Hospitals in rural communities are more prone to revenue cycle challenges, ranging from physician shortages and hospital closures to a higher degree of uninsured patients. The solutions for such complex problems are not universal to healthcare reform; rural communities are unique. The CMS Rural Health Summit has identified healthcare institutions in rural settings as the biggest opportunity for healthcare reform. By incorporating strategies tailored to the improvement of revenue cycles in rural hospitals and practices, experts aim to simultaneously improve the economy and access to care in remote settings.
Hospital closures due to revenue cycle challenges are much more common in rural areas than in large cities. With slim operating margins, fewer private payer options, and lower utilization rates, it is exceedingly difficult for small-scale community hospitals to recover from an unhealthy revenue cycle.
Opportunities For Reform
Regarding assessability, members of rural communities cannot make an effortless trip to the hospital, and those that can are less likely than the normal patient populous to have insurance. An uninsured majority, combined with limited assessability, lower patient volumes, and an aging population, positions healthcare systems in rural settings for low-profit margins. Ultimately, this slow financial input makes it nearly impossible to provide up-to-date care for patients.
From physicians and nurses to medical specialists, healthcare organizations in rural communities are currently facing an employee shortage. While personnel demand and job opportunities might both be high, rural communities account for 65% of the healthcare professional shortage nationwide. Medical professionals are simply not drawn to the small patient platform and outdated technology many rural hospitals offer. Today, only 10% of physicians work in remote community healthcare institutions.
Physician assistants and nurse practitioners carry most of the medical workload in rural counties. Many double as primary care physicians, and more administrative and patient-oriented tasks than their urban counterparts. The role of specialists is not so easily interchangeable, however, and rural areas are several lacking employees in specialty fields such as behavioral health. One in eight rural counties doesn’t even have a behavioral health department, perhaps why many issues facing these communities, such as prescription drug abuse, increasing suicide rates, and the opioid epidemic, and seemingly uncontrollable. Primary care physicians are not always equipped to handle these problems, and many rural communities rely to a significant degree on folk medicine.
Again, a large portion of rural residents are uninsured, resulting in lower patient volumes, but more significant treatment needs. These challenges are compounded by aging populations, limited access to care, and higher chronic disease rates, all of which are detrimental to hospital revenue and quality of care.
CMS Reform Strategies
CMS has taken several steps to resolve the health care and revenue cycle challenges faced by resource-depleted rural hospitals. The establishment of the Rural Health Council and provider engagement program aim to improve access to care and supply funding to small practices. CMS initiatives have the potential to increase the availability and quality of care in rural settings, and ultimately improve the physical and mental wellness of community members.
The Rural Health Council is a federal agency which has sponsored several healthcare reform initiatives for rural health care providers and their patients. The councilmembers collect community feedback on how to improve healthcare and utilize it when developing strategies. With their primary focus to increase access to care in remote settings, the council has removed physical barriers and created streamlining processes specific to rural communities. A cornerstone of this effort promotes community access to federal insurance marketplaces and Medicaid expansion.
CMS also hopes to boost rural healthcare employment with its recent launch of a provider engagement program. This program is meant to reduce the administrative burden on the small number of rural healthcare providers by decreasing the number of medical record reviews they are required to undertake. The program works in tandem with other reform initiatives, such as increasing the prevalence of telemedicine and quality improvements in rural areas. CMS has also set aside $100 million for independent practices to get technical assistance for improving themselves. This money can come from quality improvement organizations, regional health collaboratives, and other federally approved groups.
Historically, rural health care has been a challenge, and there are still some significant deficits in access and quality of care in rural communities. With targeted programs to assess and mitigate these problems, there is a great chance for improvement in the future. As rural health care systems improve, hospital revenues will rise, and the quality of patient care will rise as well.