Read the initial comments posted by your classmates and reflect upon them. Formulate one new comment of your own. It must be a logical and thoughtful response that synthesizes the comments of at least 3 classmates into one comment. Be sure to synthesize; do not simply reply to each of the 3 classmates or restate their comments. If the class is small, the discussion will be with your professor. NOTE: You are not required to cite sources and include a reference list for the second post if it is simply your opinion. However, if your opinion is based on facts (as it should be), it is good practice to strengthen your position by citing sources. post 1:  Kelsey Adams posted May 27, 2021 10:23 AM Subscribe According to The Medicare Resource Center, “ancillary services are medical services provided in a hospital while a patient is an inpatient, but paid by Medicare Part B (outpatient care) when the Part A (hospitalization) claim is denied because Medicare believes that it was unreasonable or unnecessary for the person to be admitted as an inpatient” (2021). Some examples of these services are but not limited to; diagnostic ancillary services, therapeutic ancillary services and custodial ancillary services. Diagnostic ancillary services include radiology and lab. Therapeutic ancillary services can include physical, speech and occupational therapy. Custodial ancillary services is usually in home health care. There are many services within these services but these are the main ones available to most people. From my knowledge a rural area differs from an urban area because an urban area is largely populated and a rural area is smaller in comparison. I grew up in a rural area where the hospitals were about a 45 minutes from my house. There was a little specialized clinic about 30 minutes away but the main hospitals and urgent care offices were quite a bit away from my house so when we needed medical attention we had to travel. Living in an urban area you have a much quicker and easier access point to care. As for ancillary services, sometimes these services are not in the same location where patients are seen for medical care. Depending on the insurance carrier or recommendation from the documentation it could cause a burden.  For example, when I was in high school I was playing basketball and broke my ankle, I was rushed to the emergency room and once I was taken care of referred to 6 months of physical therapy after heeling. My hospital was in an urban area but because I lived so far away from everything I had to endure the travel. For major procedures or specialties it was more of a 4 hour drive which in some instances could hurt someone. A lot of employment doesn’t pay for time off for appointments so it could limit the duration of time a patient could have to get the treatment they need. Some recommendations I would provide as a health care leader to lessen the disadvantages living in a rural area would be the delivery methods, access to ca ...

1. Read the initial comments posted by your classmates and reflect
upon them.
Formulate one new comment of your own. It must be a logical
and thoughtful response that synthesizes the comments of at
least 3 classmates into one comment. Be sure to synthesize; do
not simply reply to each of the 3 classmates or restate their
comments.
If the class is small, the discussion will be with your professor.
NOTE: You are not required to cite sources and include a
reference list for the second post if it is simply your opinion.
However, if your opinion is based on facts (as it should be), it
is good practice to strengthen your position by citing sources.
post 1:
Kelsey Adams posted May 27, 2021 10:23 AM
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According to The Medicare Resource Center, “ancillary services
are medical services provided in a hospital while a patient is an
inpatient, but paid by Medicare Part B (outpatient care) when
the Part A (hospitalization) claim is denied because Medicare
believes that it was unreasonable or unnecessary for the person
to be admitted as an inpatient” (2021). Some examples of these
services are but not limited to; diagnostic ancillary services,
therapeutic ancillary services and custodial ancillary services.
Diagnostic ancillary services include radiology and lab.
Therapeutic ancillary services can include physical, speech and
occupational therapy. Custodial ancillary services is usually in

2. home health care. There are many services within these services
but these are the main ones available to most people.
From my knowledge a rural area differs from an urban area
because an urban area is largely populated and a rural area is
smaller in comparison. I grew up in a rural area where the
hospitals were about a 45 minutes from my house. There was a
little specialized clinic about 30 minutes away but the main
hospitals and urgent care offices were quite a bit away from my
house so when we needed medical attention we had to travel.
Living in an urban area you have a much quicker and easier
access point to care. As for ancillary services, sometimes these
services are not in the same location where patients are seen for
medical care. Depending on the insurance carrier or
recommendation from the documentation it could cause a
burden. For example, when I was in high school I was playing
basketball and broke my ankle, I was rushed to the emergency
room and once I was taken care of referred to 6 months of
physical therapy after heeling. My hospital was in an urban area
but because I lived so far away from everything I had to endure
the travel. For major procedures or specialties it was more of a
4 hour drive which in some instances could hurt someone. A lot
of employment doesn’t pay for time off for appointments so it
could limit the duration of time a patient could have to get the
treatment they need.
Some recommendations I would provide as a health care leader
to lessen the disadvantages living in a rural area would be the
delivery methods, access to care, and teleworking/telehealth. I
would of course canvas the area I am working and learn what
works best for my facility/region. After some realignment and
hard thought as a leader I would suggest the area consider
“Community Paramedicine, a model of care where paramedics
and emergency medicine technicians (EMTs) operate in
expanded roles to assist with healthcare services for those in
need without duplicating available services existing within the

3. community” (Rural Health Information Hub, 2021). Having this
throughout the community would vastly help the access to care.
I also thinking having a line of communication like a hot line or
a teleconference line for patients to be able to call a nurse with
symptoms. There are many factors that need to be determined
when considering adding certain things to a rural area and one
of the main factors is money. There are many rural areas that
have a lower income rate and this could cause a potential
problem. Understanding the wants and needs of each area could
be different depending on what is needed and where the focus
is. Every area is different.
Rural Health Information Hub
. Healthcare Access in Rural Communities Introduction. (2002-
2021). https://www.ruralhealthinfo.org/topics/healthcare-
access.
What are ancillary services?
medicareresources.org. (2021, March 11).
https://www.medicareresources.org/glossary/ancillary-
services/.
Post 2:
Mateo Alba posted May 25, 2021 7:58 PM
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Ancillary services are the important services that completes the
patient treatment or the provider’s diagnosis. There are three
types of ancillary services, treatment, diagnosis and custodial.
Some examples of ancillary services are Pharmacy, Laboratory
and Radiology (x-ray). Treatment services provide the necessary
modalities prescribed by the provider. Without it, the patient
will remain sick or injured and possibly get worst. The
diagnostic services are essential to confirm the provider’s

