Telehealth Specialists Are Helping Rural Hospitals Reverse Default Transfers

Wellstar and its rural partners say the Digital Care Network has changed the operating logic of rural acute care: patients who once would have been transferred by default can often stay in their local hospital with specialist support available by telemedicine.

Matt Lyon, director of the Center for Digital Health at the Medical College of Georgia at Augusta University, said that before the Digital Care Network matured, about 70% of the patients now seen through the network would typically have been transferred from the rural hospital to a higher-acuity facility. In mature use, he said, the pattern is roughly reversed: about 70% of those patients can stay in the rural hospital, while about 30% still transfer when higher-level care is needed.

The model, as described by Lyon and Michael Purvis, CEO of Dodge County Hospital in Eastman, Georgia, embeds specialist consultation into rural emergency, inpatient, and ICU settings through telemedicine. Purvis said Dodge County made critical care through telemedicine part of its core patient-care offering after taking work developed by Lyon and Augusta University Medical Center. He said the network has reduced transfers by almost 30% and helped return two rural hospitals where he has worked to profitability and sustainability.

The operating phrase for the model is “keep with confidence.” Lyon said many patients are transferred not because they clearly need a tertiary-care bed, but because the local clinician is facing uncertainty without the support of a specialist team. The network is meant to put a specialist “in the boat” with the rural clinician, available at 2 a.m. as well as 2 p.m., so appropriate patients can be treated close to home without leaving the local team isolated.

That framing matters institutionally. Jason Stevens, Wellstar Health System’s senior vice president, introduced Wellstar as a not-for-profit integrated system with 34,000 employees and 400 sites of care across Georgia and South Carolina. He said every dollar of revenue above expenses goes back into care delivery, including care regardless of ability to pay, and that over the previous five years Wellstar had provided more than $1.2 billion in care to uninsured and underinsured patients in Georgia and South Carolina.

But Purvis’s hospital is not owned by Wellstar. Dodge County Hospital is an independent county hospital authority. Purvis emphasized that point because it is central to the model: a rural hospital does not have to be acquired by a larger health system to work with one.

Richard Freeman, Wellstar’s chief physician executive, said rural and urban healthcare have always differed, but the disparity has widened in recent years. He pointed to perinatal mortality as one example and described the causes as multifactorial, with workforce supply at the center.

Freeman’s basic arithmetic was blunt: about 20% of people live in rural environments, while about 5% of medical practitioners practice there. The long-discussed shortage of physicians, advanced practice providers, clinicians, and other healthcare workers, he said, “has finally arrived.” It is now difficult to recruit in some urban environments, and rural recruitment is harder still. Rural sites often have to pay a premium for clinicians they still struggle to find.

Lyon described the Georgia disparity as especially stark. In his framing, the state has “two Georgias”: metropolitan areas with some of the best healthcare and rural communities where people are left behind. He tied rural residence itself to lower life expectancy and higher mortality from cancer, diabetes, cardiovascular disease, and stroke, noting that the region sits in the “stroke belt.”

The intuitive expectation that rural living might produce better health — cleaner air, proximity to nature, closer ties to agriculture — does not match the outcomes Lyon described. In his words, living in a rural county means starting with a healthcare disparity.

That disparity becomes an operational problem inside the rural hospital. A clinician may be working with nurses and respiratory therapists but without the specialist colleagues available in an urban hospital. Lyon said modern medical education trains physicians in team-based care, then asks some of them to practice in rural settings where the specialist team is not physically present. The result is uncertainty: Is this the right plan for the patient in front of me? Should the patient be transferred just in case?

Freeman connected the same issue to call burden. A cardiologist considering a rural community may be facing the prospect of being the only cardiologist there, meaning no night off unless leaving town. New physicians often come out of urban training environments, may carry significant loan debt, and may have family needs. The job of being the sole specialist in a rural area can become a path to burnout rather than a sustainable career. The Digital Care Network, in Freeman’s account, is one way to reduce that isolation without pretending every rural community can recruit every specialty.

A hypothetical patient in Eastman, Georgia, arriving at Dodge County Hospital with chest pain would receive fast life-sustaining care and stabilization. Before the Digital Care Network, Purvis said, the hospital would then shift toward transfer to a larger hospital capable of heart catheterization, heart surgery, or other advanced procedures.

The transfer would not necessarily be a nearby trip. On a good day, Purvis said, a larger hospital might be about 60 miles away. On an average day, because larger hospitals are often busy or on diversion, it could be 200 to 300 miles. Diversion, as Purvis explained it, means the receiving hospital has reached capacity for the condition in question — cardiology in the chest-pain example.

