• There are a couple of problems with reversing the reimbursement reductions as an option to support rural facilities. First, it continues to hold them in a position of receiving subsides that are not value based. This leaves an impression of inappropriate favoritism. The second issue is that private insurers
    reimburse rural facilities the same as non-rural hospitals and since whatever profit is needed comes from this payer segment, it prevents the rural facility from being sustainable. The article doesn’t highlight how many of the hospitals in jeopardy have tried real innovation to transform local care in a way to be
    viable.

    Rural facilities could be more successful in several ways. Real networking with other rural
    facilities to facilitate development of specialty product lines. A part time neurosurgeon can save a rural
    hospital if they are supported as a county level referral source. This can be said for other specialists, as
    well. A single facility cannot support such a physician but a network of rural facilities can create a competitive referral model with multiple specialists.

    As “empty nester communities,” rural areas can be seen as one large “age at home community” and the rural facility can develop aging services support systems from daily meals, to home maintenance, transportation, etc. Whatever it takes to support aging at home should be a targeted product line.
    In addition, clinical services for Medicare beneficiaries only, provide a way to create cost based reimbursed program development and reduce overhead expenses at the core critical access hospital.
    This has been done successfully in many facilities with mental health and post-acute care services.

    Rural communities should work together to develop a plan for sustainable hospital care. There are a
    number of locations with multiple hospitals within 30 miles of each other. Recognizing the unlikely ability of multiple hospitals to survive, it would be prudent to have “communities” come together to evaluate
    best options for planning a new medical community before closures start occurring and resources are lost. In my experience, community leaders are more likely to find ways to creatively consolidate activities than local hospital leadership

    Finally, there is something missing from the rural hospital debate. Healthcare cost per population in many of these communities where rural hospitals are located is less than state and national averages. The Dartmouth Atlas of Healthcare is an excellent resource that identifies these characteristics very well. My point, utilization, costs, and end of life care may be better because of these facilities, a value not evaluated or articulated, but one that needs to be figured into the design of rural facility payment
    methods.

    I do believe there is a place for rural facilities in the US healthcare system. The real value of these facilities needs to be quantified and innovation applied to clinical models of care and reimbursement systems developed based on distribution of local cost/population for relevant services.
    Increases in these payment rates can be tied to annual inflation and pay for performance payments can be developed around increased capacity within capitation reimbursements, quality of care, and impact on health of the community. I do not believe there has been an exhaustive effort to evaluate the value these facilities add the healthcare system or to develop payment mechanism in response this value statement.