Disparities and Inequalities in Rural Healthcare and Patient Movement

Rural hospitals face a harsher reality than their urban counterparts.

The U.S. Department of Health and Human Services (HHS) launched the Healthy People initiative in 2010, with the explicit mission to improve the quality of life for all Americans.1 “Rurality” is recognized by the initiative as one of its 14 health disparities because the accessibility of sufficient healthcare for rural residents is significantly less than that compared to people living in more densely populated urban centers.2

And unfortunately, the disparities and inequities of healthcare accessibility for rural residents continue to grow in severity due to the progression of several critical issues rippling throughout the entire healthcare industry. In our new eBook, The Recent Rise of Disparities and Inequities in Rural Healthcare, we examine three of the most recent challenges that hospitals in the country face today. Then we uncover through extensive research how these challenges disproportionately impact rural hospitals.

The three main challenges for hospitals today

Hospital staffing shortages

As reported by HHS, about 16% of all hospitals are experiencing critical staffing shortages.3 However, even before the nationwide spike in healthcare staffing issues, only 11% of all physicians practiced in rural areas. To make matters even worse, 65% of all healthcare professional shortages occur in these same areas.2

Hospital closures

Due to a lack of staff and a limitation of revenue-generating patient services spurred by the COVID-19 pandemic, many hospitals struggle to keep their lights on. Nationwide, there have been an average of 16.4 hospital closures since 2015, resulting in a decline in the number of hospitals from 1,887 to 1,805. Rural hospitals make up an astounding 59% of these closures.4

Response delays and EMS transportation times were already much longer in rural areas than urban ones. Now, as more rural hospitals close, transportation times are increasing — while the likelihood of positive patient outcomes decreases because of delayed access to care.5,6

Worsening socioeconomic factors

People in rural areas tend to be poorer and older than those in urban centers. They live in higher concentrations of poverty, and 18% of them are aged 65 years or older (compared to 13% of the urban population). Rural areas also saw a 0.4% rise in the unemployment rate from 2010 to 1018, while urban areas saw a 4% employment rate growth.6

Based on the preexisting socioeconomic conditions, it’s easy to assume that rural hospitals were already operating on tighter margins than urban ones. In fact, many of them were already operating in negative margins.7 But with rising unemployment and a dwindling population (a 2% decline was observed between 2010 and 20186), more rural hospitals will likely be shuttering in the coming months and years — ultimately resulting in an even greater disparity in healthcare access.

How to overcome disparities and inequalities in rural healthcare

Rural hospitals are tasked with providing positive patient outcomes to an older, sicker, and poorer population than hospitals in urban areas. To do so, these hospitals must contend with staffing shortages, fewer hospitals over greater distances of travel, and worsening socioeconomic conditions.

Download our eBook, The Recent Rise of Disparities and Inequities in Rural Healthcare. You’ll learn more facts and realities behind the challenges that put access to healthcare in rural areas at greater risk — and you’ll find out what can be done to overcome disparities and inequalities in rural healthcare.


  1. HHS announces the nation’s new health promotion and disease prevention agenda. https://www.healthypeople.gov/sites/default/files/DefaultPressRelease_1.pdf.
  2. Rural Healthy People 2020. Texas A&M Health Science Center. https://srhrc.tamhsc.edu/docs/rhp2020-volume-1.pdf.
  3. Vaccine Mandates Hit Amid Historic Health-Care Staff Shortage. https://www.bloomberg.com/news/articles/2021-10-02/vaccine-mandates-hit-amid-historic-health-care-staff-shortage.
  4. U.S. Rural Hospitals Fast Facts. American Hospital Association. https://www.aha.org/system/files/media/file/2021/05/infographic-rural-data-final.pdf.
  5. Rural Hospital Closures Maps, 2005 – Present. https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures.
  6. Affected Residents Had Reduced Access to Health Care Services. https://www.gao.gov/assets/720/711590.pdf.
  7. The Causes of Rural Hospital Problems. https://ruralhospitals.chqpr.org/Problems.html.

Follow the Patient, Not the Money, for Quality, Cost-Efficient Healthcare

Guest post by Motient co-founder Dr. Richard Watson

It would not be surprising to anyone associated with healthcare to state that money drives the motivations and decision-making in the industry. It is certainly noted that the rank-and-file patient care cohort continues to carry the quality torch, but even these voices are filtered through a complex algorithm of “metrics” and “standards.” It has long been noted that the easiest way to control this US healthcare behemoth was through constriction of the dollars and then releasing surplus through carefully gated wickets. And so, as one could imagine, all behavior is now judged against the perceived disruption of revenues.

