Rural providers are largely left out of the healthcare industry's shift toward accountability, the Chicago Tribune reports.
The Department of Health and Human Services has yet to incorporate the country's 1,256 predominantly rural critical access hospitals (CAHs) into pay-for-performance programs under Medicare, according to the article. This is despite a 2013 Harvard School of Public Health study which found CAHs had higher death rates in 2010 than both other small, rural hospitals and hospitals overall.
Although the Affordable Care Act mandates testing CAH outcomes for bonuses and penalties, Congress never provided any money, according to the Tribune. Furthermore, despite the success of the accountable care organization (ACO) model, less than 5 percent of CAHs participate in ACOs.
"It's very unfortunate that critical access hospitals continue to be exempt from all the new policies aimed at improving quality and safety at hospitals in America," Leapfrog Group CEO Leah Binder told the Tribune. "If you live in a rural community and you are dependent on a critical access hospital, the federal government has abandoned you."
Many cash-strapped rural providers are reluctant to participate in a program that financially penalizes poor outcomes, according to Ira Moscovice, director of the University of Minnesota Rural Health Research Center, but "it's rather shortsighted to think you're going to be excluded from this."
Some rural providers, concerned about being left behind, take steps to correct these imbalances. For example, the Illinois Critical Access Hospital Network is developing its own ACO. And HHS' Health Resources and Services Administration approved $22 million in grants to improve care access in rural areas.
Despite these struggles, an April study found rural providers match their urban counterparts in patient safety and outcomes, and their emergency departments have cheaper, more efficient care, FierceHealthcare previously reported. Hospitals could save nearly $7 billion by adopting rural providers' spending-per-beneficiary levels.