Improving rural American health care

Published 8:26 am Monday, November 25, 2019

Over the last decade, hospital closures have hit rural America hard – especially in Tennessee. During that time, 11 rural hospitals closed across Tennessee, the second highest number of closures in the nation. When a rural hospital closes, patients are left without adequate medical care, often having to travel long distances. This doesn’t just affect people’s care — it also affects employers’ decisions about whether to invest in a region. A community without access to quality health care can be set back significantly, so it is imperative that we do everything we can to improve rural American health care. While there is not an easy answer to help reverse the trend, I believe a few steps can be taken to better ensure the sustainability of Tennessee’s rural hospitals.
A significant contributing factor to rural hospital closures has been the disproportionately lower reimbursement levels our area’s hospitals receive from Medicare, all because of an arcane formula known as the area wage index. Because politicians have gamed the formula over the years, East Tennessee’s rural hospitals only receive about 72 cents for every dollar of Medicare reimbursement that they could be getting — while there are hospitals just outside San Francisco getting paid over 2.5 times this amount for performing the exact same service. I was proud the Trump administration recognized how unfair this policy is and proposed a new rule that will result in significantly more funding for Tennessee hospitals, among others. I authored a letter with 95 of my colleagues to Secretary of Health and Human Services Alex Azar and the Centers for Medicare and Medicaid Services Administrator Seema Verma strongly supporting this rule to better protect rural hospitals.
Encouraging innovation is also critical in order to continue providing high quality care in a rural setting. That is why I was proud to join Senator Marsha Blackburn and West Tennessee Rep. David Kustoff in introducing the bipartisan Rural Health Agenda — a three-bill package aimed at helping improve health care delivery in rural America. Together, these bills will give our rural communities desperately-needed resources to develop new approaches to health care.
One piece of our agenda is addressing the urgent care needs in rural communities that are at least 30 minutes away from the nearest hospital. H.R. 4898, the Rural Health Care Innovation Act, introduced by Rep. Kustoff, creates a grant program for community health centers and rural health clinics, and a grant program for local health departments to meet the urgent care and triage needs of the community. By using these grants, proven facilities across Tennessee can promote and expand the best ideas for improving access in rural areas. If a certain process works for one community, it may work as well for others.
Another piece of our agenda promotes taking better advantage of today’s technology by encouraging telehealth. Telehealth holds promise that it can help patients access quality health care regardless of where they live, and we need to be doing more to lay the groundwork for widespread use of this technology. That is why I introduced the H.R. 4900, the Telehealth Across State Lines Act, to establish nationwide best practices for telehealth and a grant program to expand effective telehealth programs for rural communities.
Finally, rural hospitals often have a difficult time recruiting and retaining employees to work in their facilities. H.R. 4899, the Rural America Health Corps Act, addresses this issue by enhancing the National Health Service Corps (NHSC) with a new Rural Provider Loan Repayment Program to incentivize academic medical centers and graduate-level health care providers to rotate through underserved communities. By exposing physicians to rural areas like East Tennessee, our local hospitals will have a chance to attract physicians and convince them to stay.
Improving the rural health care system will not be an overnight fix, but this agenda will go a long way to help the people that need access to lifesaving care and who can benefit from innovative new ideas for care delivery and provider retention. As co-chair of both the GOP Doctors Caucus and the Congressional Academic Medicine Caucus, one of my highest priorities is to ensure rural Americans are not left behind in policy decisions and can continue receiving quality health care. I am grateful the Trump administration is giving people in rural areas cause for optimism and will look for commonsense solutions with colleagues on both sides of the aisle that allow areas like East Tennessee to thrive.

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