Senate Hearing Provides Template for Rural Health Advocacy

There is no new news about rural healthcare's plight. If citizens, media, and legislators don't get it, rural healthcare leaders are at fault.

Testimony at a U.S. Senate subcommittee last week provides an excellent template for anyone concerned about rural healthcare.

There wasn't much actual news to contemplate during the May 7 hearing before the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Related Agencies, but it was still worth noting.

In a nutshell, the hearing provided rural healthcare providers with a soapbox to spell out the unique challenges facing those who deliver healthcare to the 51 million generally older, sicker, and less affluent Americans who live in about 80% of the nation's land mass.

On the government side, Sean Cavanaugh, deputy administrator at the Centers for Medicare & Medicaid Services, assured the subcommittee that "CMS recognizes the challenges faced by beneficiaries and providers in rural areas." Cavanaugh served up a laundry list of programs that CMS has undertaken to help rural providers with population health management.

The subcommittee also heard similar assurances from the Federal Office of Rural Health Policy at the Health Resources and Services Administration.

On the provider side, Julie Petersen, CEO of PMH Medical Center, a critical access hospital in Prosser, WA, told the subcommittee about the success of rural health despite the challenges.

"PMH is typical of the healthcare organizations that serve rural areas," Petersen said. "These organizations represent, in many cases, the entire healthcare delivery system—providing access to a broad spectrum of healthcare services from primary care to hospice, home health, and emergency ambulance services. Their continued viability is critical to the health, welfare, and economic viability of these communities."

These are familiar reassurances and laments about rural healthcare.

Tim Wolters, a reimbursement officer at Citizens Memorial Hospital in Bolivar, MO, and Lake Regional Health System in Osage Beach, MO, could have been speaking for any of the thousands of small hospitals across the nation when he provided a pithy account of the rural healthcare landscape.

Wolters said the four biggest challenges facing rural hospitals are: fixed costs and staffing issues around fluctuating patient volumes, higher levels of Medicare utilization, the cumulative effect of Medicare cuts under the Patient Protection and Affordable Care Act and sequestration, and an increasingly complex regulatory environment.

The American Hospital Association also submitted to the subcommittee a concise statement detailing the issues facing rural hospitals. In addition to "remote geographic location, small size, limited workforce, physician shortages, and often constrained financial resources," a big problem is "burdensome, duplicative, and often outdated federal regulations and policies present consistent strain on the ability for rural hospitals to keep their doors open and provide needed health care services," the statement said.

Again, none of this is news. These challenges are well known to those who care about rural health. But the story of rural health cannot be told too often because a lot of good people still don't get it. If that's the case in your area, then it's the fault of leaders because you haven't explained it to them.

Print out Petersen's or Wolters' testimony and post it in your break room at your hospital or other provider site. Talk to staff about these challenges when you see them on the floor or in the cafeteria. Make sure they understand the issues and then encourage them to speak with their friends and family to get the word out. People who work in healthcare carry a certain gravitas and well-earned respect in the communities they serve. When they talk, people listen.

Don't forget about local media. If you don't already, you should have someone at your local newspaper or radio or TV station on speed dial. Direct them to the hyperlink to the hearing. It will give them a concise, easily digestible understanding of the landscape of rural health.

They can be excused if they don't understand the finer points of the 96-hour rule. It's up to rural health advocates to provide the information local media needs to inform its readers and listeners.

That's the beauty of a compelling story. It may not be breaking news, but it's important and timely, and people will want to listen.