During the Rural Health Summit Oct. 19, CMS Acting Administrator Andy Slavitt addressed his concerns regarding "the great black mark on our healthcare system" — the vast disparities in care Americans receive in rural and urban healthcare settings, and the economic factors responsible.
"The more remote the hospital, on average, the lower the operating margins," Mr. Slavitt said. He listed the plethora of revenue cycle issues rural healthcare providers face today, including razor-thin operating margins, high uncompensated care costs, fewer commercial payer options and lower utilization rates.
Higher uninsured rates in rural communities have compounded hospitals' revenue cycle challenges, such as lower patient volumes, an aging population, limited care delivery infrastructure, higher chronic disease rates and greater treatment needs.
Mr. Slavitt identified the following as key steps taken by CMS to help resolve rural healthcare's economic pressures.
1. The Rural Health Council. CMS established the Rural Health Council earlier this year, comprised of experts from across CMS, to gather feedback on how to improve rural healthcare and develop strategic plans to implement improvements. The council plans to focus on access to care and revenue cycle issues.
2. Provider engagement program. CMS launched a provider engagement initiative designed to improve the clinician experience in the Medicare program. The program aims to reduce administrative burden by decreasing the number of medical record reviews for certain providers. It also relaxed patient care and physician supervision restrictions for critical access hospitals.
3. Telemedicine. Mr. Slavitt said including telemedicine in alternative payment models under the CMSInnovationCenter was an important step to increase access of care to isolated communities.
4. ACO Investment Model. The model provides pre-paid share savings to ACOs in rural areas for staffing and infrastructure that supports population care management, financial management and other essential ACO functions.
5. MACRA. Looking forward, Mr. Slavitt said CMS has set aside $100 million for rural, small and independent practices to get technical assistance under MACRA implementation through quality improvement organizations, regional health collaboratives and other approved groups.