The burden of that transfer does not fall only on the patient. Freeman noted that the patient may suddenly be separated from a support system. Purvis said rural hospitals often see patients as neighbors, family members, and fellow churchgoers, not just as cases. When patients are transferred far away, families may need money for lodging in larger communities, sometimes for weeks or months depending on the condition. He said local communities sometimes organize GoFundMe campaigns or take up money so families can stay near the patient.

After the Digital Care Network is in place, the early steps are the same: triage, immediate treatment for life-threatening issues, labs, imaging, and evaluation by the treating provider. The difference comes when labs are abnormal or symptoms persist. Instead of immediately searching for a receiving hospital, the rural provider can bring in a cardiologist or other specialist by telehealth. That specialist can review labs and imaging, talk with the patient, consult with the treating clinician, and help design a plan to keep the patient safely in the rural hospital when appropriate.

Lyon did not claim transfer disappears. Some patients still need higher-level care. His emphasis was that the specialist remains available if the patient stays. If the concern is that something could happen overnight, the value is not only the first consult; it is the assurance that the specialist can be reached again in the middle of the night. If transfer becomes necessary, the patient-physician connection has already been established and the network helps make the transfer happen.

The model also grew out of pandemic-era necessity. Lyon said that during the pandemic, patients were sometimes unable to transfer, forcing rural practitioners to take care of conditions and patients they did not feel comfortable managing. The network took that forced experience and built a post-pandemic system around it, with telehealth and digital platforms being used more, not less.

Freeman framed quality in terms of access to the same specialists a patient would see in an urban Wellstar emergency department. In a traditional transfer pattern, an emergency physician might call around trying to get a cardiologist on the phone. In the network model, the connection is real-time and digital. If the issue is chest pain, the rural hospital can access the same cardiologist a patient would see after arriving at a Wellstar emergency department in Atlanta. If the issue is stroke, it is the same neurologist.

Freeman was careful not to suggest rural physicians lack quality. His point was distribution and call coverage. Good rural physicians are dispersed across wide areas and cannot take call every night. The Digital Care Network supplies 24/7, 365-day access to specialist expertise in a way that individual rural communities cannot sustain on their own.

The system also changes the role of nurses. Freeman said one sign the network is working is that nurses “love it.” Nurses are often closest to the patient, and the network Lyon built allows them at times to initiate a consult by saying they are not comfortable and want the digital network involved. For Freeman, that showed frontline reliance, not merely administrative adoption.

Purvis said the network has helped rural hospitals retain nursing staff and given physicians confidence “to stand in the trenches” because backup is available. He added a practical transfer point: even if Augusta University or Wellstar is on diversion, if a transfer becomes necessary, “the answer is never no.” In many cases, he said, the network can help with transport when the local ambulance system cannot send a vehicle 300 miles away while still covering 911 calls in the county.

Lyon described the effect as compounding. The program works “from triage to discharge,” not only at the first emergency-department decision. A nurse or clinician can initiate a consult at any point during the hospitalization. As more patients are admitted from the emergency department into the inpatient setting, the rural team gains experience managing more complex care locally with daily specialist participation.

At the beginning with a new hospital, Lyon said, the network might affect only 10% of transfers. Then perhaps 30%, then 50%, and eventually, when the model is mature, about 70% of patients they are able to keep rather than transfer. The change is partly clinical and partly cultural: clinicians, nurses, respiratory therapists, pharmacists, and others build confidence by taking care of a sicker cohort over time.

The community’s perception can change as well. Lyon said that when a rural hospital transfers a high share of patients, the community may start to view it as a “band-aid station”: a place to be evaluated before being sent somewhere else. Over time, people may bypass the local hospital altogether. Keeping more patients locally can rebuild confidence, which means patients seek care closer to home and sooner.

Purvis presented the financial turnaround of rural hospitals as inseparable from clinical capacity. At Candler County Hospital in Metter, Georgia, where he previously worked, he said he arrived to find $33,000 in the bank and the hospital on the brink of closure. Within 18 months, the hospital was reaching what he called more sustainable operating cash flow; within three years, it was profitable. When he left after five years, he said, the Digital Care Network had been hardwired into local physicians’ and advanced practice practitioners’ workflows enough that the hospital remained viable and sustainable.

At Dodge County Hospital, Purvis said the hospital was already part of the initial Digital Care Network rollout when he arrived. He did not claim to have introduced the model there, only to have increased utilization. When he came in, Dodge County was losing about half a million dollars a year. A year and a half later, he said, the hospital appeared likely to reach about $1 million in profitability.

