Saving rural providers brings even more challenges

Rural healthcare faces a number of problems, including reimbursement obstacles and difficulty adding and sustaining health clinics.

In Georgia, emergency departments (EDs) in rural areas face substantial reimbursement obstacles, the Albany Herald reports. Under Gov. Nathan Deal's (R) plan to save rural hospitals, the state would amend licensing rules to allow struggling or recently closed rural hospitals to offer reduced services, including ED services. However, under the proposal, those facilities would bill Medicare and Medicaid at lower "provider" rates rather than hospital rates.

"It is true that these rural freestanding emergency departments won't be able to receive a facility fee because they would no longer be classified as hospitals," Sasha Dlugolenski, a spokesperson for Gov. Deal's office, told the Herald. "However, they can still bill fee-for-service as a provider for any allowable services they choose to provide, such as basic OB/GYN services."

Georgia refused to expand Medicaid eligibility under the Affordable Care Act, exacerbating rural healthcare providers' problems. While freestanding ED services could help increase access for communities that lose hospitals, "this is not a lifeline for rural hospitals and it's not an alternative to Medicaid expansion," Beth Stephens, health access program director for the consumer group Georgia Watch, told the Herald.

The problem was further inflamed by Deal blaming the Emergency Medical Treatment and Active Labor Act for rural hospitals' problems, according to an opinion piece on Flagpole. "[T]he precarious condition of hospitals in the rural areas of our state, where most everything is precarious, has nothing to do with federally mandated unnecessary 'free' emergency medical care," the piece states. "It has everything to do with rural hospitals not having enough patients."

Pennsylvania is dealing with similar rural access issues, according to WITF. "It is more challenging to run a practice in a rural area, [because] you don't have the economies of scale," Sheri Rinehart, CEO of Pennsylvania Community Health Centers, told WITF. These underserved areas also have fewer privately insured patients, who would help offset the costs of uncompensated care.

In Virginia, struggling community hospitals are turning to mergers and acquisitions with larger hospital systems to survive, FierceHealthFinance previously reported.

To learn more:
- read the Herald article
- here's the opinion piece
- read the WITF article
- here's Deal's proposal