More than 46 million—or 15% of Americans—live in medically-underserved rural communities. About 70% of rural, or partially rural, counties are considered Health Professional Shortage Areas. And nearly one in 10 counties have no physicians at all.
Add to this picture the 142 rural hospitals that have closed since 2010, including dozens since the pandemic started; it’s no wonder that the Institute on Medicine has called for attention to rural healthcare.
Leaders, clinicians, and professionals dedicated to rural health need more advocacy, investment, technology, and available workforce to meet the needs of their residents. These same residents and neighbors are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke.
Rural health is at a crossroads
COVID-19 spurred a new movement toward equipping and supporting rural healthcare.
According to the National Rural Health Association, “Addressing rural inequities and declining life expectancy rates are a top priority for NRHA in 2023. The federal investment in rural health programs is a small portion of federal healthcare spending, but it is critical to rural Americans. These safety net programs expand access to health care, improve health outcomes, and increase the quality and efficiency of health care delivery in rural America.”
Priorities like the opioid crisis, improving access, elder care, mental health, long COVID, and increasing the rural healthcare workforce are driving innovative strategies. But, these strategies require funding and federal support.
Here are federal funding, policy requests, and grant successes that could materially move rural healthcare in a more positive direction.
Rural health secures support in FY23 appropriations bill
Three achievements stand out from the last omnibus bill for the 2023 fiscal year.
Creation of a CDC Office of Rural Health: Five million dollars have been appropriated to establish an Office of Rural Health (ORH) at the Centers for Disease Control and Prevention (CDC). The ORH aims to enhance the implementation of the CDC’s rural health portfolio, coordinate efforts across CDC programs, and develop a strategic plan for rural health that maps the way forward both administratively and programmatically.
Financial support for rural hospitals: Two programs were appropriated for additional funding, including $3.45 billion toward the existing Rural Community Facilities Program and $2 million for the Rural Hospital Technical Assistance Program. Another $64.3 million was appropriated for the Medicare Rural Hospital Flexibility Grants Program, including $21 million for the Small Rural Hospital Improvement Grant Program and $5 million for continued funding for the Rural Emergency Hospital (REH) Technical Assistance Program.
Additional resources for core rural programs: The following five programs received ongoing funding, mirroring pastoral care priorities, including opioid response, increasing rural physicians, and maternal health:
- $12.5 million for State Offices of Rural Health
- $145 million for the Rural Communities Opioids Response Program
- $12.5 million for the Rural Residency Development Program
- $125 million for the National Health Service Corps
- $8 million for the Rural Maternity and Obstetrics Management Strategies (RMOMS)
On the heels of these achievements, the NRHA published their requests for new funding and legislative action in alignment with rural healthcare’s widespread issues.
NRHA lays out funding and legislative priorities
In their 2023 Requests to Support the Rural Health Infrastructure, the National Rural Health Association laid out 11 priorities. It calls on Congress to take action in the best interest of rural residents and the healthcare ecosystem that cares for them.
Among these priorities, four stand out:
Address Rural Hospital Closure Crisis: NRHA supports the Save America’s Rural Hospital Act, which would permanently eliminate Medicare sequestration for rural hospitals, make designations as Low-Volume Hospitals and Medicare- Dependent Hospitals permanent, reverse cuts to reimbursement of bad debt, and establish increased Medicare payments for ground ambulance services in rural America permanently, as well as reauthorize the Medicare Rural Hospital Flexibility Program.
Reestablish Critical Access Hospital (CAH) Necessary Provider: The Rural Hospital Closure Relief Act is viewed as the most cost-effective, fastest way to stabilize vulnerable rural hospitals. The “necessary provider criteria” has greatly helped many rural hospitals convert to CAH status, which could be made permanent under this provision.
Permanently Expand Telehealth Provisions: While the 2-year extension of telehealth coverage in the Consolidated Appropriations Act of 2023 was a critical achievement, there is a desire to see these flexibilities become permanent, including the ability for Federally Qualified Health Centers and Rural Health Clinics to provide distant-site telehealth services at equitable payment rates.
Addressing Obesity and Chronic Conditions: Rural health advocates are looking to Congress to establish rural-specific programming and equitable coverage options to improve access to the full range of prevention and treatment services, particularly for obesity.
Rural health grants address chronic illnesses
Through the Federal Office of Rural Health Policy and their Community-based Division (CBD), federal grants have expanded access, increased capacity, and improved population health within rural communities.
Through competitive projects that are locally driven, several CBD programs have resulted in increased funding and positive results on health.
Rural Communities Opioid Response: This program invested $70 million in rural programs nationwide to address the opioid crisis.
Community health worker-based Chronic Care Management (CCM): This program started in West Virginia and expanded into a three-state area of Appalachia. Through the CCM initiative, 63% of patients achieved a lower HbA1c, and 21.5% decreased their HbA1c below 10%. The program realized $384,000 in annual cost savings.
Volunteer-driven hypertension management: Another program trained community volunteers to provide an eight-session hypertension management series for elderly patients with hypertension. Over 10% of participants met the Healthy People 2020 definition of controlled hypertension after 16 weeks.
These successes highlight what can be accomplished through targeted investments backed by proven programs and community-driven programs.
Rural health presents challenges, but there is hope
New funding, legislative action, and technologies like telehealth, chronic care management, and remote patient monitoring enable new partnerships and programs for 30 million rural residents.
How ThoroughCare supports rural healthcare providers
ThoroughCare’s intuitive software platform can help rural hospitals, health clinics, and providers who provide critical access to care to collaborate and deliver digital care coordination and chronic care management. Our solution can help:
- Streamline the creation of patient care plans
- Use SMART Goals to measure individualized progress
- Support staff workflows with guided, validated assessments
- Help motivate patients through clinical recommendations
- Analyze patient risk factors and generate clinical recommendations
- Identify behavioral health conditions
- Track and log services for an audit-proof record of care
Additionally, ThoroughCare supports comprehensive integration with leading EHRs, health information exchanges, remote devices, and advance care plans while helping providers visualize and interpret patient and operational data through analytics.
