New Ways To Address Healthcare Issues Are Needed For Rural Americans

It’s no secret the rural U.S. healthcare system faces ongoing pressures from financial struggles and labor shortages. Rural hospitals, in particular, have been hit by the shortages, according to Carrie Cochran-MacClain, chief policy officer for the National Rural Health Association (NRHA).

“We are raising a stink out here in Washington about what we're seeing in terms of the status of our rural hospitals,” Cochran-MacClain says. “We know that coming out of the Covid-19 pandemic, a lot of hospitals really took a hit during that time. They did everything they could to provide services to the people in their communities, and now they're struggling, and we're continuing to see closures.”

Since 2005, 104 rural hospitals have closed. An additional 600 rural hospitals — 30% of all rural hospitals in the U.S. — are at risk of closing in the near future, according to the Center for Healthcare Quality and Payment Reform.

In response, Cochran-MacClain says one stop-gap measure Congress has enacted now is the development of rural emergency hospitals (REH), a Medicare provider designation established through the Consolidated Appropriations Act of 2021. 

New Methods Of Care

REHs are meant to reinforce access to outpatient medical services and reduce health disparities in rural areas that are unlikely to be able to sustain a traditional, full-service hospital. Today, there are about 18 such facilities across the U.S.

“It’s a great model that’s keeping a level of (medical care) access in rural settings, and that’s fantastic,” she told Chip Flory, host of AgriTalk, on Monday.

“But I think our perspective is, in addition, we hate to see hospitals closing their in-patient units, because they can't afford to keep them open and are being forced to turn to this model,” Cochran-MacClain adds. “We want to make sure those facilities that are in rural communities and want to keep their inpatient care are able to do that.”

Achieving that goal – and continuing to provide rural Americans with healthcare options – will require addressing the costs and labor issues, she told Flory.

“We have to do more to make sure that we're training (medical) folks from rural areas, that we're recruiting folks to rural areas, and really investing in that workforce,” she says. 

Reimbursement rates to rural hospitals also need to be addressed. Many rural hospitals struggle to maintain financial viability under traditional Medicare payment models.

“When we moved to the way that we pay hospitals now, called prospective payment rates, those rates were not made for small, low-volume facilities,” Cochran-MacClain says. “So, we continue to really need some adjustments to the way we are paying for health care in rural areas. And that's what we're trying to do with a whole slew of proposals in Washington.”

The rural healthcare discussion between Cochhran-MacClain and Flory is available here.

More Funding Resources Needed

The U.S. Department of Health and Human Services (HHS) announced in late 2023 some of the steps underway to help rural communities keep access to local healthcare available to residents. These include:

Funding to rural providers to join value-based care initiatives. Medicare’s largest value-based care program, the Medicare Shared Savings Program, encourages providers to collaborate to provide coordinated, high-quality care to people with Medicare by forming or joining Accountable Care Organizations.

Grants to rural hospitals and communities to provide health care services. HHS has several grant opportunities to support rural communities, including $28 million to provide direct health services and expand infrastructure and $16 million to provide technical assistance to rural hospitals facing financial distress. 

Developing and investing in the nursing workforce. Nurses play a critical role in primary care, mental health care and maternal health care, particularly in rural areas. HHS has announced more than $100 million in awards to address the increasing demand for registered nurses, nurse practitioners, certified nurse midwives and nurse faculty nationwide.

Expanding access to services provided via telehealth. During the first year of the Covid pandemic, Medicare telehealth visits increased 63-fold, especially benefiting patients in rural communities.  The Centers for Medicare & Medicaid Services is extending many of the Medicare telehealth flexibilities that were provided during the Covid pandemic through December 31, 2024.

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