Those figures were offered as examples of why keeping patients locally matters to hospital survival. A transfer is not only a clinical decision; it is also lost revenue for a rural hospital and a signal to the community that the hospital cannot manage serious care. Conversely, every appropriate patient kept in the local hospital supports both care continuity and the hospital’s economics.

The reimbursement model is mixed. In response to an audience question about who funds the Digital Care Network if Wellstar is not taking over the patient, Lyon said rural hospitals pay a fee, which is self-sustaining because they can keep more patients and generate revenue. The network also bills patients for its services. Stevens added that in the chest-pain example, Dodge County Hospital pays a monthly fee to the Digital Care Network, while the patient’s payer — Medicaid, Medicare, or commercial insurance — is billed by Wellstar for the professional cardiology telehealth encounter. He described enabled billing for telehealth visits as “one of the few gifts” from the pandemic.

Lyon stressed that sustainability was designed into the model from the start because many rural hospitals have experienced what he called “grant whiplash.” Organizations arrive with a grant-funded idea, implement an intervention, and leave when the grant ends. For rural populations, Lyon said, giving someone a service and then taking it away can be worse than never providing it.

Grants are still part of the story. Lyon said the initial equipment was supported by a USDA grant, which helped prove the concept. Going forward, equipment and connectivity costs are part of the sustainability model. He also said the network was pursuing Rural Health Transformation Grants to bring in next-level technology and expand to more hospitals. Stevens said Georgia had received just over $200 million in Rural Health Transformation funding over the relevant spending timeline, and that many rural hospitals would be able to tap into the Digital Care Network using those funds.

Freeman described Wellstar’s role partly as mission-driven and partly as a long-game strategy. He said Wellstar would rather intervene earlier than have a patient show up a week later much sicker, when the system would still take care of them and might not be reimbursed in some cases. The network is designed to be self-sustaining where possible, but he said Wellstar pays for some of it and uses grants and other funding because it views the work as part of its mission.

Purvis put the issue in capacity terms: rural hospitals are trying to turn capability into capacity, and capacity into sustainability. In his closing remarks, he said rural hospitals do not primarily have a technology problem; they have an access-to-specialty-services problem. He said reimbursement remains “the gorilla in the room” and argued that the model now needs health-outcomes data strong enough to support innovative reimbursement models. He also warned that, in his view, if cuts he associated with the “Big Beautiful Bill Act” arrive in 2029, 30% of rural hospitals will not be here unless rural care innovates and changes course.

The partnership with Augusta University and the Medical College of Georgia is not incidental to the model. Matt Lyon described education as essential because rural recruitment requires more than exposing trainees to rural life. Students also need to see how they can remain connected to a larger clinical community while practicing in rural areas.

In the model he described, medical students at the Medical College of Georgia can observe and provide digital health support to rural communities early in training, then later rotate into rural communities as the recipients of that support. The goal is to bridge both knowledge and experience gaps so future clinicians can envision themselves practicing rurally without feeling professionally isolated.

That training logic is tied to a broader change in the relationship between urban and rural hospitals. Lyon said traditional hub-and-spoke systems tend to pull people out of rural Georgia and into academic or tertiary-care centers, often into the most expensive beds. He argued that rural health transformation funding creates an opportunity to move toward a “hub-and-hub” model: keeping patients as close to home as possible, even if the transfer is from one rural hospital to another rural hospital with the right capacity, capability, and digital connectivity.

That would mean building a backbone across the patient’s care journey: from a smaller rural hospital to a larger rural hospital, or to a tertiary or academic medical center only when necessary. The point is not to refuse transfers. It is to reserve tertiary and quaternary beds for the cases that require them.

Freeman said COVID revealed that the United States did not have enough tertiary and quaternary beds for a once-in-a-lifetime surge. Since then, he said, major centers have remained on diversion, with large numbers of people in emergency departments waiting for beds. If tertiary centers take every rural transfer, they cannot do the work only they can do, such as transplants. Keeping more patients closer to home is therefore both better for those patients and necessary for the functioning of the higher-acuity system.

Lyon illustrated this with a patient story from Sylvania, Georgia. A friend with COVID and risk factors for a bad outcome called him, worried. Lyon said Augusta’s emergency department was quite full and urged him to go to Candler County Hospital. The patient was seen immediately and discharged after two days with excellent care. For Lyon, that was an example of the model’s power: rural care can be the right care when the system behind it is strong enough.

An audience question from Deacon Turner of the Cherokee Nation of Oklahoma put the model’s scalability in national terms. Turner said Cherokee Nation runs its own health system, contracted from the Indian Health Service, serving 500,000 citizens and functioning as a dominant provider in a rural area. He asked who Wellstar’s peers are and where systems facing the same problems should turn.

