In Depth Series: Rural health care is in crisis – here are 5 innovative ways Biden can help it transform

In Depth Series: Rural health care is in crisis – here are 5 innovative ways Biden can help it transform

As part of daily newsfeed, I came across an insightful article posted in The Conversation that I think is worthy of sharing, and in this message I will summarize that document in hopes that you will do just that.

The five innovations discussed in the article are:

  1. Rethink how rural health care providers are paid
  2. Expand mental health services
  3. Build transformational leadership
  4. Bring back pregnancy care – in a better way
  5. Invest in health-promoting rural infrastructure

An  Executive Summary follows:


This statement of purpose stands out to me:

Rural hospitals have struggled with financial troubles for years. Over the past decade, more than 130 have closed, forcing residents to drive farther or delay needed care. Now, the COVID-19 pandemic has many of them wondering whether rural health care systems will survive.

Twenty percent of the U.S. population lives in rural America, a region that fuels the country with food and energy. These Americans believe their health care needs have been overlooked or misunderstood by Washington for years.

One of the first crucial steps is to ensure that trusted rural health care professionals who intimately understand rural America’s challenges are in positions that empower them to shape federal policies that respect rural culture and context. The announcement of the original 13 experts nominated for the Biden transition team’s COVID-19 Advisory Board raised concerns because they largely reflected the coasts and cities at a time when the pandemic raged in rural areas.

As experts in rural health policy and population health, we work with rural health professionals on solving these challenges. Here are five creative ways the Biden administration can help.

(1) Rethink how rural health care providers are paid
I am a big fan of the CMMI and thought it appropriate to point out that this article examines innovative programs already in process; like the one in Pennsylvania: 
Normally, a hospital bills its patients per service. That can encourage hospitals to focus on elective procedures and new technology that can draw more paying patients, rather than promoting wellness and preventing disease. In small, rural hospitals, the volume of services – and ultimately, payment – can also fluctuate widely throughout the year.
Pennsylvania, working with the Center for Medicare and Medicaid Innovation (CMMI), came up with a new design. The Pennsylvania Rural Health Model pays participating hospitals an annual fixed budget that covers inpatient and outpatient services provided at hospitals.
(2) Expand mental health services
Though the pandemic is not addressed directly, there has been an indisputable and concerning spike in the need for mental health care nationwide, and in rural areas.

Rural clinics could better address higher rates of behavioral illness and substance misuse if they could fully bill for these services. Changing how telemedicine visits are billed by making them equal to in-person visits would also help rural patients access needed services. To avoid unnecessary costs, these payment changes could be tied to quality measures, such as follow-up appointments after emergency department visits. Nearly a quarter of emergency department visits in the U.S. could be more appropriately managed in outpatient clinics, saving billions of dollars each year.

(3) Build transformational leadership

I thought this section was a bit less expected and obvious, and the insight provided was, to me, and important consideration. Lifelong learning in adaptive mechanisms to confront changing requirements and goals is crucial to a healthcare leader’s success and that of her/his facility

Two potential tactics: Rural professionals interested in administrative careers could enroll in innovative master’s programs, supported by their employers or through scholarships. The National Health Service Corps, which provides doctors with incentives to work in underserved areas, could also adjust its eligibility criteria to repay student loans for healthcare administration leaders in rural health professional shortage areas..

(4) Bring back pregnancy care – in a better way
While the loss of obstetrics services in rural areas is well known, I thought it important to note that this article offers a possible solution to restoration of those critical  community resources.

The new administration could offset costs necessary for Critical Access Hospitals – small, 25-bed hospitals that exist only in rural areas – to deliver babies through special maternity care payments tied to quality outcomes such as increasing breastfeeding rates. These payments would prevent the temptation for small hospitals to grow expensive surgical service lines to cover financial losses commonly associated with offering maternity care. Such payments would also allow rural hospitals to hire dedicated obstetrics nurses.

(5) Invest in health-promoting rural infrastructure

While social determinants of health are not mentioned in the article, there is, to me, a clear link between what the authors suggest as an innovation and these key factors in fostering and maintaining health in a community.

Both the Obama and Trump administrations strengthened rural infrastructure by prioritizing transportation and telecommunication. However, these investments were often viewed as solutions rather than tools for innovation. Rural towns would benefit from infrastructure investments that also encourage healthy behaviors.

It is an excellent, thought-provoking article, I hope I have provided enough information to cause you to view it in total rather than rely on my commentary and excerpts.

I will end with another except, the concluding paragraph.

Rural America is rich in resourcefulness and diverse in its demographics, politics and economics. A transformative approach to revitalizing rural health care would respect its unique assets and culture. With the right commitment to innovation and accountability for achieving equitable outcomes, the Biden administration can build a healthier and more resilient rural America.

I was impressed by the article, and think you will find value there. If you want to talk about incorporating ACUTE CARE, INC. into your efforts at implementing these, or other, innovations, please give me a call or email.
Paul Hudson, FACHE
Chief Operating Officer