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BPC Report: Rightsizing Rural Health Care in America Demands National Attention

Wednesday, January 17, 2018

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Washington, D.C.– While there are renewed efforts to revive rural America, its residents continue to face greater disparities and barriers to quality health care than their urban counterparts and should not be disenfranchised from national policy discussions. Today, the Bipartisan Policy Center releases a new report which highlights the challenges of health care delivery in rural areas of the Upper Midwest and identifies key areas for reform that could apply nationally to all rural communities.

The report, Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States, was created over a six-month period in collaboration with the Center for Outcomes Research and Education (CORE). It includes insight from nearly 100 national thought leaders and health care providers in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming on the current state of rural health care, and the strategies and tools needed to deliver high-quality, high-value care to rural and frontier areas of these states.

Centers for Disease Control and Prevention data show that 46 million Americans living in rural areas are at a greater risk of dying from heart disease, cancer, chronic lower respiratory disease, and stroke than their urban counterparts. Rural residents also have higher rates of obesity, tobacco and opioid use, and suicide than those living in urban areas.

“In order to address health care in rural America, federal laws should better align to meet the unique needs of rural areas of our country,” said G. William Hoagland, BPC senior vice president. “The 115th Congress has introduced numerous bills that address rural health care, but acted upon individually, they are piecemeal and take a siloed approach to improving access and delivery and that will not solve this problem.”

BPC’s survey of the seven Upper Midwest states identified four specific policy areas for developing recommendations:

1) Rightsizing Health Care Services to Fit Community Needs. Recognizing not every community needs a Critical Access Hospital (CAH), communities should adjust services to better suit the needs of the local area. In an effort to prevent closures, CAHs should be allowed to provide more primary care and prevention-focused services.

2) Creating Rural Funding Mechanisms. Given small population sizes, growing health care needs, and demographic trends, rural areas need alternative Medicare and Medicaid reimbursement metrics and payment mechanisms that allow for value-based alternative payment models and innovation. Appropriate reimbursement mechanisms for telemedicine should also be examined to accommodate the virtual provider and the on-site provider or host hospital.

3) Building and Supporting the Primary Care Physician Workforce. New workforce models should be examined in collaboration with universities and residency programs to expose providers to rural environments and telemedicine, and reserve placements in medical programs for rural residents. Alternative providers such as nurse practitioners and physician assistants can fill vital primary care roles in rural communities.

4) Expanding Telemedicine Services. Telemedicine is a promising way to connect patients with providers and create a peer network for rural providers that will improve recruitment and retention. However, it must be supported by adequate broadband services and reimbursement. Rural health systems need to provide health professionals with the necessary tools and technology to offer this type of quality care to their patients.

“This report serves as a critical snapshot of the health care challenges and opportunities for reform in rural communities across America, said Walter Panzirer, a trustee at the Helmsley Charitable Trust. “Strengthening the financial viability of the rural health care system and providing an injection of innovation and technology to these underserved communities is imperative.”

“Rightsizing America’s rural health care system will require bipartisan action from Congress,” said Anand Parekh, BPC chief medical advisor. “Tackling the barriers to delivering quality and efficient health care to rural America is long overdue.”

This work was funded through a grant from The Leona M. and Harry B. Helmsley Charitable Trust.