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There have been 60 plus rural hospital closures since 2013, while some see this as a sign that rural health is dying, others see a new dawn on the horizon, spurred by the expansion of telehealth technologies and restructured rural healthcare standards.
As a partner to rural providers across the nation, we’ve had the opportunity to speak with thought leaders who commented on the current climate of rural health. We sat down with National Rural Health Association’s (NRHA) Chief Executive Officer Alan Morgan to get his thoughts on rural healthcare in America, its current status, trends, and his vision of rural healthcare in the future.
He also shared with us valuable insights as to what NRHA is doing to push rural healthcare into the national spotlight, along with some thoughts on how, as an industry, we can help strengthen the heart of rural communities.
Alan: I've been with National Rural Health Association since 2001. My background is in health policy. I'm originally from a small town in Northeast Kansas, and for me, I think it's always been my passion to ensure that there's a future for rural Americans, making sure that they have healthcare access within their communities. It's been a great fit.
At NRHA, our focus is on the community, and how we make sure that we have a healthy vibrant rural America moving forward–for those people that want to perhaps move back to rural America and for kids growing up in rural towns across America. We don’t want them to have to leave their communities. We want them to have an opportunity to stay and to thrive.
Alan: We talk a lot about how we’d like to see policy changed, but to do that you have to highlight the shortcomings and obstacles, right? I think a lot of times we focus in on what rural healthcare doesn't have or what needs to be changed. Often, what gets overlooked is all the innovation that's happening and the assets of rural healthcare.
Alan: I think it’s a story that's not well told or well understood, but in many cases, rural America is what's driving healthcare redesign now, as we're seeing in our nation.
Almost any substantial innovation in the healthcare delivery system over the last 20 years has a beginning in rural health. Most notably, telehealth, telemedicine, and teleconsultation. All this is addressing workforce shortages, most notably shortages in specialty care. A lot of the innovation on that, and the driving force behind it, comes from rural providers.
Workforce shortages gave rise to concepts like patient navigators and community health workers. Dental health aides—that concept took off in rural Alaska. The basic concept of a medical home model is primarily seen in rural areas.
When you talk about the move towards accountable care organizations, to some regard, that has already been occurring at some level in a rural context.
These things happen because of the financial pressures rural providers are facing, the workforce shortages, and the level of health disparities. That's why, when we talk at a national level, it's important not to just push rural providers to the side, but to lead with them and build awareness. Especially when we're talking about new models of care, new reimbursement payments, and new systems of care overall.
Alan: It comes down to a misconception of what rural health is. I think a lot of times people think access to resources and specialty care are the gold standard of what constitutes great healthcare. When you look at the quality measures from the Centers of Medicare and Medicaid (CMS), in a rural context of basic primary care, those measures are often better than their urban counterparts.
Rural hospitals are very capable of delivering high quality healthcare services, as opposed to thinking ... Oh, well this is smaller, and a smaller hospital equates to less than…Smaller doesn't always equal less.
When you see your patients shopping at the grocery store, you know what they're eating. It's easy to recognize why they're experiencing healthcare issues—that community knowledge lends itself to a better understanding, and in many cases, a better healthcare partnership between provider and the patient.
Alan: Telling those stories is a huge part of our mission, but there is also a grassroots effort at the community level. At NRHA we have a strong focus on maintaining access to rural hospitals because for most of these communities, the hospitals are usually the second largest employer behind the school system. They provide that 24/7 emergency room service, and that's really key, not so much just having a hospital building, but being able to know that if something goes wrong, you have a resource within your community.
Alan: I think it really is getting our successful models out there and communicating their stories. We try to make sure that you have peers talking to peers—that’s the reason NRHA exists.
There are a lot of other organizations that deal with healthcare, but we’re focused on rural relevant models. What we need is our successful practitioners and community leaders sharing their stories because then people see the validity. They see this can be our community. Approaching education from a peer-to-peer model—sharing and explaining—is important.
Education is at the forefront for us. We have these conferences, and we'll have hospital CEOs get up and talk about their story and all the success, but we really need them to get to the meat of it. What are you doing? What were your challenges? How did you overcome them? Then tell us about the results. Once they get to that component people can then say, "Oh, yeah. That can work in my community too, or with this tweak, I can make that happen."
A lot of the times the audience ends up being primarily successful administrators and successful physicians, they come to these educational conferences, and the good get great. The hospitals and the clinicians that are really struggling, that really need that education, they say, "Well, I don't have time for that." That's one of the reasons why we focus so much on the webinars and what we communicate to our rural partners.
How can we get them to make this trip to share success with their peers? How do we reach them in the community?—that's an ongoing challenge…
Alan: We receive a lot of recognition from our membership for our work on the state level and the federal level, both, in policy development and advocacy. However, from an organizational level, the most important thing that we do is connect rural relevant products and business solutions to local providers, whether they'd be physicians, or hospital CEOs, or clinicians. We do this to make sure that there's an immediate partnership that can help sustain healthcare within that community. You can't oversell the importance of good partnerships between business solutions and the local providers.
Alan: That’s such a key topic because that is where the healthcare system is going. A lot of rural CEOs already know healthcare is moving outside their walls. The payment systems and the changes happening within the payment systems are pushing that along.
Rural hospitals need to start thinking of themselves as community connectors. How can they work with Meals on Wheels, the senior citizen center, a local primary care physician, and other community leaders to improve the overall health of their community?
As payment changes come from the Medicare, Medicaid, and private payers there's going to be this continued shift in financial support for hospitals and health systems. They need to start looking outside of inpatient services to see what they can do to improve overall health statuses.
Alan: I'm very optimistic about the future of healthcare, and so is National Rural Health Association, primarily because of the changing demographics of America, and what we're seeing in population trends. For the last four years, we've seen population increases in rural America. As broadband expands, people have the option to live where they want to live, and work where they want to work, and from a national perspective, that is rural America.
The concept that rural may be dying just simply isn't true. You've got a rural renaissance happening, and there's no reason to expect that won't continue.
We're finally seeing systems of care and payment methodologies that are rural relevant. New concepts, such as global budgeting, recognize that healthcare systems within a rural community need to work together to keep the community healthy. These types of trends, coupled with emerging technologies, both in telehealth and mobile technology, allow the practitioners to become partners with the patients.
Healthcare hospitals of the future are not going to look like hospitals today. Care will occur outside the walls, and it's going to be in collaboration with other healthcare entities and outside the healthcare sector.
References:
https://www.beckershospitalreview.com/finance/gao-10-things-to-know-about-the-spike-in-rural-hospital-closures.html
https://www.marketplace.org/2018/02/02/health-care/reinventing-rural-health-care-system
