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BPC Task Force Recommends Immediate Actions to Improve Rural Health Care

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Joann Donnellan

Washington, DC –  With the coronavirus spreading across the country, the challenges facing the rural health care system are more dire than ever before with staff furloughs and even more hospitals on the brink of collapse. Today the Bipartisan Policy Center’s Rural Health Task Force releases recommendations designed to stabilize rural hospitals and clinics with financial relief in the short-term and new transformational pathways over the long-term, stop the wave of obstetric unit closures, permanently expand access to telehealth services, enhance value-based care, and incentivize clinicians to work in rural areas for a longer period of time.

The task force report, Confronting Rural America’s Health Care Crisis, is co-chaired by former Senate Majority Leader Tom Daschle; former Sen. Olympia Snowe; former Gov. Ronnie Musgrove; and former Gov. and HHS Secretary Tommy Thompson.

“Today, 60 million Americans living in rural areas are at increased risk of dying from heart disease, cancer, stroke, and chronic lower respiratory disease,” wrote members of BPC’s Rural Health Task Force in the report. “Despite worsening health and rising maternal and infant mortality rates, 126 rural hospitals have closed since 2010 and nearly 560 hospitals are at risk of folding. These policies offer a necessary step forward to stem the steady stream of rural hospital closures and the loss of access to care in remote areas.”

As Congress continues to work on legislation to address the health and economic consequences of the pandemic, including providing additional funding to keep rural health providers in business, the task force calls for legislators and the administration to take immediate action to address the long-term health care needs of rural communities through the recommendations in this report.

Key Recommendations:

  1. Stabilize rural hospitals. Provide immediate financial relief to hospitals for three years in order to transform to meet the community’s needs. This includes suspending 2% Medicare payment cuts and Medicare bad debt payment reductions beyond 2020 and increasing reimbursement rates by 3% for Medicare Critical Access Hospital services.
  2. Transform rural hospitals. Following a comprehensive community needs assessment, allow rural hospitals to transform from full-service hospitals to outpatient and emergency care centers with the flexibility to choose different payment methods; allow rural health clinics or Federally Qualified Health Centers to add emergency services and get paid at hospital level rates, if a local hospital closes.
  3. Enhance value-based care. Make technical changes to current payment systems to enable more patient-centered care, including eliminating co-insurance for care management services.
  4. Stop obstetric unit closures. Reimburse rural hospitals for obstetric care in shortage areas at national median commercial rates; increase education funds to equip primary care clinicians with skills in prenatal and maternal services.
  5. Expand telehealth services for patients. Drop the temporary status of waivers on point of care and make services permanent and give clinicians the ability to treat across state lines.
  6. Incentivize clinicians to stay in rural areas. Provide federal tax credits to encourage rural physicians, physician assistants and nurse practitioners to stay in rural communities; expand J-1 visas from 30 to 50 to allow international medical graduates to stay in the U.S. for three more years to practice in rural areas.

“The recommendations in this report address fundamental and immediate problems in rural areas by ensuring the provision of appropriate inpatient and community-based services, addressing workforce shortages, improving access to maternal health care, and optimizing the use of technology to meet those goals,” added the members.

This year-long effort builds on BPC’s 2018 report and was influenced by site visits in Iowa, New Hampshire, Maine, Wisconsin, Tennessee, and Vermont, and numerous interviews with rural health experts around the country.

Task force members include: Georges Benjamin; executive director, American Public Health Association; and former secretary, Maryland Department of Health and Mental Hygiene; David Blair, chairman, Accountable Health Solutions; former Rep. Henry Bonilla; former Sen. Kent ConradKaren DeSalvo, chief health officer, Google; former national coordinator for Health Information Technology and Assistant Secretary for Health, HHS; former Senate Majority Leader Bill Frist, M.D.; Chris Jennings, BPC fellow; and founder and president, Jennings Policy Strategies; Jennifer McKay, M.D., medical information officer, Avera Health; Keith Mueller, director, Rural Policy Research Institute Center for Rural Health Policy Analysis; Karen Murphy, former Pennsylvania Secretary of Health; former Rep. Tom Tauke, and Gail Wilensky; senior fellow, Project Hope; and former administrator of the Health Care Financing Administration (now CMS).

BPC would like to thank the Helmsley Charitable Trust for its generous support in funding the Rural Task Force’s mission of identifying the barriers and challenges facing rural health care and creating the educational opportunities to affect change.

Read the report

View our infographic on telehealth expansion

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