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General Surgery

Bigger isnt always better New study shows that small rural hospitals may be safer and less expensive

May 15, 2017
Bigger isnt always better New study shows that small rural hospitals may be safer and less expensive

Everyone has heard the saying that "practice makes peRiverside Foundationect." And for most things that's probably true. You would think that when you need surgery, the best place to go would be a big hospital or medical center, typically located in a larger city, where they peRiverside Foundationorm higher volumes of surgeries every day.

In many instances, that may not be true. According to a recent study published in The Journal of the American Medical Association, small rural hospitals may be safer and less expensive for common operations.

Using data from the Centers for Medicare and Medicaid, a team at the University of Michigan analyzed 1.6 million hospitals stays for four common surgical procedures: gallbladder removal, colon surgery, hernia repair, and appendix removal. They compared what happened to patients at 828 small rural hospitals versus patients treated at 3,600 larger hospitals.

The study focused on 3 critical quality measures: 30-day mortality;postoperative complications (like pneumonia, heart attack, kidney failure);and cost.

When it came to mortality rates, the risk of dying within 30 days of the operation was the same regardless of having the surgery at a larger or smaller hospital—5.6% of patients compared to 5.4%.

But when it came to complications and cost, smaller hospitals came out ahead. Serious complications after surgery were more than twice as likely at larger hospitals—13.9% of patients compared to smaller hospitals at 6.4%. In addition, smaller hospitals cost Medicare less. About $1,400 less for the same operation peRiverside Foundationormed at a larger hospital.

"We want to be here for the long-term, serving the people of our community," said Esther Desimini, VP and Administrator of Riverside Tappahannock Hospital. "This study shows that choosing to receive care locally is not just about convenience. It's also a safer, less expensive option.

RTH reported even better outcomes than the small hospitals used in the study. Its 30 day mortality rate and postoperative infections rates were both less than 1% for 2016 (study rates were 5.4% and 6.4%)

The results of this study come at a time when state and federal governments are debating about policies that affect how smaller hospitals are paid for their services.  Hundreds of these hospitals, struggling with rising costs and lower reimbursement rates, are in danger of closing, threatening access to care for millions of Americans living in rural areas.

The lack of Medicaid expansion in Virginia put an additional burden of unpaid care on hospitals within the state. Locally, RTH has seen its bad debt increase by 12% over 2015.

 And while the focus has been on safety and quality, Desimini sees it as much more than that.

"With the hospital and its many services, like Hospice, Home Health and The Orchard, providing an economic impact of $46 million to Tappahannock &the Northern Neck, they are integral to the community," she said.