Bipartisan Policy Center Releases Rural Health Report With Concerning Headlines

This morning, the Bipartisan Policy Center (BPC) was joined by Senators Heidi Heitkamp (D-ND) and Senator Mike Rounds (R-SD) to announce the release of a report on rural health titled, “Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States.” The BPC worked with the Center for Outcomes Research and Education (CORE) to study the cost of care, the availability of care, and innovative payments methods for rural Midwest communities. We appreciate the work that the BPC has done to explore and acknowledge the unique needs of rural communities, and we believe that these issues shouldn’t be partisan. That being said, we have some concerns with the conclusions of the BPC’s report and with many of the sensationalized headlines being generated from this report.
The report finds that adjustments need to be made to fit the health care needs of rural communities. We agree, and NRHA has led the way in advancing new rural payment models.  However, what the report ignores, is that the Federal government has created much of the instability in the rural health care delivery system by imposing cut after cut in Medicare and Medicaid reimbursements. NRHA strongly believes that the most prudent and cost effective method of ensuring access to care for rural Americans is to stop federal reimbursement payment cuts.  Keeping rural PPS hospitals and Critical Access Hospitals open provides cost-effective primary care delivery as well as economic stability in rural communities across the nation. 
We must also recognize one major limitation of this study. While the Midwest has many rural communities, the report does not look at rural areas in the South and in Appalachia, who have been hit hardest by the rural hospital closure crisis, the opioid epidemic, and changes in health care policy. These same communities continue to struggle with the same sociodemographic factors that have long resulted in poorer population health including large minority communities and high rates of poverty. Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming, have all been swept up in the storm of rural health issues, but none have been as hard hit as Alabama, Tennessee, Texas, Louisiana, West Virginia, and Kentucky. To make conclusions about all of rural America based on a specific region of the country’s rural communities leads to flawed conclusions about the role of rural care facilities in providing a necessary safety net for vulnerable patient populations.
Greater access to care, not less, is the solution to improve the troubling health care outcomes in rural America.  NRHA strongly supports allowing greater flexibility to the strict requirements of CAHs. Just this morning, we reached out to Members of Congress to stress the importance of flexibility for CAHs in the case of a public health emergency, such as the current flu pandemic. However, a broad call for less CAHs and fewer rural hospitals will mean increased barriers to care for our rural communities most in need of local access to care. New Models of care are what NRHA has long championed including the Community Outpatient Hospital model included in the Save Rural Hospitals Act that NRHA worked closely with Reps. Graves and Loebsack to develop and champion.  NRHA applauds the idea of tailoring models to meet the needs of rural communities, it is eliminating access is what we strongly oppose.