Morgan says NRHA supports stop-gap legislation now in Congress called the Save Rural Hospitals Act. "It stabilizes the current environment for rural hospitals while establishing a path forward for those rural facilities," he says.
"It stops and reverses the Medicare cuts we have seen. It reverses the sequestration, and it provides an opportunity for hospitals to transition into a new provider type, a freestanding emergency room, outpatient services, and provides that new model. It also would provide the ability for rural hospitals to access federal grants to do the transition to population health."
While acknowledging that rural hospitals need more money to keep the doors open, the bill also calls for a re-examination of how care is delivered in rural America.
"We need a new hospital model for rural and remote," Morgan says. "The No. 1 key is how do you ensure 24/7 emergency room services in these very small rural communities, and for the larger rural communities, how do you help them move towards keeping the population healthy and making that transition we are all talking about as a nation."
"It has to happen. We know that is the direction we're headed. We have to make sure that in the process we don't shut down a lot of rural hospitals as we make this transition," Morgan says. "That is the difficult part. How do we keep the doors open until we get to that new payment mechanism that provides a sustainable healthcare access point in rural communities?"
Topchik is skeptical of suggestions that moving rural patients to more centralized care at larger regional hospitals will save money or improve outcomes.
"Our research tells us it is not terribly expensive to maintain that rural safety net," he says. "What a lot of people want to do is centralize care. Every bit of research tells us we would not improve or lower the cost of care. We would shift the cost of care to more expensive cost centers."
"Yes, they have more robust clinical capabilities and when appropriate, rural hospitals are transferring there today. We don't help the system by doing that, but we hurt it two-fold," Topchik says. "We lose access and people in rural America need access to care close to home. If these rural hospitals were to disappear, the entire safety net crumbles because docs aren't going to practice in rural communities if they're a one-horse shop with no hospital for a backstop. It really has a ripple effect."
"The other side of it is I don't think it will be cheaper," he says. "It's market-by-market, but you shift costs and it's a wash. In most cases it's more expensive."
Topchik says policymakers and politicians must acknowledge that, whatever the model, providing care to a rural American population that is older, sicker, and poorer is not a money-making proposition.
John Commins is a senior editor at HealthLeaders.