Now, during the last two years of navigating the rapidly decreasing number of resources, facilities and systems have come to the end of mitigations. The need to move patients creatively in the environment of no hospital capacity and the flexibility needed to make decisions on the fly is not supported in the current CMS reimbursement environment of comply or appeal. Even the easing of constraints does not offer the motivation and direct view to revenues that our health care system requires.

Connecting the Right Resources to the Right Needs

What will it take to comprehensively adapt to a rapidly changing environment? If we approach the answer from the standpoint of what is lacking in the current environment, it would be quickly evident that the system has little ability to match needs with resources. Continuing to push the needs of the patient back to the pinnacle of health care decisions must be the fundamental guiding light for decision-makers. Next, the system should have the ability to assess, categorize and apply the correct resource to the correct need. Standardizing this idea of capability is critical to understanding capacity, which is crucial to the idea of margin in the system. But that is not the whole story. When a new movie hits the streaming services, and suddenly the network is dealing with an isolated surge, the server confirmation flexes to meet demand. The system is decentralized so that multiple resources can be dealing with the traffic, not just a central hub. The math surrounding distributive networking comes into play to shift resources to areas of need. No doubt we are a ways from that dream in healthcare. But we can begin to reward those types of behaviors in the reimbursement process.

Systems that consistently assess the acuity and needs of the patient, track and connect with ecosystem resources using consistent methodology as well as analyze post hoc for trends and outcomes should be rewarded. These small steps are quickly obtainable if the revenue path is clear. We must continue to embrace the idea that matching the right patient with the right resource at the right time is the surest path to the highest quality, cost-efficient care. The technology is there to deal with this environment, and interested groups can see this vision. The question will be if larger facilities and particularly larger health systems can look beyond their own desire for advancement and make the choice to join the ecosystem. I can imagine that the disincentives for that type of protectionist behavior will have to be in place.

We Must Change for the Better, and for Each Other, to Get Where We Need to Be

If there is a lesson we should learn from the last couple of years, it is that we are all in the same sandbox, and we need each other. Citizenship in this privileged industry requires us to care about each other and look beyond self-interest. We no longer have the luxury of a never-ending supply of healthcare, and it will take several years to build back from where this pandemic has taken us. The reimbursement system must change, not only to recognize from where we have come, but those changes must also take us to where we need to be.

It’s Time to Change How We Handle COVID-19 With Concise, Effective Actions

Guest post by Motient co-founder Dr. Richard Watson

Recently, I was on several calls concerning the rise of COVID-19 cases and the burden to the health care system. There’s no doubt that there is a point where challenges become crisis — and crisis becomes collapse.

The constant influx of “Breaking News” into our psyche has blunted any ability to decipher the nuances of this escalation.

And, as this is not our first go at this sort of thing, most of the stakeholders have exhausted their list of mitigations. The problems are well known:

  • Among the unvaccinated individuals, there is a real percentage that will need hospitalization and intensive care.
  • No one vaccinated or unvaccinated has complete immunity.
  • Everyone will have an experience with the virus.

Vaccination does not prevent infection, but it will most assuredly keep you from needing hospitalization. The young do well; the older, the obese, and the unhealthy fare less well.

Faster, Harder, More is Not Working. It Never Does.

When I was a doc on the sidelines at the small college football games in the town where I was a family physician, I was fortunate to get to experience quite a few halftime locker room speeches — some effective, some… not so effective. We weren’t a great team, most of the players were there for the academics, not for some higher sporting aspiration. More often than not, we would be behind on the scoreboard as we came in at the half. The guys would be worn and tired, but always competitive.

I remember one particular halftime ended with the plan: “We’re going to run faster, block harder, tackle more, and we’re gonna win this game!” Little consolation for guys who were already giving it all they had — not one player takes to the field to do less.

But I remember one coach, who had the fortune to be on the coaching staff of a Super Bowl championship NFL team. His words went something like this: “They are killing us in the secondary, so we’re going to switch it up. We’re going to a four-man front and blitz more. On offense, we’re going to keep it on the ground even if we don’t score in the third quarter. We’ll draw them in close and then we’re going to open it up in the fourth quarter.”

A real plan — something tangible, thoughtful, and informed. The players knew what they needed to do and there was buy-in that the second half would be different.