Stevens said there are not many comparable players. He named Sanford Health in South Dakota as having an equal commitment to rural health, but otherwise said the field lacks significant players and that Wellstar sees a gap to be filled.

Lyon’s answer separated operational scale from cross-border scale. He said the network has grown over the previous 18 months from about 15 hospitals to about 25 hospitals, moving from roughly 25% to about 35% of rural Georgia hospitals. “Scaling is not a problem,” he said, within that frame. The challenge begins when scaling crosses state borders, where credentialing, licensing, and other policy barriers accumulate.

Freeman noted that the rural health transformation grant is recent, while Lyon has been building the network for six years. His hope was that the existing model would allow others to leapfrog that six-year development timeline. Lyon agreed that much of the model is not the technology itself, but thought process, relationships, and systems of care.

Telestroke, in Lyon’s example, shows both the power and limitation of established telehealth models. A stroke neurologist can advise a rural hospital to give a clot-busting drug, but the next step is often “now transfer them to me.” Lyon argued that digital health can do more: change the paradigm from the patient coming to the specialist to the specialist coming to the patient.

That requires active local partners, alignment with rural CEOs and clinicians, and goals of care that match the rural hospital’s goals. The model does not replace local primary care doctors or rural specialists, Lyon said. It partners with them.

Several audience questions pushed on areas where the model is not yet fully developed. One physician from western Colorado described the outpatient specialty problem: patients with severe rheumatoid arthritis, Graves disease, or other chronic conditions may not show up in an emergency department but still face severe long-term morbidity and mortality if not treated appropriately. In her federally qualified health center, two internal medicine physicians help care for more than 17,000 patients and have had to teach themselves to manage many complex conditions because specialist access is inadequate.

Richard Freeman said Wellstar is contemplating how best to extend the model into outpatient medicine and is already doing some of it “one-offish.” His vision for a future outpatient building included exam rooms for primary care clinicians and a dedicated telehealth room where patients already used to coming to that office could see an endocrinologist or another specialist virtually. He said Wellstar has 14 rheumatologists in its Atlanta practice and can get people in, but patients do not want to drive three hours. The outpatient model, he said, is on the list but not as mature as Lyon’s emergency-department and inpatient work.

Another audience question raised consultant workload. If specialists at academic and tertiary centers are doing these consults, they are adding work, even if they can bill for it. Freeman said the model has to make consults easy for the specialist, just as it must make access easy for the rural clinician. In his outpatient analogy, a specialist might see four in-person patients in exam rooms and then walk into a fifth room for a telehealth consult. If the specialist has to go to another building or fight with a computer for 30 minutes, the model will fail.

Lyon said the network has used e-consults — peer-to-peer specialist input — to good effect by making them “concierge” and as easy as possible for both the specialist and the rural provider. Infectious disease is the largest e-consult category he mentioned. In one example, a consult from Purvis’s orthopedist to infectious disease generally takes about 10 minutes, making it efficient enough for specialists to participate.

Purvis said the most common question he gets from local physicians is when outpatient access is coming. He said the work is underway through transformation funds, and identified rheumatology as a particularly visible need. In his community, he said, rheumatologic disease affects not only families but also absenteeism among nurses, and accessible resources to manage it day to day are lacking.

Maternal and pediatric care are emerging extensions of the model, especially in rural areas where obstetric services have disappeared. An audience member who identified herself as a pediatric hospitalist working in a small community hospital maternity desert asked how the model works for maternal care, pediatric care, Medicaid threats, and under-reimbursement.

Purvis said one of the most exciting pieces of work underway through transformation funding is bringing digital telemedicine obstetrics into rural emergency departments. Dodge County Hospital, he said, had been losing $2 million in its OB practice and discontinued obstetrics about two years before he arrived. That created a new emergency-department challenge: pregnant patients still come to the hospital wanting to deliver there and learn only then that the hospital no longer provides that service.

Through the network connection, Purvis said, the hospital has been able to sustain a 24-week delivery and transfer the patient to the next level of care, with the baby surviving. He said that would not have happened before without the digital connection. Lyon added that maternal-fetal medicine is also being pushed out through the digital network.

Freeman explained the specialist gap. Average OB doctors care for women through childbirth, but very complicated cases require maternal-fetal medicine physicians, who are rare and especially scarce in rural areas. Those specialists are becoming part of the Digital Care Network.

