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Rural Hospitals Have Threatened Futures

Medicare cuts and failures to expand Medicaid provide limited access for patients

While the Patient Protection and Affordable Care Act (PPACA) has increased the number of insured people in the U.S., certain aspects of reform — such as practice-of-medicine regulations and Medicare and Medicaid reimbursement cuts — are hurting rural hospitals.

There are approximately 2,000 rural hospitals, 1,333 of which qualify as critical access. Modern Healthcare reports that the overall number of critical-access hospitals did not shrink over the past year, but there has been a steady drumbeat of closings over the past few years, leaving hundreds of thousands of patients with limited access to services, according to advocates for rural hospitals.

 The worst financial hits have come from cuts to Medicare's bad-debt program and disproportionate-share hospital payments. Sequestration, which slapped a 2% across-the-board cut on Medicare payments, hit rural areas with their older populations especially hard.

Maggie Elehwany, vice president of government affairs for the National Rural Health Association, said significant Medicaid cuts in the past few years have been suffocating rural hospitals. The 20 states that have not yet expanded Medicaid eligibility under the PPACA tend to be more rural states with Republican governors. These states also have residents who tend to be older, poorer, and sicker, Elehwany said.

Bills have been introduced this session in both chambers of Congress that would help rural hospitals, some with bipartisan support. But they have received little attention in Congress and have almost no chance of passage.

Desperate for alternatives, some doctors and rural hospital administrators see telehealth as an option to access health care in rural areas. Dr. Michael Meza, who has been a family practice physician in north-central Idaho for 20 years, started incorporating telemedicine services when he saw his patients traveling long distances for specialty care, often after waiting months for an appointment.

Source: Modern Healthcare, October 3, 2015.

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