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'Mega Boards' Could be Rural Healthcare Disruptor

By John Commins  
   December 03, 2014

Comprised of a wide array of stakeholders from across the care continuum, "mega boards," with members trained in thinking about the health of the community as opposed to the financial performance of a hospital, could change rural healthcare delivery.

Rural healthcare delivery doesn't need to be tweaked. It needs an overhaul.

Even after years of talk and studies and calls for reform, most healthcare delivery in rural American remains overly reliant upon small hospitals with limited resources that provide fee-for-service inpatient sick care.

Care coordination, community outreach, and wellness and prevention programs often don't get the money or the emphasis they deserve because hospital leaders with immediate budgetary concerns aren't reimbursed for them.

This happens even though almost every rural provider and hospital leader I've spoken with understands that cost-effective care delivery must extend beyond the walls of the hospital.

We have well-intentioned rural hospital leaders and other providers who are ready and willing to act, but who are constrained by lack of money and other resources and must continue operating under an antiquated care delivery system.

A. Clinton MacKinney, MD, MS, a clinical assistant professor at the University of Iowa, and a family physician in rural Minnesota, says rural providers "are hamstrung on a payment system that is focused on hospital and illness and we are hamstrung by a small scale that tends to leave us out."

"The Centers for Medicare & Medicaid Innovation has a $10 billion budget. They tend to look to places to implement projects that have large scale to begin with. That automatically excludes rural," he says.

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John Commins is a senior editor at HealthLeaders.

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