Improving rural patient outcomes by avoiding unnecessary transfers

In rural health care, every mile matters — especially when patients are transferred far from home for care they could have received locally. For critical access hospitals (CAHs) and rural facilities, clinically unnecessary transfers represent more than just logistical disruptions; they break the continuum of care, strain patients and families, and erode trust in the local health system. In many cases, they are also avoidable.

As rural health leaders seek solutions that improve outcomes and sustainability, reducing unnecessary transfers has emerged as a strategic and compassionate imperative. Thanks to innovations in telehealth, more patients can now be treated closer to home — safely, effectively, and with specialist support once limited to large urban centers.

Understanding the human cost of unnecessary transfers

A patient transfer is not a neutral event. It may mean hours in an ambulance, nights spent alone in a distant ICU, or delays in treatment while beds are located or specialists consulted. For rural patients and families, this disruption often includes lost income, childcare hurdles, or simply the stress of being far from home during a critical moment.

Unfortunately, these transfers are often prompted not by medical necessity but by gaps in local capacity, such as the absence of a specialist or staff discomfort with high-acuity cases. According to a multi-network study of tele-emergency services, approximately 20 percent of transfers in rural emergency departments were avoidable with telehealth support, and 43 percent of those patients were treated and discharged home from their local hospital (Ward et al., 2020).

Better outcomes begin with local treatment

The implications of these findings are profound. When rural hospitals are equipped to treat more patients in place, outcomes improve:

• Faster interventions: In stroke cases, tele-neurology enables timely administration of therapies like tPA, improving survival rates and recovery times (Zachrison et al., 2021).
• Stronger continuity: Local treatment supports a smoother care experience — from emergency admission through discharge and follow-up — with familiar providers.
• Greater safety and satisfaction: Being close to home offers emotional comfort and logistical ease, enhancing the healing process and patient satisfaction.

The message is clear: When rural hospitals can safely treat patients locally, the entire community benefits.

Why these transfers happen – and how to stop them

Unnecessary transfers stem from a few recurring challenges:

• Lack of on-site specialty expertise (e.g., neurology, cardiology, infectious disease)
• Limited overnight physician or critical care coverage
• Low comfort levels in managing complex or high-acuity patients
• Staffing strain and burnout

Telehealth-enabled clinical services offer a scalable solution to this issue. Remote access to board-certified specialists — from critical care to cardiology, nephrology, and beyond — allows bedside teams to co-manage complex cases without automatically defaulting to a transfer.

Whether it's a virtual hospitalist assisting with a new admission or a tele-intensivist guiding sepsis management, the result is the same: the local care team is supported, empowered, and equipped to keep more patients safely in place.

The data speaks for itself

Evidence continues to support the clinical impact of virtual care models:

• Multi-specialty programs enable rural hospitals to administer time-sensitive treatment, reducing long-term complications and mortality (Zachrison et al., 2021).
• Infectious disease consults via telehealth improve early management of sepsis and complex infections, increasing the likelihood of in-house treatment (Mathur, 2024).
• Tele-psychiatry reduces emergency department boarding times and connects patients to appropriate behavioral health services faster (NRHA, 2025).

And just as importantly, patients notice the difference. Local treatment means they’re surrounded by family and community. It shortens the distance between diagnosis and care — not just physically, but emotionally. When rural hospitals can treat more conditions in place, patient satisfaction and community trust rise.

A win for patients and hospitals alike

While the focus here is on patient outcomes, the financial and operational benefits are equally important. When hospitals reduce unnecessary transfers:

• Bed space is better utilized
• Admission and observation volume increases
• Transport costs and administrative burdens are reduced
• Staff confidence, retention, and morale improve

For CAHs operating under cost-based reimbursement, even modest gains in retained volume can be transformative. For example, keeping just one extra patient per week could net over $500,000 in revenue annually, even after accounting for telehealth program costs (NTCA, 2017; Equum Medical, 2025). Additionally, each avoided transfer saves an estimated $2,673 in transport costs — savings that benefit patients, hospitals, and the health care system at large (Ward et al., 2020).

Keep care local, when safe and possible

Unnecessary transfers compromise more than the patient experience — they weaken rural health care systems from the inside out. But with the right tools and the right partnerships, hospitals can shift that dynamic.

By integrating virtual specialty services into their care model, rural hospitals can become more than stabilization points — they become hubs of high-quality care. Patients stay closer to home. Outcomes improve. Trust grows.

The future of rural health doesn’t require building urban-style hospitals in every town. It requires building access, support, and confidence. Telehealth is not just a tool — it’s a lifeline that empowers rural hospitals to provide the right care, in the right place, at the right time.

Let’s ensure rural patients no longer have to leave their communities for care they could have received just down the street. Let’s keep care closer to home.

References

Mathur, A. (2024, March 7). Harnessing telehealth for rural critical access hospitals. National Rural Health Association. https://ruralhealth.us

National Rural Health Association (NRHA). (2025, February). Telehealth’s impact on rural hospitals: A literature review. https://ruralhealth.us

NTCA – The Rural Broadband Association. (2017). Anticipating economic returns of rural telehealth. https://www.ntca.org

Ward, M. M., Vojta, C. N., Nelson, R. E., et al. (2020). Averted transfers in rural emergency departments using telemedicine: Rates and costs across six networks. Telemedicine and e-Health, 26(5), 597–603. https://doi.org/10.1089/tmj.2019.0159

Zachrison, K. S., Schwamm, L. H., & Onnela, J.-P. (2021). Paying for telemedicine in smaller rural hospitals. JAMA Health Forum, 2(9), e212694. https://doi.org/10.1001/jamahealthforum.2021.2694

Equum Medical. (2025). Financial ROI modeling and value proposition. Internal white paper.

NRHA adapted the above piece from Equum Medical, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.

About the author: Karsten Russell-Wood, MBA, MPH, resides in rural Maryland and is passionate about improving health care access in underserved communities. As the chief marketing & experience officer at Equum Medical, he works to connect innovative virtual care solutions with rural health care needs. With a background in health care marketing and a commitment to community development, Karsten advocates for telehealth as a means to ensure equality in care, regardless of geography.