Sebelius Hears Rural Health Concerns

Not every rural health leader gets a chance to discuss the issues facing his or her hospital directly with Health and Human Services Secretary Kathleen Sebelius. But that was the case for more than 15 Pennsylvania health leaders last week when the Hospital & Healthsystem Association of Pennsylvania (HAP) hosted a rural health roundtable.

Topics up for discussion included health IT, financial stability, and access to quality care. Participants included CEOs of rural hospitals, including two critical access hospitals, as well as representatives from the Pennsylvania Office of Rural Health, Penn State, and others.

"The secretary took a lot of notes and indicated that these were all valid issues that she would have further conversations about," Carolyn F. Scanlan, HAP president and CEO, tells HealthLeaders Media. Secretary Sebelius spent an hour discussing these issues, which, given her busy schedule, indicates to Scanlan that she has a real interest in supporting and sustaining rural healthcare in this country. "The issues that she raised were issues that we know have been important to her around delivery of quality care," Scanlan says.

I recently spoke with Scanlan and asked her to give an overview of the roundtable conversation with Sebelius.

HLM: Why was the time right for such a discussion?

Scanlan: Rural health is important in Pennsylvania. Twenty-seven percent of the 12.5 million people who live in Pennsylvania live in one of our 48 rural counties. As Congress and the current administration address issues in regard to the implementation of the Affordable Care Act and talk about deficit reduction, we need to make sure that healthcare is still available to 27% of Pennsylvania's residents in the rural areas. It is…that kind of vulnerability, particularly of rural hospitals, that is of concern.

In addition to the financial issues, there are other issues that rural communities are faced with [such as] the availability of physicians. As the country is faced with a physician shortage, both now and into the future, it makes recruitment of physicians into rural areas more difficult. And we talked to the Secretary about incentives or initiatives or current programs that might be able to help rural communities.

In addition, we talked about barriers for midlevel health practitioners—nurse practitioners, physician assistants, nurse anesthetists—to make sure that there were no barriers for their practice, and that their scope of practice in any given state, was fully recognized by the federal government.

HLM: What were participants' major concerns related to health IT?

Scanlan: There were several. One was just the ability of a small community and a small hospital to be able to have both the human and financial resources to put in place a sophisticated information technology [system]. Secondly, the ability to communicate with other providers or hospitals, such as use of telemedicine, and having the kind of infrastructure—broadband or otherwise—that allows that kind of communication to take place.

HLM: Did anything surprise you during the roundtable?

Scanlan: There weren't surprises. There was more a good sense of what the Secretary's priorities are: quality issues and access to care. The conversations around clinical staff availability, telemedicine, [and] ambulatory care all really centered around access and making sure that people had care available to them and [that] the care that is available to them [is] delivered in a quality fashion.

HLM: What unanswered questions remain?

Scanlan: I don't know that there's as much unanswered questions as there is a list of important issues for rural hospitals that need to be addressed at the federal level by HHS, as well as by Congress, to make sure that there is adequate payment for care that's delivered in rural communities, particularly to rural hospitals. And that as part of the conversation about deficit reduction, [ensuring] these smaller hospitals aren't disproportionately hurt in the process.

HLM: Did you feel that you were heard?

Scanlan: Oh, I think the Secretary clearly heard the issues. I'm not sure she was surprised by any of them. She was a governor of a state that has a large rural area, Kansas; she reminded the group of that. She's very articulate on rural issues. I think it was a reaffirmation of the kinds of issues that are important for rural health, rural communities, and rural hospitals.

HLM: Do you feel like it was successful overall?

Scanlan: We do. We were pleased that she was able to make the hospital association and rural issues a stop on her trip here in Pennsylvania, and we think from that perspective alone is was worthwhile. And then to have the ability to spend about an hour talking with her about all of these issues, I think was very helpful.

HLM: Were participants satisfied with the outcomes of the roundtable?

Scanlan: They were pleased with the conversation; pleased that the Secretary took time out of her schedule to meet with them. They felt that the Secretary understood their issues, heard their issues, and where she could, where it was under her purview, where she had the ability to affect change, she would attempt to do so.

HLM: Should this be a signal to rural hospitals around the country that this is a priority for the federal government?

Scanlan: I think it's a signal that the Secretary of HHS has an interest in rural health. I think that it's a signal that she continues, from her days as governor and to her role as Secretary, to understand the importance of rural health.

HLM: What do you hope Secretary Sebelius walked away from the roundtable with?

Scanlan: That there were some real concerns, real issues, both in human capital, financing, [and] payment, that are important in rural communities and that there are remarkably dedicated individuals living in those rural communities, dedicated to assuring that hospitals and other healthcare services in those communities are sustained and are sustained at a high level of care.