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3 Big Rural, Community Healthcare Challenges

John Commins, for HealthLeaders Media, January 9, 2013

I spent a recent afternoon reviewing some of my columns from 2012.

Clearly the biggest issue facing all healthcare providers, both rural and urban, this year 2013 and into the next decade or longer is the implementation of the Patient Protection and Affordable Care Act.

There are still a lot of questions about the rollout, particularly as they relate to Medicare/Medicaid reimbursements and the development of state-and federally sponsored healthcare exchanges.

With that in mind, it's easy to forget that rural and community-based healthcare providers have other challenges that precede or are not directly tied to PPACA. That's what I'd like to look at today.

Rural Patient Migration
The story that I found most interesting in 2012 concerned patient migration from rural areas. As I noted in September, a study found that nearly half of Tennesseans living in rural areas who seek healthcare drive past the hospitals closest to their homes to look for care in more urban settings, even when their local hospitals offer the same services.

Unfortunately, the data used to compile the study doesn't say why rural patients travel farther from home to get their healthcare. Study author Steven L. Coulter, MD, president of the BlueCross BlueShield of Tennessee Health Institute says "that actually is the question of the hour."

"My speculation is that they perceive, whether true or not, that the services are better elsewhere. We really can't make a policy-level judgment based on the data we have found. All we can say is people are mobile and they are moving. What we can't say is whether that is a good thing or a bad thing, because we haven't looked at clinical outcomes or the economic impact on the communities that these small hospitals serve."

These findings suggest that profound changes are underway for rural hospitals, at least in Tennessee. Maybe it's time for rural hospitals to wave the white flag for elective procedures and instead focus on services that take advantage of their proximity to patients: Trauma and chronic care.  

The Affordable Care Act will place a renewed emphasis, and money, on chronic care treatment. Coulter believes that rural hospitals are a perfect source point. Instead of traveling longer distances for their more-frequent chronic care consultations, patients could drive to the hospital down the street.

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