4. diagnosis. It provides the treatment team a clear picture of what
the best course of action or treatment plan for the patient.
Urban area ancillary services
Ancillary services in urban areas can be a very profitable
business. Due to the demographics, cultural background, high
tempo and social norms in an urban environment patients will
always pay for the convenience of the location. As an example,
services like Optometry, Pharmacy and Physical Therapy, can
be found in or around the same parking lot of a big grocery
store like Fred Myers, Super Walmart or Costco. It gives the
patient the convenience of multitasking which in an urban
environment is essential. Ancillary services that can be found in
an urban area not only provides the basic services but also the
convenience. If the patient requires special treatment or
diagnostic modality, they can go to a hospital or treatment
facility in their network within their local area. Additionally,
Urgent care centers or clinics provides the majority of the
ancillary services the patients needs. Again, it is a one-stop
shopping and prevents the patient from sitting around for hours
in the hospital. Majority of these services accepts most medical
insurance which is great for the patient and good business for
the services.
Rural area ancillary services
Ancillary services in a rural community can be isolated and
austere. They are normally very limited, operating with bare
essentials and sometimes none existent. These services are
normally collocated within the medical clinic and with limited
hours of operations. Since the services are limited, patients tend
not to use them or just make do of what they have. For example,
patients will travel long distance just to get their medicine.
Disadvantages of patients living in rural areas

5. It is a challenge for the patients and the providers. From the
patient side, it can be frustrating because the time and distance
it takes to travel to the medical facility. Limited hours of
operations and services they offer, sometimes it is better
making the effort of traveling to the urban community just to
get the services they need. That means spending time and
money which can be hard for the families. From the provider
side, it is also a challenge. The issue are volume and cost to
operations. Even though the rural providers would like to get
the state-of-the-art diagnostic or therapeutic machines and the
highly trained staff to operate it is not cost-effective. Rural
areas normally do not have the patient load compared to the
urban areas. Therefor, the providers must balance on what type
and volume of patients they normally have, what modalities or
treatment they can perform and the cost to business operations.
Recommendations to providers in rural areas
One recommendation which has been validated during the
current COVID 19 pandemic is the use of telemedicine
(Weisgrau. 1995). From the basic primary care patient visit to
specialty appointments like allergy, dermatology appointments.
Also, it is currently being used effectively by the military and
the Veterans Healthcare system for mental health services. It
was initially used in the Philippines and Iraq (Chen. 2016).
Invest in basic diagnostic equipment that is portable, easy to
use, can conduct multiple test and cost-effective like the i-
STAT-1 Handheld Blood analyzer (Abbott. n.d.). It will save
lives and good for business.
Lastly, keep it simple and basic. Always remember to goal of
healthcare (even in the most austere environment) is the
same...save lives (U.S. Army. 2020).

6. References
Abbott. (n.d.).
i-STAT-1 Point of care Blood analyser
. Retrieved May 25, 2021, from
https://www.pointofcare.abbott/us/en/offerings/istat/istat-
handheld
Chen, M. (2016, November 7).
Lessons on Bringing Surgical Care and Telemedicine to Iraq
Kurdistan
. Linkedin. Retrieved May 25, 2021, from
https://www.linkedin.com/pulse/lessons-bringing-surgical-care-
telemedicine-iraq-kurdistan-chen
U.S. Army. (2020).
Army Health System FM 4-02
[PDF].
Post 3 :
Jaydin Davis posted May 28, 2021 7:39 PM
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Ancillary services are medical support services offered to
primary physicians. They are the services offered by hospitals
and medical institutions, other medical and nursing services.
Ancillary services are divided into three categories: diagnostic
services like laboratory tests, therapeutic services like hospice
care services, and custodial services.
Access to medical services is the main problem facing the rural
population. The same applies to ancillary services, where the
main difference between rural and urban is access. The services
are usually provided in different areas in rural areas. Rural

7. hospitals are usually smaller in size than urban hospitals
(Hatten & Connerton, 1986). The size leads to the geographical
disbursement of ancillary services. Patients have to travel for
distances to obtain ancillary services. Spasojevic et al., (2015)
articulated that rural folks are more likely to travel more than
15 minutes to obtain medical services.
Rural consumers of medical services living in rural areas are at
a disadvantage when receiving ancillary services. The services
are disbursed in different places making access to the services a
problem. The charges for ancillary service in rural areas are
higher than in urban areas. Ancillary services follow a pattern
where medical services are charged higher (Hatten &
Connerton, 1986). This increases the cost of medical care for
the patients in rural areas.
One way of improving access to health care services and
ancillary services in rural areas is through better remuneration
of physicians and providers of ancillary services. This will
make the services in rural areas more attractive, attracting more
professionals, and improving access. Medicare payments to
rural physicians should be increased. Studies have shown that
lower payments to physicians in rural areas may be why rural
areas are not attractive to professionals.
References
Hatten, J. M., & Connerton, R. E. (1986). Urban and rural
hospitals: how do they differ?
Health care financing review
,
8
(2), 77–85.
Spasojevic N, Vasilj I, Hrabac B, Celik D. (2015). Rural -
Urban Differences In Health Care Quality Assessment. Mater

8. Sociomed. 2015 Dec;27(6):409-11. Doi:
10.5455/Msm.2015.27.409-411. Pmid: 26937222; Pmcid:
Pmc4753384.