Prisma Health takes services into rural hospital void

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Few physicians choose to work in South Carolina’s rural communities, and relatively few have the opportunity to do so.  

Out of the 90 health care facilities across the state, only 14 hospitals operate in the rural regions that make up much of South Carolina. Four of the 14 are federally certified as Critical Access Hospitals, according to the South Carolina Office of Rural Health.

And the number appears to be shrinking, as more than 30% of all rural hospitals across the United States are at risk of closing, according to the Center for Health Care Quality and Payment Reform. 

Three rural hospitals have closed over the past decade in the state in Barnwell, Bamberg and Winnsboro, while 10 suffer from negative total profit margins of up to minus 43%, according to data from the University of North Carolina’s Cecil G. Sheps Center for Health Services Research. 

Prisma Health Oconee Memorial Hospital’s profit margin was at negative 10.3% over the past three years, while the Medical University of South Carolina’s Lancaster Medical Center was 43.2% below zero during the same time period, according to the report. Self Regional Healthcare’s Edgefield County Healthcare, Allendale County Hospital and Tidelands Health in Georgetown are also in the red when it comes to patient services. 

The Upstate’s Union Medical Center, also in the red for all profits, has lost out on 25 cents for every dollar spent at the hospital over the past three years.

Shuttered hospitals add insult to injury in parts of the state with fewer options, say health care providers. 

“In rural communities, we know that there are higher rates of uninsured individuals,” said Stacey McPhail, director of Prisma Health’s Community Health office. “Transportation is a huge barrier in rural communities. (People) often lack access to transportation — access to public transportation in particular.”

House call revival 

More urban-centric hospitals have been able to fill a few of the gaps through telehealth channels. 

McPhail told SC Biz News about partnerships Prisma Health forged with elementary schools in the Midlands where telehealth serves in lieu of a school nurse or local doctor where there is none.

 In many rural communities, if a child is reported sick, most parents don’t have the option driving from work to school to a distant doctor’s office to pharmacy and finally back home, she said. 

“We don’t have doctor’s offices in our communities,” said McPhail, who grew up in a rural community. “We don’t have pediatricians in our community, so we have to leave work, pick the child up, go back downtown — so not only am I losing a day’s pay, but gas is expensive.”

Through Prisma’s new partnerships with rural elementary schools, students can see a remote doctor at school for a diagnosis before parents or guardians are called in from work. If the condition isn’t contagious or acute, they can return to class and the parent can pick up a prescription on the drive back home without missing a day at work. 

But telehealth is far from a panacea to the challenges that plague rural communities. Sometimes health care systems must take their services to patients instead.

During the COVID-19 pandemic, Prisma Health began investing more in mobile health units across the state to meet urgent care and community health needs, according to McPhail. Prisma Health-Upstate has served more than 4,000 uninsured or underinsured patients with a mobile unit since 2016, according to a news release. The unit visits 21 community sites each month. 

Funded through winnings from an American Hospital Association award, Prisma Health-Midlands’ first community health mobile unit was deployed from Columbia in January 2020 and offered screenings for blood pressure, blood sugar and cholesterol. 

The success of the mobile care program and a $200,000 grant from the South Carolina Center for Rural and Primary Healthcare has prompted Prisma Health to expand its mobile care footprint to Eastover in Richland County, Rembert in Sumter County, Ridgeway in Fairfield County and Gaston in Lexington County. 

Starting in May, the hospital system will schedule the 38-foot mobile care unit to service alternating locations, published online at PrismaHealth.org, each Saturday, according to a news release. 

“We have a total of 10 mobile clinics under the umbrella of Accountable Communities and Community Health,” said McPhail. “And so the goal, of course, with the clinics is to improve access to care for the underserved populations in both the Midlands and the Upstate and, in fact, Prisma Health’s entire footprint.”

Patients will receive care at the mobile clinic regardless of their insurance status or ability to pay.

Holistic care

Prisma Health is also seeking to gain community trust and a clearer picture of community needs through local partnerships. 

“Often in rural communities, it’s the faith communities that people trust,” McPhail said, adding that churches and schools often serve as the crux for social events and connections. “If they know that the church is on board, then they tend to trust us a little more. If they know that the school is on board with having us there, they tend to trust us a little more. Those partnershps are extremely important.”

In fact, Prisma won’t enter rural communities without those established partnerships, she said.

“We want to be there alongside the community,” she said. “And we don’t want to be in that community as the leader because we’re not. We walk and partner with them, alongside of the church, alongside the school, alongside of the neighborhood associations. We want to be seen as an equal partner.”

Moving forward, Prisma Health seeks to pinpoint social determinants to health care quality and access in rural communities, not just meet medical needs. 

Data from the South Carolina Office of Rural Health will be used to select sites for the mobile clinics, according to a news release. Once established, surveys in areas serviced by the clinic will be used to help identify which communities are hindered by lack of access to transport, child care, nutrition and the management of chronic diseases.

“This opportunity to take health care services into rural communities to help residents overcome access barriers for timely medical care is a win-win,” Valerie Sullivan, Prisma’s mobile health clinic manager said in the release. “Providing a great health care experience beyond our hospital walls helps people see the benefits of care and learn about their options.