Lyon said the team begins by surveying rural hospitals and conducting needs assessments. In Georgia, where some counties have among the worst maternal outcomes, the question is why those outcomes are so poor. If a hospital lacks an OB presence, it may not be prepared for obstetric emergencies, even if emergency preparedness is required for Medicare participation. The network’s answer is to tie in an OB doctor prepared for emergencies and to standardize equipment, with the hope of changing that paradigm.

Pediatric care raised a similar issue. ? alana-arnold, a pediatric emergency medicine physician, asked about pediatric initiatives in rural care and noted that many pediatric transfers are unnecessary, burdensome for families, and a source of revenue leakage. Lyon said the network does emergency work, inpatient work, and pediatric emergency work. He also noted that most rural hospitals will not admit many younger children, particularly children under 12, to the floor.

Even so, pediatric emergency consultation can reduce unnecessary transfers. Lyon gave the example of avoiding a CT scan when it is not indicated. He said the team has been working to involve pediatric surgeons and pediatric subspecialties. Some of that work falls on the outpatient side, where there are clinics in partnership with the Department of Public Health around rural communities specifically for pediatrics. His conclusion matched Arnold’s premise: tying in a pediatric-specific emergency provider affects transfer rates because many children do not need to be transferred.

Julie Wernau, a journalist with the podcast Tradeoffs who said she lives in rural Georgia, asked what health outcomes data the speakers could share beyond the change in transfers. The question sharpened a central tension in the model: transfer reduction, financial improvement, patient confidence, and patient stories are easier for the speakers to describe than population-level health outcomes.

Lyon said it is difficult sometimes to project the acute-care work into population-health statistics. What the network can see, he said, is a shift in patient satisfaction and confidence: patients are more willing to get care in their home community rather than skip past the local hospital. The network tracks in-county and out-of-county care and sees that, as the rural hospital works with the network, both financial performance and ability to provide complex care improve, as does community perception. More care is delivered in county.

Lyon’s argument was that the operational changes should matter over time because they change access behavior. If people access healthcare more frequently and easily, he said, there should be fewer delays. Fewer delays should mean fewer patients deteriorating before finally reaching specialist care — for example, reaching a cardiologist only after heart function has worsened. But he said broader statistics will take more time, especially if the aim is to change the deeper rural health penalties visible across Georgia.

Freeman added a less obvious consequence of transfer reduction: emergency medical services capacity. A small rural hospital may run the 911 service and may have only two ambulances. If one ambulance must travel three hours each way for a transfer, a local 911 call may not get a response. Reducing transfers therefore affects more than the transferred patient and the hospital’s finances. It can preserve emergency response capacity for everyone else in the county.

The claims presented were layered. Lyon emphasized transfer reversal, broader local admissions, specialist availability, increased in-county care, and community confidence. Purvis offered financial examples from Candler County and Dodge County. The patient evidence included specific stories, including the chest-pain example and Lyon’s COVID story from Sylvania. Lyon’s position was that the model creates the access conditions under which stronger outcome data may become visible, especially as outpatient, maternal, pediatric, and specialty layers mature.

Purvis’s action-oriented takeaway was that rural hospitals do not primarily have a technology problem. They have an access-to-specialty-services problem. The “rubber meets the road” in whether rural hospitals can reach specialists when needed and build meaningful data showing that the network helps them remain sustainable.

He argued that the next step is to produce health data strong enough to support innovative reimbursement models. Rural hospitals will need funding structures that recognize the value of keeping care local, avoiding unnecessary transfers, and preserving hospital and EMS capacity.

Lyon’s final point was that digital health can blur lines that healthcare has treated as rigid: inpatient and outpatient, home and hospital, rural and urban. In cities, he said, people feel connected through smart watches, technology, remote patient monitoring, and access to care in the home. In rural environments, digital access is not a convenience feature. It is a way to change healthcare access itself. He called for policy oriented toward systems of care that support patients in rural environments and give them the same ability to affect their own healthcare as people in cities.

Freeman cautioned that the Digital Care Network is one strong idea, but rural healthcare will need many more. He expects the rural healthcare problem to get worse before it gets better, and urged clinicians and healthcare professionals to develop other innovative approaches because the problem is not going away.

Stevens closed by pointing to philanthropy as another part of the funding picture. He said he met Tom Golisano in December 2025, and that Golisano’s $50 million gift to Wellstar led to the renaming of the children’s hospital as Wellstar Golisano Children’s Hospital of Georgia. Stevens said Golisano told him he believed in Wellstar’s work to expand access in rural Georgia and wanted to be part of it.

His lesson was not only that large gifts exist. It was that models need to be explained publicly and concretely. When organizations can show a working model for expanding access, he said, there are people who want to help and who share an obligation to provide care regardless of ability to pay.