Twenty percent of the U.S. population lives in rural America and most of those citizens are part of a rural health care crisis. Rural populations are older, sicker and less likely to be insured or seek preventative services. They are more likely than their urban counterparts to experience preventative death from heart disease, cancer, unintentional injuries, chronic lower respiratory disease and stroke. Over the past decade more than 130 rural hospitals have closed including 17 in 2020 alone in the midst of the worldwide COVID pandemic. How can the U.S. address the rural health care crisis?
Rethink How Rural Health Care Providers are Paid
Pennsylvania just implemented their innovative Rural Health Model guaranteeing its 13 participating rural hospitals the revenue they will receive in the coming year. The idea is that by giving hospitals certainty about their budgets, they can focus on preventative care and chronic illness treatment. They are rewarded for keeping patients healthy and out of the hospital, not for performing elective procedures. “Over time the idea is to devote more resources to population health measures and put less emphasis on trying to fill their beds,” said Dr. Rachel Levine, the Pennsylvania secretary of health.
Rural Representation in Federal Policy Making
The 13 experts nominated for the Biden COVID-19 Advisory Board transition team were all from the coasts or large cities during a time when the virus was raging in rural areas. But remember Dr. Levine and her innovative financial model for Pennsylvania rural hospitals? She was just confirmed as the new Assistant Health Secretary. One of the ideas put forth is a dedicated division within the Center for Medicare and Medicaid Innovation focused on rural health.
Build Transformational Leadership
Rural communities have a long history of recruiting physicians through rural medicine rotations or loan repayment programs. Doing something similar to attract innovative hospital administrators and encouraging “locals” to pursue health care careers is essential to turn the tide on the rural health care crisis. Innovative master’s programs that produce administrators with the courage to transform health systems, steward resources and think outside the box and that are funded through scholarships or other incentives is essential.
Deliver Babies
Fewer than half of rural counties nationwide have hospitals that deliver babies. Establish small, 25-bed hospitals that exist only in rural areas to deliver babies through special maternity care payments tied to quality outcomes. These special payments allow rural hospitals to hire dedicated obstetrics nurses and would dramatically improve maternal and infant mortality.
Expand Mental Health Services
Mental health needs are similar in rural and urban areas but Medicare’s lopsided billing rules create a problem. Federally qualified health centers are more prevalent in urban areas and are able to bill for a wider array of mental health and substance abuse services than the more common health clinics in rural areas. Evening out this difference for areas of the country where suicide rates are higher is essential to help stem the rural health care crisis.
Invest in Infrastructure
The deterioration of infrastructure like roads and dams endangers health, jobs and economic competitiveness. Both Obama and Trump strengthened rural infrastructure by prioritizing transportation and telecommunications. Infrastructure investments that encourage healthy behaviors like bike paths, accessible playgrounds and open space acquisition are critical to fight the rural health care crisis.
The closure of rural hospitals hurts surrounding businesses and decreases local tax revenue along with people losing their jobs and the distancing of health care services from those who need it. The pandemic has highlighted and accelerated the problem, hopefully, not too late for the 557 rural hospitals currently at risk.
Interested in a health care career? Contact Smith Hanley Associates’ Executive Recruiter, Nihar Parikh at nparikh@smithhanley.com.
