The National Rural Health Association's annual meeting in Austin, Texas, this week gave rural healthcare providers some reasons to be cheerful, despite concerns about rural health's currently limited role in healthcare reform.

The main source of the cheer would be the current administration, which has put leadership in place that is giving rural health more attention than previously given, according to Tom Morris, associate administrator for rural health policy and head of the Office of Rural Health Policy, which is a part of HHS' Health Resources and Services Administration.

Morris said that HRSA Administrator Mary Wakefield and HHS Secretary Kathleen Sebelius both understand how important rural health is, and it's been “a treat” working with them on rural issues. Sebelius met with the National Advisory Committee on Rural Health & Human Services in February and discussed issues of substance, the first time the committee has met with an HHS secretary since 1998, he said.

Still, the CMS can expect to get an earful from rural providers and their advocates in comments on proposed Medicare rules for accountable care organizations under the Patient Protection and Affordable Care Act. As different speakers at the conference noted, federally qualified health centers and rural health clinics—two backbones of the rural health safety net—are essentially squeezed out of ACO participation under the proposed rule. And Dr. Tom Dean, a member of the Medicare Payment Advisory Commission said the question of rural participation may be moot given that the ACO set-up currently under consideration has not yet shown to be successful. The idea is a good one, but implementation is going to be tough, he said. Dean, a physician with both the Avera Weskota Memorial Medical Center, a 23-bed hospital in Wessington Springs, S.D., and the Aurora County Clinic, Plankinton, S.D., noted he was speaking for himself and not MedPAC.

Rural providers are interested in participating in ACOs and other provisions of the ACA, and conference keynoter Dr. Mark McClellan thinks they should be. McClellan, a former CMS administrator and currently director of the Engelberg Center for Health Care Reform at the Brookings Institution, sounded fairly optimistic about ACOs and their ilk and encouraged the audience to get going on the core components of such vehicles ahead of Medicare's implementation. Providers that find success early may find their approach getting adopted by Medicare, he said.

The deadline for commenting on the ACO rule is June 6.

Paul Barr covers public health, post-acute care, specialty hospitals and rural hospitals. Follow him on Twitter: @MHpbarr