Changing the Game Plan Utilizing the Tools We Have

There are few times in the last two years that this global scenario has afforded us the ability to have a tangible, thoughtful, and informed plan. But we know more now than we ever have. We have more tools at our disposal than ever before, and we have people who day in and day out are committed to taking the field — they just need a plan.

Emergency declarations and crisis standards of care are a knot at the end of the rope, a stopgap, a plan of last resort. Essentially, it is telling our caregivers and first responders to run faster, block harder, and tackle more.

We must change the game plan. Here’s how:

  • Reimbursement must be changed to allow compensation for the type of patient movements that haven’t had to occur in the system before: longer distances, different destinations, movements up and down the chain more freely.
  • We must address agency nursing that allows poaching of staff from one state to another.
  • We must use the technology that already exists to improve communication, leverage data, and improve networking at all levels of the system to enhance care in place, match demand with resources and protect quality.

State and federal leaders are constantly looking for new ways to change the COVID-19 landscape. No one likes to deliver the same ineffective byline.

We have the power to do something tangible. We have the information to make concise, effective change.

It’s time to go out and finish the game!

Motient Facilitates Over 5,000 Patient Transfers for 120 Healthcare Providers in 2021

Patient movement pioneer triples headcount while streamlining transportation for critical care patients

TOPEKA, Kan./Jan. 5, 2022 — Motient, a pioneer in patient movement solutions, announced today that its web-based patient movement platform facilitated more than 5,000 patient transfers from 122 hospitals to more than 209 destinations in 2021. Nearly half of these interfacility transfers represented time-critical cases.

Motient’s Mission Control solution streamlines providers’ transport workflow via patient acuity scoring and a comprehensive logistics dashboard. The platform is now averaging an accelerated rate of 20 to 30 patient transfers per day — and, on many days, sees more than 40. Interfacility transfers typically arise when one facility lacks the specialized resources needed to properly care for a patient and play a key role in the delivery of optimal patient care.

Over the course of the year, the Mission Control solution assisted hospitals, health systems, healthcare networks, and other healthcare facilities with a wide variety of patients requiring a higher level of care.  The vendor-agnostic platform worked with more than 132 transport agencies to move patients across 11 states. More than half (52%) of client requests involved ground transport, while 48% of patients were transferred by air.

In 43% of transfers, the referring hospital requested Motient’s assistance to locate an appropriate destination for the patient, particularly as the pandemic exacerbated inpatient acute care capacity constraints. Overall, 17% of transferred patients were identified by the sending facility to require COVID-19 transfer protocols.

Among the company’s key milestones of 2021 was the extension of its partnership with the Kansas Department of Health and Environment (KDHE) and Kansas Department of Emergency Management (KDEM) to facilitate and track emergent interfacility transfers. Under the terms of the agreement, all Kansas hospitals and state correctional facilities will be able to use Mission Control to arrange patient transportation, source destination facilities, and analyze data to improve the patient transfer process.

Internally, Motient tripled its employee headcount and launched a new data analytics department focused on simplifying the consumption and application of patient transport data for clients. The company also evolved its product development process, adopting a responsive, rapid iteration deployment model to reflect customer feedback in real-time.

“Motient is proud to conclude a year of innovation and growth. We value our partnership with the state of Kansas and are deeply appreciative of the response we’ve received from so many EMS agencies and local and private transport vendors,” said Dallan Huff, president of Motient. “In 2022, we look forward to collaborating with forward-thinking healthcare organizations to improve patient outcomes through a more cohesive interfacility transfer process. We are grateful to our key stakeholders for partnering with us to harness the power of patient movement.”

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I have really enjoyed working with the knowledgeable and innovative staff within Mission Control! They have observed and created a dashboard that significantly meets our data abstraction needs. This information is in real time and we can access the data points we need very quickly. Mission Control has saved me hours of manual abstraction and I can now present this information to our physicians and leadership through creative charts and graphs. At Newman Regional Health, we are very excited to integrate Mission Control into our daily workflow and look forward to the valuable information the dashboard can provide!

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We started using Mission Control a few months ago because we were struggling with finding patient placement and transportation. Mission Control helped with that significantly. MC is very user friendly! All staff has been so kind and helpful! They are always prompt with assisting us and do a great job in keeping us up to date and informed on any progress they’re making whether that be with a phone call or a message through mission control. They continue to work until transport has been found! We would be lost without them!

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The Creation of Motient: Two Doctors See Possibilities in Challenges

After experiencing the hurdles of patient movement first-hand, two doctors decided to transform them.

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