The Senate Appropriations Labor, Health and Human Services, and Related Agencies (Labor-HHS) Subcommittee held a May 7 hearing on rural health.
Chairman Roy Blunt (R-Mo.) opened the hearing highlighting the obstacles faced by patients and health care providers in rural communities stating, “Both our inner-city hospitals and our rural hospitals have challenges that are unique to them. Challenges with rural access can range from primary care physicians to difficulty finding specialists. As a result, patients have to drive long distances to receive care or may not simply seek care until it’s too late.”
Ranking Member Patty Murray (D-Wash.) echoed similar sentiments and urged, “We need to think carefully if there are enough doctors and health care providers to treat patients.”
The first panel of witness testimony included Sean Cavanaugh, deputy administrator and director of the Center for Medicare, Centers for Medicare and Medicaid Services; and Tom Morris, associate administrator, Federal Office of Rural Health Policy, Health Resources and Services Administration (HRSA).
Highlighting the unique challenges of rural health care, Cavanaugh said, “Medicare beneficiaries in rural areas often reside a significant distance from the nearest health care providers and in medically underserved areas,” and, “have fewer physician practices and hospitals, and face longer travel times to specialists.”
Cavanaugh further outlined potential methods to mitigate access issues including, working with stakeholders to minimize burden; promoting access to care in rural America through various initiatives including telehealth, Critical Access Hospitals (CAHs), Rural Health Clinics; and fostering innovation of rural health efforts.
Morris reiterated similar comments and further highlighted key programs at HRSA that aim at addressing health care training and recruitment issues in rural areas noting particularly HRSA’s health professional training programs. He stated, “In fiscal year (FY) 2014, HRSA provided rural health exposure to students through 11,389 training sites in rural communities. In addition, HRSA’s primary care, oral health, geriatrics, public health and behavioral health training grants supported 180,401 students from rural areas.”
He further outlined the National Health Service Corps (NHSC), stating the program “supports loan repayment and scholarships for primary care providers, with almost half of the participants serving in rural areas. As of last fall, 3,529 National Health Service Corps members, or 44 percent of the National Health Service Corps field strength, were working in rural communities and 75 NHSC clinicians were working at Critical Access Hospitals. Half of the nearly 5,000 active NHSC-approved sites are located in rural communities.”
“HRSA also invests in community-based residency training to improve access to healthcare in rural areas. Rural Training Tracks (RTT) are an innovative model where residents spend two of their three residency years in a rural community. Over the past six years, HRSA has worked to expand the RTT residencies nationally, and the number of training sites has grown from 23 to 34,” Morris said.
A second panel of witnesses included, Tim Wolters, director of reimbursement, Citizens Memorial Hospital, and reimbursement specialist, Lake Regional Health System; Kristi Henderson, M.D., chief Telehealth & Innovation officer, University of Mississippi Medical Center; Julie Petersen, chief executive officer, PMH Medical Center; and George Stover, chief executive officer, Rice County Hospital.
In her testimony, Dr. Henderson highlighted the AAMC’s workforce projections and stated that physician shortages are “partially to blame” for access issues as, “patients living in rural areas always have lacked access to healthcare, and, even today, those who are not able to travel often receive inadequate care, or no care at all. Many patients are not able to see a specialist or get the treatment they need without traveling long distances.”
Speaking to the issue of physician recruitment and retention in rural areas, Petersen testified, “Physician recruitment is a full-time job for me and my colleagues. And once we’ve recruited physicians, keeping them here is even more important. Physicians in rural areas are still routinely required to participate in on-call rotations. That is no longer the case in many urban and suburban settings and can greatly affect a physician’s work-life balance."
She added, “They also often work in multiple locations. In primary care, physicians see far more complex patients than their urban counterparts. Rural hospitals and health clinics also face constant struggles to retain nurses and the other health professionals we need to keep our doors open. Making matters worse, we have an aging workforce, so keeping the workforce pipeline open and running smoothly is critically important to us.”
Explaining the complexity of managing a rural hospitals healthcare workforce due to fluctuating patient volumes, Wolters stated, “While recruiting physicians to rural areas is a longstanding problem, the complex environment of implementing electronic health records, ICD-10 and various quality reporting programs means most physicians are unwilling to practice in rural areas unless a hospital is willing to manage their practice and ensure income stability.”
In urban areas, independent physicians can join larger clinics with the expertise to manage these complex issues outside of a hospital. In rural areas, these large clinics do not exist, with the hospital taking on the role of managing clinic operations on behalf of most physicians,” he explained.
Sen. Shelley Capito (R-W.V.) stated having heard that “500-1000 graduates of medical schools don’t match, they don’t get a residency, and that obviously stalls out their professional career. They’ve got student loans and all sorts of other issues. I think we should be looking at rural health as a way to expand the availability of rural residencies to fill this gap.”
Morris confirmed the issue and replied, “We recognize the challenge you’ve just laid out.” He further suggested more grants to expand RTT programs, thus creating more residency slots.
Addressing similar questions posed by both Sens. Cochran (R-T.N.) and Murray regarding the importance of telehealth services in rural and underserved communities, Dr. Henderson and Peterson both expressed the necessity of such services as they bridge rural hospitals and communities with the expertise and resources available at academic medical centers.