The challenges facing the rural health care system are more dire than ever before with staff furloughs and even more hospitals on the brink of collapse due to the coronavirus pandemic. On Tuesday the Bipartisan Policy Center’s Rural Health Task Force released recommendations designed to stabilize rural hospitals and clinics with financial relief in the short term and new transformational pathways over the long term. 

Among the objectives are to stop the wave of obstetric unit closures, permanently expand access to telehealth services, enhance value-based care, and incentivize clinicians to work in rural areas for a longer period of time. 

More than 100 rural hospitals have closed in the United States since 2010, and an additional 647 are at risk of folding, including 17 in Iowa, according to the Bipartisan Policy Center. In a survey conducted last summer, 46% of the rural Iowans polled said they believe that access to medical specialists such as cardiologists, oncologists and gynecologists was a problem in their community, as was access to quality health care generally.

The task force report, Confronting Rural America’s Health Care Crisis, is co-chaired by former Senate Majority Leader Tom Daschle, former Sen. Olympia Snowe, former Mississippi Gov. Ronnie Musgrove, and former governor and Health and Human Services secretary Tommy Thompson. 

“Today, 60 million Americans living in rural areas are at increased risk of dying from heart disease, cancer, stroke and chronic lower respiratory disease,” the task force wrote in the report. “Despite worsening health and rising maternal and infant mortality rates, 126 rural hospitals have closed since 2010 and nearly 560 hospitals are at risk of folding. These policies offer a necessary step forward to stem the steady stream of rural hospital closures and the loss of access to care in remote areas.” 

As Congress continues to work on legislation to address the health and economic consequences of the pandemic, including providing additional funding to keep rural health providers in business, the task force is calling for immediate action to address the long-term health care needs of rural communities through the recommendations, the policy center said in a news release. 

The key recommendations include: 
1. Stabilize rural hospitals. Provide immediate financial relief to hospitals for three years in order to transform to meet the community’s needs. This includes suspending 2% Medicare payment cuts and Medicare bad debt payment reductions beyond 2020 and increasing reimbursement rates by 3% for Medicare Critical Access Hospital services. 
2. Transform rural hospitals. Following a comprehensive community needs assessment, allow rural hospitals to transform from full-service hospitals to outpatient and emergency care centers with the flexibility to choose different payment methods; allow rural health clinics or Federally Qualified Health Centers to add emergency services and get paid at hospital level rates, if a local hospital closes. 
3. Enhance value-based care. Make technical changes to current payment systems to enable more patient-centered care, including eliminating co-insurance for care management services. 
4. Stop obstetric unit closures. Reimburse rural hospitals for obstetric care in shortage areas at national median commercial rates; increase education funds to equip primary care clinicians with skills in prenatal and maternal services. 
5. Expand telehealth services for patients. Drop the temporary status of waivers on point of care and make services permanent and give clinicians the ability to treat across state lines. 
6. Incentivize clinicians to stay in rural areas. Provide federal tax credits to encourage rural physicians, physician assistants and nurse practitioners to stay in rural communities; expand J-1 visas from 30 to 50 to allow international medical graduates to stay in the U.S. for three more years to practice in rural areas. 

“The recommendations in this report address fundamental and immediate problems in rural areas by ensuring the provision of appropriate inpatient and community-based services, addressing workforce shortages, improving access to maternal health care, and optimizing the use of technology to meet those goals,” the members said. 

This yearlong effort builds on the Bipartisan Policy Center’s 2018 report and was influenced by site visits in Iowa, New Hampshire, Maine, Wisconsin, Tennessee and Vermont, and numerous interviews with rural health experts around the country.