A bill being pushed by the American College of Emergency Physicians to require a board-certified or board-eligible physician be in a hospital emergency room at all times the Emergency Department is open has patients’ best interests at heart.

That’s commendable.

It’s also likely not realistic for rural hospitals that are closing due to decreasing patient volumes and expenses that are rising faster than revenues. At least three states – Indiana, South Carolina and Virginia – have signed on to bills similar to House Bill 2265, which was introduced in the Pennsylvania House of Representatives last week. We’re not sure how healthy rural hospitals are in those states, but we know the situation in rural Pennsylvania hospitals is increasingly dire. We struggle to see how a requirement that could lead to adding doctors in an already challenging environment is going to work either financially or logistically at a time when rural areas are struggling to attract doctors.

It’s obvious a small facility like the Bradford Regional Medical Campus could have survived under such a requirement since it is scheduled to be closed now. The Hospital and Healthsystem Association of Pennsylvania released a report in January stating as many as 12-14 more hospitals could close over the next five years. Rural hospitals are especially at risk as they serve a greater share of Medicare, Medicaid, and uninsured patients.

House Bill 2265 includes exceptions to the staffing requirement if a facility demonstrates low patient volume and documented recruitment challenges. The fact that an exception exists means the bill’s sponsors know full well that most small hospitals aren’t going to be able to meet the ACEP-backed staffing requirement.

The sponsors of House Bill 2265 have the best interests of patients in mind as long as hospitals remain open. But adding new costs and regulations doesn’t help keep hospitals open. Quite the contrary, new costs and regulations are more likely to push hospitals out of business. Is it better to have a limited emergency department or no emergency department at all?