A number of different formats have been floated.
"At the end of the day, a transformed entity is better than a closed entity for both the community health and the local economy," he said.
U.S. Sen. Chuck Grassley is championing a proposal before Congress called the Rural Emergency Acute Care Hospital Act, which would create a new Medicare classification to allow rural hospitals to limit themselves to providing emergency and outpatient services. The bill doesn't have a House companion.
"The goal of the REACH Act is also to help rural hospitals stay open while meeting the needs of rural residents for emergency room care and outpatient services," Grassley said in a statement.
The National Rural Health Association, which represents rural hospitals, supports the REACH Act, but prefers its own proposal, the Save Rural Hospitals Act. That would allow for the creation of "community outpatient hospitals," but also includes increased Medicare funding and other provisions.
Nonetheless, Brock Slabach, NRHA's senior vice president, said, "We're willing to work with anybody on working towards a new model."
Another resounding take-home message that emerged: There's no one-size-fits-all policy that will tackle the challenges in every rural community. Solutions will have to be flexible.
Congress and the current presidential administration have largely left rural communities out of value-based payment initiatives, focusing instead on strengthening those systems' financial viability and access to healthcare in those areas, according to the report. Most delivery system reforms under the Affordable Care Act either outright excluded rural healthcare providers or allowed them to participate with little financial risk.
The NRHA has developed a proposal to help critical-access hospitals to dip their toes into value-based purchasing. It would increase hospitals' Medicare reimbursement by 2% if they submit quality data, which they're currently not required to do, and agree to join Medicare managed-care groups. Slabach said the proposal will likely be introduced in Congress next month.
While the ACA didn't address telehealth and other remote-monitoring technologies in rural areas, the new report said it's becoming increasingly important for rural communities. Significant barriers exist, however, including continued discomfort with the technology among providers and staff in the states studied. Local providers said both private and public payers have limits around what types of telemedicine they'll reimburse for, and it's not always the same as an in-person visit.
All states studied have changed laws to allow nurse practitioners to practice independently without direct supervision by a physician. Other states are considering allowing pharmacists to perform medication management for patients, although various provider associations oppose such measures, the report said.
Rural communities are also embracing the use of community health workers, case managers and care coordinators that travel to patients and help arrange their care. In-home care workers who visit several patients a day are also becoming increasingly important in rural areas with aging populations.
An edited version of this story can also be found in Modern Healthcare's Jan. 22 print edition.
