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Rural healthcare in 2021: How legislative changes will impact rural providers

Apr 29, 2021

On April 20, as part of Wipfli’s 2021 Rural Health Clinic Virtual Conference, Wipfli convened a panel discussion on the current and future state of rural healthcare. 

Panelists represented national association leaders and policy influencers:

  • Brock Slabach, MPH, FACHE Sr. Vice-President, Member Services, National Rural Health Association 
  • Nathan Baugh, Director of Government Affairs, National Association of Rural Health Clinics (NARHC) 
  • Bill Finerfrock, CEO, National Association of Rural Health Clinics (NARHC)

The following themes stood out:

COVID-19 relief funds

The American Rescue Plan Act allocated additional COVID-19 relief dollars, with specific funds available to rural healthcare. Panelists noted, however, that rural providers will most likely have to apply for these funds — there may not be an automatic allocation as in the past.

Regarding the June 30 deadline to expend funds issued in earlier relief cycles, panelists affirmed the deadline is still in place but expressed hope that it would be extended. Industry groups are actively working with the Department of Health and Human Services (HHS) to shift that deadline. 

Brock Slabach shared that his group is advocating for clarity on how those funds can be used — specifically with a request that they can be used for capital expenditures. “If we’re going to harden our facilities for future pandemics, we need to find a way to use this money,” Slabach said.

Panelists also discussed the challenge of managing provider relief funds from multiple funding sources and making sure they do the most good with available dollars. 

Staffing shortages

When asked for ideas to address the staffing shortages in rural healthcare, Slabach noted that the American Rescue Plan Act has added $800 million to the National Health Service Corps. The program, which recruits clinicians for underserved areas, typically runs out of funds before all the available slots can be filled. The infusion of cash is good news, but Slabach noted the deadline to apply is coming up fast on May 25, 2021. 

Longer term, Slabach said his organization is working to get more rural training tracks set up for graduate programs. Bill Finerfrock pushed for the need to get students thinking about healthcare careers earlier, in high school or junior high, and encouraged providers to take part in educational outreach. 

Telehealth

It’s no surprise that telehealth was another big topic of discussion. Panelists raised two key themes here: 

  1. Temporary policies: Temporary policy changes gave providers flexibility in delivery and reimbursement for telehealth services during the pandemic. The question is how long those temporary measures will remain in place and where lasting change will occur.

    Panelists are lobbying for rules that make telehealth feasible for rural providers going forward. “We want normal coding, normal reimbursement, normal cost reporting rules. We want telehealth visits to count toward productivity standards. That’s what we would like to see,” said Slabach.

    Finerfrock indicated policymaker education would be essential. “There are those who believe it’s less expensive to provide a telehealth visit. That’s not true,” he said. “You’re still maintaining the infrastructure for that in-person experience. Telehealth is an adjunct, not a complete substitute.” 

    Nathan Baugh said that telehealth will be an ongoing policy issue for quite a while. “My guess is Congress won’t be ready to answer all these questions, so we’ll see a temporary extension beyond the public health emergency,” he said. “But many policies are probably not permanent.”

  2. Telehealth competition: Panelists communicated an urgency for rural providers to develop their telehealth platforms. “If we’re not able to compete and offer good telehealth, providers in the city will use their most robust technology to reach out and take our clients,” said Baugh. 

    Slabach echoed that sentiment: “If we can’t get the mechanisms in place to join that revolution, we’re going to be left in the dust. We have a lot to do.” Works goes beyond technology issues to include workflow challenges. 

Preparing for the next pandemic

Finerfrock is looking ahead to the next pandemic or public health crisis. “What lessons should we have learned from the COVID experience and how do we apply those? What should we be doing to fortify our organizations?”

For example, he mentioned physical infrastructure, greater storage of PPE, and the super-cold freezers required to store the Pfizer vaccine and their relative non-existence in underserved areas. 

Infrastructure

Infrastructure issues were top of mind for Slabach, too. “We’ve submitted a letter to Congress,” he said. “We need a renaissance of our rural facilities — hospitals and clinics. Reinvestment in our infrastructure. Retooling to meet the needs of a future generation. And we need broadband. We can’t have telehealth without broadband.” 

He continued, “We think that rural health is infrastructure, and we want to make sure Congress and the Biden admin understand that.”

Defeating COVID-19

Finally, Slabach asked rural providers to promote vaccination. “I think the mission for facilities in rural communities, between now and end of the year, is to get your community vaccinated against COVID.”

He said additional work was underway with the CDC and Ad Council to address vaccine hesitancy in rural areas. “We don’t want to see rural left behind.” 

Serving rural healthcare providers and their needs

Our panelists touched on many important themes, so which do you focus on first? Wipfli can help. We specialize in serving rural health clinics and can assist you with technology, strategic planning, stimulus funding and more. Click here to learn more.

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Kelly Arduino
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