(This content was originally published in Cooperative Connections Newsletter)
Raise your hand if you are exhausted from
the never ending news coverage, heated campaign promises, and scores of
misinformation being broadcast pertaining to health care reform. (It’s okay…go ahead!) The complexities and confusion surrounding
the recent Supreme Court decision aren’t lost on anyone and the confusion is
compounded by election-year rhetoric and posturing that dismantles
communication and banishes progress.
Since we’re not running for office, we’ll give it to you direct—and with
a sprinkling of enthusiasm for the role of rural health networks in the
changing healthcare landscape.
The 5-4 Supreme Court ruling upholding the
Affordable Care Act determined that the individual mandate, the most
controversial part of the ACA, was a valid exercise in Congress’s power to tax
(although it is not a valid exercise of the Commerce Clause, which was the
clause that many opponents were expecting would deem the mandate
unconstitutional). In addition to upholding
the policies and provisions that are scheduled to take effect in the coming
years, the ruling solidified that the money, payment modifications and
workforce modifications that have already gone into effect will not be
rescinded.
Okay, so that much you know, but what does
all of this mean for rural? There are a
variety of rural-specific provisions within the ACA that will move forward as
scheduled because of the ruling. A
compressive list of the rural-relevant provisions can be found on the website of the National
Rural Health Association (NRHA). Because
it’s a long list, we’ll walk through a few of them, and why they are critical
to the success of rural health care facilities.
Approximately 25% of the country’s
population resides in rural areas however, there are more rural Americans who
are uninsured and underinsured than their urban counterparts.[1] The ACA contains provisions for the
guaranteed issue and coverage renewability, along with the prohibition of
exclusions based on pre-existing conditions.
This will help to ensure that more citizens are covered. Increased coverage, however, does not equal
access and workforce shortages will continue to be felt acutely in rural
communities. Currently, less than 10% of
physicians serve the country’s rural population and with increased insurance
coverage, the strain felt by providers will be even greater. Included in the ACA are investments in the
National Health Service Corps which will assist medical students with
scholarships and loan repayment programs should they decide to practice in
rural communities. The ACA also
designates critical access hospitals, for the first time, eligible sites for
Corps assisted physicians. The ACA also
calls for increased funding for Area Health Education Center’s (AHEC) to
improve the pipeline of potential future health care leaders, although the
House of Representatives recently voted AHEC out of the running for funding for
next year. (Hopefully the Senate will
reinstate funding.) The improvement in
the rural healthcare workforce will be vital to support the higher rates of
chronic disease exhibited in rural communities[2]. With an increased focus on primary care and
prevention, the ACA incentivizes patients to seek care before their condition
becomes chronic or requires treatment from a specialist.
Networks will play a crucial role in all of
the health reform models as rural providers and hospitals become valuable
players in both accountable care organization (ACO) and Medical Home
demonstration projects. The development
and participation in ACO and the Medical Home concept all require
collaboration, staff and resource sharing, collective innovation, and
willingness to challenge the status quo.
Increasingly, rural hospitals will have to prepare themselves for a
challenging future, based on value, quality transparency, and
physician-hospital partnerships while maintaining a successful business model
in the current system. It’s is somewhat
like navigating two canoes downstream with a leg in each canoe…it could end up
being very painful!
[1] Lenardson, J.,
Ziller, E., Coburn, A. & Anderson, N. Profile
of Rural Health Insurance Coverage: A Chartbook. Rural Health Research and
Policy Centers. June 2009.
[2] Glasgow, N.,
Johnson, N., Morton, L. Critical Issues
in Rural Health. Wiley-Blackwell. May 2004.
A
special thank you to the National Rural Health Association for their breakdown
of the rural-relevant provisions in the ACA.
No comments:
Post a Comment