Rural healthcare is under threat nationwide: 170 rural hospitals have closed since 2005, and hundreds more are at risk. To preserve vital services and healthcare access, leaders say a wide range of actions and strategies are needed.
Among them are services becoming more virtual, more preventive and more centered around the home. In addition, CMS payment reform is critical to prevent further hospital closures and adequate reimbursement from commercial payers must be addressed. On the workforce shortage front, initiatives to incentivize a new generation of clinicians in rural care are needed, as well as the removal of practice barriers for advanced practice nurses, leaders say.
Meanwhile, the American Hospital Association is urging Congress to pass the Rural Hospital Support Act. The bill was first introduced in 2021 to modify and extend "certain payment adjustments for rural hospitals under Medicare's inpatient prospective payment system." If passed, the AHA said it would provide "greater financial stability" for Medicare-dependent hospitals and "leave them better able to serve their communities."
Here is what four leaders told Becker's about what the future of rural healthcare could — or should — look like:
Bill Gassen. President and CEO, Sanford Health (Sioux Falls, S.D.): "By 2030, the patient experience in rural and urban areas must fundamentally change. Patients today don't just want excellent, high-quality care, they also want care delivered with more ease, convenience and choice.
Looking ahead to 2030, one of the most exciting opportunities for the patients we have the privilege of serving — two-thirds of whom live in rural communities — is our landmark $350 million virtual care initiative, which will increase access, convenience, care coordination and continuity, improve patient outcomes and fill in provider gaps, particularly in underserved areas across Sanford Health's footprint.
With the industry facing historic workforce and financial challenges, the future health of our communities relies on our ability to attract and develop highly trained clinicians and employees. By doubling our graduate medical education programs, we will bring highly sought-after clinical expertise, resources and subspecialties to the Upper Rural Midwest so patients can access high-quality care close to home."
Julie Gauderman, DNAP, APRN, CRNA. Associate Director of the Nurse Anesthesia Program at Saint Mary's University of Minnesota (Minneapolis): Dr. Gauderman put it simply: "It's time to get smarter with the resources we do have," and enable advanced practice nurses to practice at the top of their license. Minnesota is one of 27 states that grants nurse practitioners full practice authority. For example, in those states, hospitals are not required to have an anesthesiologist to bill out for services on behalf of advanced practice nurses. In addition to cost savings, "it's also freeing up another provider to provide care in a whole other OR setting," Dr. Gauderman said. "If everybody is doing their jobs, then we are providing that many more points of service.
"I don't think that this is the time that we can continue to limit people's abilities when their scope is broader. We need to put everybody to work that we are paying to do the jobs and let them do everything that they're educated to do," she said.
Along with national nursing associations, Dr. Gauderman voiced support for the Improving Care and Access to Nurses Act, which would permit nurse practitioners, physician assistants and other APRNs to provide certain services under Medicare and Medicaid. Another consideration she proposed was developing a way for rural hospitals to band together to address supply chain challenges and improve their purchasing power and lower costs.
Martin Hutson. CFO, Coffee Regional Medical Center (Douglas, Ga.): "The first step to 'save' rural healthcare is to accept that the one-size-fits-none model of Medicare does not work. Rural hospitals face more difficulty in recruiting and retaining staff. Given your location, access to goods and services is also more expensive. CAH based on bed size is not effective when some facilities are too big to be considered critical access but remain just as remote and important as those with that designation."
At the Becker's Hospital Review 13th Annual Meeting in April, Mr. Martin emphasized the importance of not being afraid to close programs that are not financially viable or have low patient satisfaction scores. One way to stay innovative is to dedicate idea time for brainstorming new ways to improve patient experience or save money, he said.
Shannon Wu, PhD. Senior Associate Director of Policy at the American Hospital Association: Across the next decade, the AHA hopes to see more support and advancement of the rural emergency hospital designation and other models that create more flexibility for small hospitals, Dr. Wu said.
The RHE designation from CMS went into effect at the start of the year, giving struggling critical access hospitals and small rural hospitals the ability to continue operating as an emergency services provider without offering inpatient care. Hospitals that convert receive a 5 percent increase in Medicare payments for outpatient services, and an average annual facility fee payment of about $3.2 million.
"That's a big move for many hospitals that are struggling to survive, especially for rural hospitals that don't typically see the volume that other hospitals see, but still have very high costs in maintaining that inpatient facility," Dr. Wu said.
While not a permanent solution, the RHE designation is one example of a flexible model that can serve as a lifeline for rural hospitals and safeguard access to outpatient and emergency care, which already account for 66 percent of Medicare payments to small rural hospitals. CMS did not respond to Becker's inquiries regarding how many hospitals have applied for the RHE designation so far and how many have been approved. Becker's has reported on a handful that have applied for the conversion. Earlier this month, La Grange, Texas-based St. Mark's Medical Center and Holly Springs, Miss.-based Alliance HealthCare secured the designation.