Rural health care leads the way in innovation | State & Regional

Providing health care in rural areas has challenges, although providers and communities have shown innovation in addressing those obstacles.

National Rural Health Association CEO Alan Morgan says his organization shares what’s working with other rural health care providers.

“We’re identifying best practices of what’s happening in rural communities, sharing those best practices, in expectation we can replicate those successes,” he says.

The challenges rural health care providers face are formidable, Morgan says.

“You’ve got limited budgets, you’ve got workforce challenges, and in rural communities you’ve got a population that is older with more severe health problems,” he says.

Shannon Wu says these issues have been a battle for a while in rural areas. She is the senior associate director for the American Hospital Association, and she says rural patients have to travel longer distances to access care.

“For rural areas, a lot of these issues have been longstanding issues that these communities face,” Wu says.

She says accessibility can be tough, especially for behavioral health services. The numbers illustrate the challenge. Wu says 10% of U.S. physicians are in rural areas, but 20% of the population lives there.

Still, facing these obstacles often means rural areas are where some of the newest strategies for care are happening, Morgan says. Rural health care can provide a window to the future.

“You see a lot of the innovations in health care happening in these small towns,” he says.

One of these is the rise of community health workers, who are not doctors or nurses but are trained in health care and provide a link between patients and doctors. Community health workers can take patients to appointments, share public health info, and in general help fill needs for people seeking health care.

Morgan says the rise in telehealth and telemedicine is most common in rural areas, where the spread-out population can connect with doctors from afar. He says increasing rural broadband Internet access is crucial to fully utilizing this tool, which can provide access to specialists who might not be in rural communities or might only be there one day a week.

Using telehealth is part of broader efforts to bring more behavioral health services to rural America, Morgan says.

The health of rural hospitals is a key part of rural health care, and Morgan says it is a nuanced picture.

“It’s a complicated story right now,” he says. “Rural hospitals are spending down the federal pandemic assistance that they’ve had over the last two years.”

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The extra funding has bolstered many hospitals, but many of those programs are done or will be wrapping up, and costs have risen.

“Staff salaries are really up in these rural communities, patient volumes are down, and all the challenges that rural hospitals have had going on before are still there,” Morgan says.

Wu says the COVID pandemic and workforce shortages have been another problem for the financial health of rural hospitals.

“They’ve really been exacerbated by COVID and the workforce challenge,” she says.

Morgan says over the last decade, 140 rural hospitals have closed, primarily in the southeastern United States. He says this issue is not directly due to population loss, and many areas with sparse populations still support hospitals, but rather it is an issue of how much of the local population is under-insured or uninsured. This becomes more of an issue if the population is older or has more health problems than national averages.

Wu says the care mix is also an issue in rural areas, where half or more of the patients might use Medicare or Medicaid, federal programs which Wu says do not fully cover costs for hospitals.

“Both these federal programs reimburse less than the cost of providing that care,” she says. “… The difference is getting wider and wider in recent years.”

Morgan says preventative health measures can help, with rural health care providers leading efforts to keep people out of hospitals as much as possible. He says people know they need to eat well and exercise, but doing so can be difficult. He says he is optimistic about the future, and that studies show technology like watches that track activity can help encourage people to be more active.

There are also structural issues with the health care system that Morgan says can be addressed to help the bottom line for rural health care providers, including a focus on preventative care — essentially paying health care providers to keep community members out of hospitals to begin with — as well as improving inefficiencies in how state and federal governments and private insurance stack together to pay for health care.

“We really need to, as a nation, start changing how we pay for health care and what we’re paying for health care,” Morgan says.

He says removing regulatory burdens could help, as well as a focus on investing in telehealth.

“Telehealth is not a magic bullet, but it’s a resource,” Morgan says.

Wu says some policy areas that could help rural hospitals include continuing federal financial support for rural hospitals facing financial distress, increasing regulatory flexibility, and addressing the workforce issue.

She says one way rural communities and hospitals are doing this is by providing training in exchange for workers staying in the community, and working with local high schools and recent graduates to recruit them to stay in their home communities and work in health care.

Wu says rural health care providers continue to innovate.

“The big picture going forward is going to be the financial stability for rural hospitals,” she says. “They are some of the most creative and innovative groups out there. They love serving their communities.”