Interview with Alan Morgan, National Rural Hospital Association – Part Two
In Part 1 of our interview with Alan Morgan, CEO of the National Rural Hospital Association talked about the reasons for the economic difficulties healthcare facilities are currently facing, and the fears that the states have that Medicaid expansion will bring added expense in the future. He continues.
“Whether the fears are founded or not, the reality of it is, you need to have local access points of care in this rural communities. Regardless of whether you’re a Republican or Democrat, you recognize the relevance, the importance, that these rural hospitals provide. However we proceed, all policy makers need to understand – either you have local access, and you have these thriving rural communities, or you don’t. It’s a policy decision that everyone is going to have to make – what is the value that we place on rural communities, and the health of rural communities.
“I tend to think at the end of the day, this is going to get beyond the politics of it, to a realization of, look, we have to keep our local rural hospitals open – what do we do from a policy sense to make that happen. Now, whether that is expansion of Medicaid, directed state and Federal payments to rural hospitals, or completely new models of care, of how we pay rural hospitals. But regardless, we’ve got to find some mechanism, that if we’re requiring rural hospitals to treat low income populations without health care, we’ve got to figure out a way to make sure that they can keep their doors open for the entire community at need.”
He spoke about solutions to address the issues.
“What we’ve been promoting at the Federal level is an entirely new payment system to help out rural hospitals. We believe in many cases, you’re just not going to have the patient volume you need to keep a rural hospital open. If you just have an emergency room, and a little health clinic there attached to deal with basic health care needs, how do you make that work? So we’ve been promoting legislation on the House and the Senate side both that would create a new payment model for really low volume rural hospitals.
“Now, that being said, I think you’ve got to divide rural hospitals into two categories – very small rural hospitals that really need to be an extended clinic, with limited outpatient care and emergency room services. And then you’ve got the larger rural hospitals that really need to make the transformation from a volume based approach to an outcome based approach. What that means is, how do we keep people healthy in the community, and not in the hospital in the first place. If you change a rural hospital to focus on keeping people healthy, population health, keeping them out of the hospital, what’s that payment mechanism by which they can do that, and survive.
“Step one is at the local community level. If you are living in a rural community, you’ve got to realize that your hospital is a community asset. Looking at the data nationwide, rural hospitals provide quality care at a level that is equal, sometimes better than the urban counterparts, when it comes to basic primary care. I think there’s a misconception in many rural towns that “oh, if we want quality care, we need to go to the big city.” The data just doesn’t prove that out.
“What I’m saying is, rural towns and communities need to support their local hospital – they need to support it through foundation support, they need to utilize their local hospital – that’s step one.
“Step two, certainly state governments need to figure out some way to address the Medicaid population, and, at the Federal level, that’s where you get into, for the elderly population, in rural America, what changes can be made to the Medicare program, what new payment types can keep the doors open.
“At the end of the day, you have to realize that in rural communities, you have a larger percentage of low income individuals, and a larger percentage of elderly individuals – that’s Medicaid and Medicare. So to keep these rural hospitals open, you need to have a solid state/Federal/local partnership. It really takes collaborative effort to make sure that we maintain local access to heath care.”