Rural healthcare on the mend

Rural healthcare is more stable than ever before, thanks to technology and initiatives introduced by the Affordable Care Act. But the challenge now is to maintain and grow those success stories, according to a panel of experts speaking at an Alliance for Health Reform event on July 26 in Washington, D.C.  

Keith Mueller (pictured right) of the Rural Policy Research Institute explained that before the ACA, the level of health insurance ineligibility for rural areas was higher. Now, more people can get coverage, but recruiting and retaining professionals for rural practice is a burgeoning challenge--community healthcare centers are affecting workforce expansion.

"The questions we need to be asking [are] what do rural residents really need to gain access; what is different about the challenges they confront; how do policy changes affect them?" Mueller said.

Regarding accountable care organizations (ACOs), Mueller said, the numbers of enrollment are already "higher than anyone expected."

Tom Morris (pictured left) of the Office of Rural Health Policy (HRSA), said his office wants to know how federally-funded programs such as Medicare, Medicaid and ACA initiatives affect access in rural communities. Rural hospitals are unique, and must be treated as such.

"Anytime we talk about rural communities, you have to realize it's not a smaller version of urban or suburban--it has its own characteristics," Morris said. The focus is more on primary care and chronic disease management. Any changes made in policy have had a disproportionate impact in rural communities, he said.

The HRSA is focused on getting the word out in the coming months. Reaching out to rural communities is different--patients must be able to sign up for health information exchanges by paper. The word must get out about Healthcare.gov, but not necessarily via the Internet.

"Healthcare is changing dramatically--a lot of consolidation, focus on quality, and trying to focus on costs better. What can we do to make sure we're helping rural providers survive and thrive, more focused on value, and [less focused] on volume?" Morris asked.

Art Kaufman (pictured right) from the University of New Mexico Sciences Center pointed out that rural healthcare is not just affected by its own programs--it's a variety of social determinants. In his state, they're working to bring those determinants together.

"Social exclusion, transportation, food--they're all related to health. How is all the money in the health system going to be shared with those who impact social determinants?" Kaufman asked. He spoke on New Mexico's initiatives, a "model developing [we'd] like to share," including cooperative extensions that teach nutrition classes and focus on food and economic development around primary care physician clinics.

Lisa Miller (pictured left) former member of the Maine House of Representatives, and now with healthcare nonprofit The Bingham program, spoke on Maine's particular struggle with staffing rural clinics.

"We're looking for about 100 PCPs at all times," she said. Despite this, Miller said she isn't worried about what the ACA will mean for her "little rural state."

In Maine, hospitals are buying up PCPs right and left, Miller said--she estimated 70 to 75 percent of clinicians in the state are owned by hospitals now.

"I worry, because rural health centers are not being bought up, and their salaries are much lower… how are we going keep recruiting when the salaries are so very different?" Miller asked.

The answer, she said, is payment reform--a "tectonic change in reimbursement," mostly with primary care and specialty service.

To learn more:
- see the Alliance for Health Reform event page

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