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Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States

In 2017, the Bipartisan Policy Center and the Center for Outcomes Research and Education (CORE) spoke with over 90 national thought leaders and stakeholders about the current state of rural health care in the Upper Midwest region, including Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming. BPC and CORE used these discussions to determine the real-world implications of existing federal policies, to understand ongoing care challenges, and to identify opportunities for improvement in rural health care access and delivery.

This paper details the findings from our outreach efforts. It begins by providing context for the current policy debate and offers a detailed account of different issues and perspectives that are shaping that debate. It then highlights key points and takeaways from the roundtables and interviews and identifies the challenges and opportunities for advancing rural health policies.

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What We Learned

Rural health issues affect more than just the Upper Midwest region and the seven states included in this effort. Furthermore, these issues do not exist in isolation – they are interdependent and build off each other. The nation cannot just fix one part of rural health care; the whole system needs be addressed.

Not every rural community needs to have a Critical Access Hospital (CAH); communities should tailor available services to the needs of the community, which for many rural areas are driven by changing demographics.

BOTTOM LINE: In order to build tailored delivery services, policies need to be flexible and not just have a “one-size-fits-all” approach. The Rural Emergency Acute Care Hospital Act envisions transforming CAHs in certain communities from small inpatient care centers to new models, such as rural emergency centers.

What’s the Current Policy Trajectory?


A few highlights of current activities and proposals:

The Save Rural Hospitals Act proposes providing financial relief to rural hospitals by eliminating the Medicare sequester for rural hospitals and by providing a permanent extension of rural and super-rural ambulance payments, as well as by establishing a new designation for rural hospitals that allows them to transform into outpatient-care hospitals.

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