Washington Takes Action To Help Rural Healthcare
The Department of Health and Human Services (HHS) follows through on an executive order issued by President Trump with the introduction of the Rural Action Plan
Early in August, President Trump issued an executive order focused on improving rural health. In response, the U.S. Department of Health and Human Services (HHS) is moving forward with a series of assertive measures featured in a formal strategic plan to remedy the significant healthcare challenges of farmers and others living in rural communities. It addresses access to quality care, medical staffing, technology, clinical innovation, reimbursement and sustainability.
Innovation in care, reimbursement and technology destined for rural healthcare
The new Rural Action Plan, introduced by HHS Secretary Alex Azar, is not a drawn-out overhaul typical of so many other legislative actions. Based on the specific directives featured in President Trump’s executive order that stresses quality and immediacy, it accelerates increased access to care, enhances the level of care and improves the financial wellness of rural healthcare provider organizations. It purposely features specific requirement to establish and maintain robust telehealth capabilities for rural populations.
Rural populations, healthcare provider organizations and medical professionals share obstacles
Americans living in rural communities experience unique circumstances and obstacles when seeking healthcare. They include extended travel distances, limited public transit options, a shortage of credentialled healthcare staff (nurses, nurse practitioners, doctors, physician assistants, medical technologists, etc.) and modestly-equipped facilities further hampered with an inability to capitalize on new, technology-driven care options like telehealth (frequently due to broadband access issues).
Based on these and other hurdles, rural patients are often disadvantaged when seeking basic primary care and those persons with cardiovascular, oncology and respiratory issues are at greater risk in addition to behavioral and women’s healthcare not being adequately supported.
The Rural Action Plan is the catalyst engaging the needs of rural populations through four strategic applications
A cross-functional strategy enables each of the 4 components of the Rural Action Plan to accomplish their respective goals while enriching the functionality and success of each other. Collectively, they deliver more accessible, high-quality care to rural communities nationwide. The four Rural Action Plan components are comprised of:
Building a sustainable Health and Humans Services model for rural communities through:
- Investing in the funding of the Rural Healthcare Providers Transition Project, a new program to provide support for hospitals and rural health clinics transitioning to value-based care models
- Expanding the Community Health Aide Program that provides education and training of tribal community health providers to increase access to quality health care, health promotion and disease prevention services
- Designated funding towards the Integrated Rural Community Care project to connect federally qualified health centers with rural hospitals to better coordinate preventive, primary and emergency health care
Maximizing the use of technology and innovation to deliver quality care and services to rural communities more efficiently and cost-effectively:
- Precisely assign more than $8 million in grant funding for the Telehealth Network Grant Program to provide emergency care consults via telehealth to rural providers without emergency care specialists
- Support for the new HHS Health Challenge to leverage technology to improve screening and management of post-partum depression for rural women patients
- Developing flexibility for Medicare Advantage (MA) plans to improve access to managed care options in rural areas including modification of network adequacy assessments for MA plans to account for telehealth providers in contracted networks
A purposeful focus on wellness and disease prevention through specific “rural-centric” efforts to improve health outcomes:
- Assigning over $2 million in funding in 2020 as an investment in a four-year, $8 million project to identify evidence-based interventions that reduce health risks faced by residents in rural areas
- Designating an investment of over $2 million in additional funding for rural oncology control grants with a focus on geographically underserved rural areas with deep and/or persistent poverty that fortifies a multi-year research effort to increase prevention efforts coupled with enhanced oncology treatment for individuals living in rural areas
- Launch of the Healthy Rural Hometown Initiative to identify strategies to address the growing rural disparities attributed to the five leading causes of avoidable death: stroke, heart disease, cancer, respiratory disease and injury/substance use
Increasing rural access to care and its quality by confronting the shortage of trained medical professionals in rural areas:
- Issuing $8.25 million to 11 communities that develop new rural residency programs through the Rural Residency Planning and Development Program
- A new policy brief examining the workforce shortage challenges state-based licensure restrictions create for rural residents by failing to let health care clinicians practice to the full extent of their training and credentials
- Deploying an investment of $5 million in 2020 to recruit and train emergency medical service (EMS) personnel in rural areas
The Rural Action Plan fortifies other rural health initiatives developed and launched by the Trump administration
The current administration has previously assessed other rural healthcare issues, identified their causes and created solutions. Moving forward it has developed and launched earlier measures that will be further reinforced by the Rural Action Plan. These are some of the affirmative steps taken to benefit rural healthcare leading up to the Rural Action Plan:
- The Centers for Medicare & Medicaid Services (CMS) finalized wage index reform to increase payments to hospitals in low wage areas, including many rural hospitals, that empowers them to attract more medical talent as they compete with higher wage hospitals and health systems
- CMS was spurred to create new ways for Medicare to pay providers specifically for forms of “virtual care” so medical professionals and healthcare provider organizations are reimbursed for remote patient monitoring, virtual assessments and review of electronically transmitted images
- The Health Services Resources Administration (HRSA) launched the Rural Communities Opioid Response program that actively provides the funds (over $157 million to date) to rural areas in 47 states to enhance their ability to implement and sustain prevention, treatment and recovery services in underserved rural areas
- Through the Rural Tribal COVID-19 Response Program, HRSA awarded $15 million to 52 Tribes, Tribal organizations, urban Indian health organizations and other health services providers to Tribes across 20 states to prepare, prevent and respond to COVID-19 in rural tribal communities
- Through the CARES Act, HRSA directed $150 million to over 1,700 rural hospitals to deal with COVID-19 (including $1 million allocated to 12 tribal hospitals across 3 states to boost their ability to combat COVID-19 in their communities with expansions of telehealth, purchases of PPE and greater testing capacity)
A brighter horizon for rural residents and the medical professionals that care for them
Access to quality healthcare is an essential element in the commercial success of farmers and rural communities. Between 2005 and 2020, about 170 rural hospitals closed, over 30 were critical access hospitals. Improved broadband access to support more telehealth will help but not resolve this issue. Preventing further rural health facility closures and building up the ranks of medical professionals working in the rural health market are two important priorities. The series of new funding and federal government initiatives that started 2 years ago is now further supported by the Rural Action Plan. When the pandemic subsides these measures will provide even greater value to farmers and others living in rural communities nationwide.
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