Rural hospitals developing strategies to cope with worker shortage (copy)

Emergency room nurses at the Grant Regional Health Center share a work station adjacent to construction walls as an expansion project continues at the center in Lancaster. The center allows nurses to work in multiple departments, one of many strategies to help attract and retain employees.

Preserving access to quality health care in rural parts of Wisconsin is becoming a bigger and bigger challenge. Reimbursement rates from Medicaid and Medicare that are too often below the cost of the service, provider shortages, dairy industry struggles and an aging population are some of the factors conspiring to present existential challenges to rural health care providers.

In fact, according to the University of North Carolina Center for Health Services Research, 119 rural hospitals have closed across the county since 2010. Even more disturbing, a 2016 report for the National Rural Health Association found that 700 rural hospitals were at risk of closing.

Unfortunately, despite the already fragile nature of rural health care, providers are facing a new threat in the form of legislation being considered in Congress right now.

As you might have heard, policy makers from the president to members of Congress on both sides of the aisle have grown rightfully concerned about “surprise medical bills.” Surprise bills happen when a patient receives needed medical treatment only later to find out the provider is not covered by his or her insurance. The result can sometimes be a very large medical bill that is sent to the patient.

There is general consensus by all stakeholders that patients should be taken out of the middle of these kinds of disputes, which are really between insurance companies and health care providers. However, unfortunately, some are pushing a plan that would greatly advantage insurance companies at the expense of health care providers.

Under this scheme, “benchmark” rates would be established that providers would be required to accept — regardless of what the actual services cost — in any case when a patient receives an unexpected out-of-network bill. The benchmark rate would be based on median in-network rates paid by insurers.

By basing reimbursement rates for out-of-network care on the rates for in-network care, insurers would have little to no incentive to contract on equitable terms with providers — especially in rural areas — leading to even smaller provider networks. At the same time, many rural patients would find themselves paying higher co-payments to access local providers or weakening the rural safety net by out-migrating needed care.

If there are fewer doctors, clinics and hospitals available in rural areas, patients will struggle with access to care. Longer wait times for appointments, longer travel distances and unmet health needs are all consequences of losing rural providers.

The good news is there are alternatives to benchmark rate-setting that are fair to both insurance companies and providers. No one disputes the need to address surprise medical bills. However, the solution should not be an insurance company giveaway that would lead to driving down already too low reimbursements rates for rural providers.

Geography should not be a factor in access to quality health care. Congress should keep that in mind as it works on surprise medical billing.

Tim Size is the executive director of the Rural Wisconsin Health Cooperative.

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