and urban areas play a critical role in unscheduled healthcare.

According to a recent study published in JAMA, examining new trends in these markets may give your ED a way to better anticipate patient healthcare needs, budget for expenses, and earn more revenue.

What New ED Patterns In Urban and Rural Areas Show

Researchers examined visits to hospital-based EDs from January 2005 to December 2016 and learned:

Urban ED Use Is Greater But Rural ED Use Jumped Over 50%

Nearly one-fifth of all emergency department visits occurred in rural locations by 2016.

Rural ED visits went up from 36.5 to 64.5 visits per 100 persons, or from 16.7 to 28.4 million patients.

Data shows this over 50% increase in ED use over the 12-year period studied occurred despite a 5% decline in the overall US rural population[*].

Hospital Finances

Rural ED visits increased for:

  • Non-Hispanic white patients (13.5 million to 22.5 million)
  • Patients between 18 and 64 years old (9.6 million to 16.7 million)
  • Medicaid beneficiaries (4.4 million to 9.7 million)
  • Patients without insurance (2.7 million to 3.4 million)

In comparison, urban ED visits only grew from 40.2 to 42.8 visits per 100 persons. Yet urban visits increased from 98.6 to 117.2 million patients.

So while the total number of urban ED visits may be greater, the rate of increase in visits was greater for rural areas.

And that may be because the emergency department is the only form of healthcare patients in these remote areas know or have access to.

More EDs Categorized As Safety-Net Status

EDs categorized by safety-net status — patient populations with a substantial amount of uninsured, Medicaid, and self-pay patients — provide a high volume of healthcare (more than 30-40% of visits) to vulnerable populations[*].

The estimated number of rural safety-net EDs was around 38% in 2005. By 2016, that number increased to 65%.

Though rural Medicaid visits increased from 26% to 32%, urban EDs experienced a larger boost in Medicaid patients from 24% to almost 40%.

Hospital Finances

With greater utilization rates and lower rates of reimbursement, these EDs face enormous pressure to stay out of the red. 

Over 100 rural hospitals have closed since January 2010, possibly because of these issues[*].

But that trend doesn’t have to continue.

What New ED Patterns In Urban and Rural Areas Show

The research aimed to help policymakers make data-driven decisions regarding new models of healthcare delivery for rural and urban communities.

According to the study authors, health systems should figure out how EDs can be supported to best serve their populations rather than discouraging patients from seeking care.

Just like preparing for summertime in the ED, your group can also prepare to handle these trends, keep utilization rates high, and help traditionally disadvantaged populations without losing revenue.

Coordinate with Local, Non-Emergent Care 

Researchers noted that some rural facilities now co-locate primary care with extended hours, care coordination, and behavioral health contacts for patients in their emergency departments. 

While this may increase and not reduce non-urgent ED visits, it would give additional resources to EDs in rural areas without placing additional expenses on their budget. 

It may even improve overall care and patient satisfaction while mitigating capacity management issues.

Telemedicine options can also be used to focus on outpatient management and follow-up as well.

Consider Telehealth Options

An increase in ED use in rural areas may be due to a lack of facilities, a shortage of primary care physicians, and rapid physician turnover[*][*][*].

But thanks to trends in telemedicine, patients with limited mobility or access to physicians have the chance to check in with an expert.

From e-visits to manage chronic conditions to triaging emergency symptoms before patients arrive at your ED, this option allows your physicians to connect with patients and reduce non-urgent visits.

Hospital Finances

Additionally, evidence shows that rural patients are less likely to have a primary care follow-up visit and more likely to return to the ED following admission[*]. But they could check in remotely with your team instead.

As one of the best new ED operations strategies, telehealth promises to improve efficiency, patient satisfaction, and potential outcomes.

It’s also much more likely to catch on since research shows an increase in patients using the ED between the ages of 18 and 64 — which includes tech-savvy Gen Z kids to Facebook-loving baby boomers.

Outsourcing your medical billing, coding, and compliance may also make a big difference for not a lot of money.

Invest In a System To Maximize Your Reimbursements 

The rise in safety-net EDs may be responsible for destabilizing hospital budgets.Researchers noted that even with Medicaid expansion, many rural EDs operate on thin margins requiring them to participate in special payment provisions to stay afloat[*].


Increased Medicaid reimbursements and innovative payment and delivery models may help stabilize EDs financially, no matter where they’re located[*].

But your team should still learn how to improve self-pay collections and how to deal with denials in medical billing the right way.

You may also want to consider outsourcing all your revenue cycle management. 

DuvaSawko’s proprietary billing software and Practice Monitor analytics are designed to measure and ensure that every possible dollar is collected, preventing any collectible revenue from slipping through the gaps.

Reimbursements are received faster and more accurately than ever.

DuvaSawko Collects 30% More For Clients, On Average

Analyzing these trends and following these tips may help your emergency department provide quality care to more patients without losing revenue.

No matter where your ED is located, DuvaSawko can make sure you’re not leaving money on the table. Our revenue cycle management services include tailored technology to grow your business the smart way.

Click here for a complimentary practice analysis now!

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