A new agenda could mean improvements for rural healthcare08.08.19
“This was done in response to what the communities were saying to us,” said U.S. Senator Marsha Blackburn (R-Tenn.) of her recently proposed Rural Health Agenda.
Sen. Blackburn answered questions and gave insight into the three healthcare bills that comprise the agenda in a briefing held at Waller’s Nashville office this week.
In light of the growing number of hospital closures, particularly in rural areas, “we need to begin to look at a new way to address healthcare.” Sen. Blackburn described her three-bill agenda as doing just that, finding new ways to solve endemic problems in rural America. “You can’t have economic development without these two things: high-speed internet and healthcare. And you can’t have quality healthcare without high-speed internet.”
Without basic resources, such as high-speed internet, these communities either lose or remain without much-needed healthcare services, unable to pull themselves up. Sen. Blackburn addresses this particular issue in her third bill calling for telemedicine expansion. But first, consider her other two bills.
Rural America Health Corps Act
Attracting and retaining talented providers is a struggle for rural hospitals. Given the low pay and limited resources rural hospitals can offer, there is little these facilities can do to incentivize physicians and other healthcare professionals to set up camp in their communities.
This problem is what Sen. Blackburn addresses in the first of her three bills, the Rural America Health Corps Act (S. 2406). Co-sponsored by Senators Dick Durbin (D-Ill.), Kevin Cramer (R-N.D.), Doug Jones (D-Ala.) and Lisa Murkowski (R-Alaska), the proposed bill calls for an enhancement of the National Health Services Corps.
The enhancement would create a Rural America Healthcare Corps to incentivize an enhanced range of providers to practice in underserved communities. Incentives would include the creation of a new program, providing loan repayment for practitioners on a sliding scale, and waive income tax liability for the loan repayment program. Offering these types of incentives could bring more skilled providers to rural populations, making better healthcare possible.
Rural Health Innovation Act
The second bill, the Rural Health Innovation Act (S. 2408), was co-sponsored by Sen. Murkowski and, as described by this press release, “incentivizes communities to leverage their existing resources to provide for the community’s urgent care needs.” This includes the creation of two 5-year grant programs to establish “new model” facilities, with added priority given to communities that have lost a hospital in the last seven years.
Whether newly constructed or repurposed from closed or failing hospital space, robust Federally Qualified Health Centers and Rural Health Clinics, furnished with the equipment needed to triage and stabilize patients in an emergency, would be established to serve the urgent care needs of rural communities. Sen. Blackburn suggests that using existing space in vacant hospitals for emergency departments could be a productive use of existing resources.
During the briefing at Waller, John Tishler and Denise Burke, among others, voiced their support of the new agenda. Denise noted the significance of the fact that this bill, in particular, sends resources to the right places — e.g., invests in more efficient sources of care, either new or repurposed — rather than propping up failing hospitals with dozens of empty beds, as has been done in the past. If a rural community can establish a freestanding ED, ancillary services will grow around that facility as opportunities and needs arise. Keeping large, failing hospitals alive only perpetuates the problem.
Senator Blackburn acknowledges that passing her Rural Health Agenda might encounter some pushback, but believes in the mission and is determined to address the challenges presented by hospital closures and preserving access to care.
Telemedicine Across State Lines Act
The third piece of proposed legislation is the Telemedicine Across State Lines Act (S. 2411), co-sponsored by Sen. Cramer. This bill would do three main things:
- Create uniform, national best practices for the use of telemedicine across state lines, with the opportunity for states to adopt those best practices
- Create a grant program to incentivize the expansion of telemedicine into rural communities
- Require the Center for Medicare and Medicaid Innovation (CMI) to create a payment model that would incentivize the adoption of telemedicine in rural communities
Stroke patients serve as a poignant example of the value of telemedicine. If a stroke patient is taken to a rural hospital where there is no neurologist, a physician at another facility can call in critical medications remotely, such as TPA, to limit long-term damage to the patient.
“Bring the doctor in instead of get the people out” is the mentality behind this bill, improving patient access to care without building and maintaining an expensive full-scale hospital with specialty physicians on-site. While hands-on care is certainly necessary in many situations, effective telemedicine can serve as the first line of treatment before patients are transferred to a more specialized facility.
While the Centers for Medicare and Medicaid Services (CMS) has started reimbursing for telemedicine services, the Department of Health and Human Services (HHS) has yet to provide much substantive support or guidance, something this bill would remedy.
Ultimately, if legislation can create incentives to move healthcare professionals and technologies into these unserved or underserved communities and perhaps even convert already existing brick and mortar facilities into more purposeful healthcare resources, rural healthcare might start to look very different and become much more effective.
More details about the proposed agenda are available here.
For more on the challenges faced by rural providers, read this Waller blog article.