The allure of rural America varies for the 60 million people who call these parts of the nation home. For some, it’s the slower pace of life, while others crave the sense of community; in some cases, people are drawn by the lower cost of living.
But access to healthcare services in rural America is an ever-growing burden.
Nov. 21 is National Rural Health Day, so it’s the perfect opportunity to draw attention to the challenges faced by these communities and highlight some solutions.
Since 2010, 119 rural hospitals have closed from the Carolinas to California and dozens of states in between, and 47% of the remaining facilities are currently facing negative operating margins.
Rural hospital closures cause ripple effects within their communities. The erosion of patient access to basic healthcare services eventually translates into a lack of economic activity and overall disinvestment in rural areas. Rural hospitals often serve as anchor institutions that attract physicians, specialists and families to live in rural areas.
Currently, more than 40% of outpatient visits in rural areas are to family physicians, and due to the diminishing healthcare access in these areas, doctors are tasked with caring for a growing range of issues, including maternal health outcomes. According to a recent report from the American College of Obstetricians and Gynecologists, in some places, family physicians provide 100% of obstetric care.
The declining access to OB-GYNs encapsulates a larger healthcare issue facing rural areas: specialty practices are leaving small, rural communities. The result, according to the CMS, is that tens of thousands of women now must travel 100 miles or more to access maternal-care services.
Hospital closures are also causing complications in emergency situations. When seconds count, ambulances are being forced to transport patients longer distances; this takes extra time, which a patient may not have.
But amid these challenges, people in rural America are doing what they have done for generations: adapt to hardship. They are doing more with less and using their sense of togetherness to make their communities healthier. Rural hospitals and providers are leading the way by creating programs that bring care to the people who need it most.
The administration is helping too by increasing its focus on improving care in these areas through the CMS’ Rural Health Strategy. While there are limitations to telehealth, the program is expanding access to virtual services across the Medicare program–giving patients access to specialists they might not be able to see without extensive travel. In addition, the agency is implementing policies that raise payments for rural hospitals saddled with low wage-index values.
However, there are other actions the federal government could take to revive rural healthcare. Payment policies under the Medicare Dependent Hospital and the Low Volume Hospital programs, which will sunset in 2022, need to be made permanent. Rural hospitals are also disadvantaged compared with urban hospitals by an unfair Medicare disproportionate-share payment policy. This too can and should be fixed.
While we see promise in the care quality and savings coming from the accountable care organization program, we take issue with the fact that not all ACOs are treated equally. A flaw in the system disadvantages programs in rural areas, making it harder for them to achieve savings even when they improve quality and reduce costs on par with (or better than) their urban counterparts.
Our two organizations have joined with a dozen other provider groups to support a bipartisan fix to this glitch. The Rural ACO Improvement Act (S. 2648) would level the playing field and give further incentives for healthcare coordination in rural areas.
America depends on rural communities, and those communities depend on healthcare. Let’s make sure rural Americans have access to the care they need and deserve.
