Which is best for rural hospitals?
Posted On August 8, 2021
By Andrew R. Shultz and David D. Levine, Washington Post Staff writersOn Wednesday, the federal government announced a new program that will provide rural hospitals with $2 billion in cash for hiring more nurses and doctors.
It is the latest sign that the Trump administration is looking for ways to make up for the shortfall in rural health care services.
But it is also the latest example of a president and his advisers who have not yet learned the lessons of the Affordable Care Act’s failure to attract large numbers of rural doctors.
Rural hospitals are not just the mainstay of the nation’s health care system, but also a vital source of funding for many communities.
And they have become a key battleground for efforts to reform the nation´s Medicaid program, which relies on Medicare for most of its payments.
While there are many reasons why rural hospitals are so important to America, one of the most important is their ability to attract doctors from across the country.
As more Americans are uninsured and have lost their jobs, rural hospitals have been one of their most valuable assets.
In recent years, however, there has been a growing realization among many rural Republicans that rural hospitals need to be more competitive.
The Affordable Care Bill has created a slew of new programs designed to bring more rural hospitals into the mix.
The Rural Hospital Competition Act (RHCACA) will provide up to $2.2 billion for rural health systems in 2018 to hire nurses, doctors and other staff, which will help them attract and retain top-quality doctors and nurses.
The bill also provides for up to a $400 million grant to states for expanding Medicaid, a $10 billion grant to rural hospitals and a $5 billion grant for new community health centers.RHCaca also includes a number of incentives to attract health care workers from outside the U.S. That includes a tax credit for workers who move to rural areas and a rebate of up to 80 percent of their Medicare Part D premiums for a family of four.
The idea of giving health care to workers who have moved to rural communities was first floated in a 2015 study by the U of T Medical Center, the University of Manitoba, the U-M Health System and the University at Buffalo.
That study found that the average salary of a health care worker who moved to a rural community was $20,500, compared with $46,700 for a worker who did not.
That is partly because most rural areas are very rural.
In many cases, only 1 percent of the population lives in a community that is 50 miles or more from a major city.
The RHCACA, which is currently awaiting Senate action, will be available to hospitals and medical centers that do not qualify for Medicare Part B. The Senate is expected to vote on it later this month.
The legislation is not perfect.
The federal government is providing about $7 billion a year in cash to states to pay for nurse and doctor recruitment.
That money is not set to expire until 2024, which means states could end up paying for fewer nurses and more doctors if they do not sign up for it.
Still, the bill represents a promising start.
The Congressional Budget Office (CBO) has estimated that it will save $2 trillion over 10 years, mostly by boosting the number of doctors and reducing the amount of care they provide.
And the Rural Health Competition Act will also help attract more workers to rural facilities.
The CRS estimates that it could save more than $3 billion annually in costs by providing rural hospitals additional training and equipment, expanding the number and types of nursing homes and increasing the number or types of doctors in rural hospitals.
It also could boost the quality of care in rural communities, according to a study published last year by researchers at the University Health Network at Duke University and the Center for Medicare & Medicaid Services.
In a study of more than 2,000 rural hospitals, the researchers found that nearly half of the hospitals were in poor or moderate health.
About a third of the rural hospitals had a patient mortality rate of more then 10 percent or higher.
About 20 percent of hospitals had an emergency department mortality rate that was 10 percent, compared to 9 percent in the national average.
More than two-thirds of rural hospitals reported that their ER patients were younger than 60 years old, compared, for example, to the national median age of 62.
The authors wrote that they hope the Rural Hospital Competitiveness Act will encourage states to take these actions, but that they are not optimistic that it can replace the ACA’s success in attracting physicians and nurses from rural communities.
For many rural hospitals like the one in the village of Newburyport, S.C., it is difficult to get qualified nurses and physicians to come to rural locations.
In the past two years, Newburyfield Hospital has hired more than 600 new nurses and other workers, but only two percent of those have completed their training.
Newburyfields CEO John Ehrlich said that the rural community needs more experienced, highly trained health care providers