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A Rural Health Reform Shopping List

Cheryl Clark, for HealthLeaders Media, September 23, 2009

Anesthesia – Close loopholes that allow certified registered nurse anesthetists standby and pass-through costs and change policies so that CAHs are properly reimbursed for anesthesia services.

Rural Residency – Increase reimbursement caps on rural residency training programs in primary care and general surgery by 30% and provide appropriate funding for faculty to train additional residents. Also, create interest-free loan programs and tax credits for those practicing in rural and underserved locations.

Unused Residency Slots – Preserve unused slots in rural residency programs, slots they now lose because rural programs struggle to fill their slots. Provide incentives to help fill them.

Area Health Education Centers – Reauthorize these centers, which provide health career recruitment programs and provide training. Under the Senate Health Education Labor and Pensions Committee proposal, AHEC would receive $125 million annually between 2009 and 2014.

National Health Service Corps – Make a significant investment in this program and allow more flexibility, so health professionals can fulfill their commitment by working part-time.

Telehealth – Create a telehealth advisory committee to be administered by the Centers for Medicare and Medicaid Services and which would include practitioners from a variety of geographic regions.

508 Hospitals – Extend this designation that would enable certain hospitals to continue to receive better Medicare rates. These hospitals generally operate in rural areas, but are so close to high-priced urban areas that they must pay salaries that are similarly higher.

Therapists – Make marriage and family therapists and mental health counselors in rural areas eligible for Medicare reimbursement to improve provision of their services in areas where there is a vast shortage.

Of course, Elehwany acknowledges, "The biggest obstacle is in finding the offsets; we have to find a way to pay for some of these important provisions." That's going to be tough, she says.

"These are not health facilities in big urban areas with independent, expensive lobbyists."

But as her organization says on all its health reform fact sheets, "for any health reform to be a success, the healthcare crisis in rural America must first be resolved – for it does not matter if you have health insurance coverage if you do not have access to a physician or health provider.

"Legislation that finally addresses the long-standing inequities and disparities in rural America must be included as part of federal healthcare reform."

It's impossible to know which of these provisions –contained in a variety of legislative packages, amendments or separate bills – will end up in the final health reform bill passage.

For rural America, however, she hopes it will be all of them.


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Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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