The arrival of accountable care organizations creates another set of hurdles for rural providers. "ACOs are challenging to rural hospitals and rural providers because of the isolation and the low volume of patients they treat," Elehwany says. "They are worried the larger healthcare system might purchase them and they will lose their autonomy. Also per capita rural patients are older and sicker with a higher percentage of chronic diseases. The rural ACOs might not be able to demonstrate equally and be able to share in the savings that others envisioned in the ACOs."
On other fronts, the biggest single challenge to rural healthcare in the near term predates the ACA. Elehwany says it critical that Congress extends beyond the Oct. 1 expiration date the special funding status for about 200 rural Medicare dependent hospitals across the nation. "If they lose this Medicare reimbursement rate, we will be terribly concerned," she says. "We have heard a lot of facilities will close their doors if they lose this payment and that will cut off a lot of critical access to care for rural seniors."
Another antecedent of the ACA, the federal stimulus package, provides billions of dollars in funding to create or enhance access to healthcare information technology. Elehwany says that even with the incentive money for HIT improvements many rural providers are still hobbled by a lack of front-end capital, access issues and the aggressive timeframe for implementation.