Health Policy Institute Held in D.C.

Rural health advocates came from all over the U.S. to attend the NRHA Rural Health Policy Institute held February 5-7, 2019 in Washington D.C. They attendees heard rural health leaders express their views on what is needed to deal with issues affecting rural health facilities today.

HHS Secretary Alex M Azar speaking on February 5, said, “Rural hospitals are in crisis as GAO reports that 64 rural hospitals closed from 2013-2017. However rural health challenges are not just about healthcare infrastructure, as communities can also face social risk factors, such as limited employment and education opportunities.”

The opioid epidemic unlike past drug crises, has hit rural communities harder than urban areas. Last year, Secretary Azar put together a rural health task force at HHS with key leaders and stakeholders from across the department. The taskforce’s goal is to bring together disparate efforts across HHS to develop policy changes where and when needed.

As the Secretary explained, “Rural communities continue to have noticeably worse cancer outcomes than urban areas. Actually, there are lower rates of cancer in rural areas but at the same time, have higher rates of cancer mortality. High on the list is the use of new technologies in rural communities especially when it comes to treating cancer.”

HHS is exploring the use of technology-enabled team-based care models that could offer more high quality cancer care among rural populations. As the Secretary mentioned, “The Mississippi Medical Center in Jackson with support from USDA, has equipped ambulances and emergency rooms across the state with sophisticated diagnostic equipment with telehealth capabilities.”

However, there are a number of regulatory and payment barriers holding back telehealth. The Medicare fee-for-service system currently pays for telehealth services only in a limited range of circumstance typically because of a shortage of healthcare professionals.

HHS conducts an annual review to identify services that can be removed from statutory limits on telehealth so that these services can be reimbursed by Medicare regardless of whether they originate in areas that are designated as rural shortage areas.

The Secretary reports, “HHS has also proposed allowing Medicare Advantage enrollees to enjoy even more telehealth flexibilities to include plans to offer telehealth services as part of the basic benefit.

He summed up the need for telehealth by giving an example. “In Hughes Alaska, a town of less than 100 people, the HHS team visited and noted how community health aides used a two way diagnostic tool to examine a patient and then were able to confer with care providers and pharmacists in Fairbanks, about 250 miles away. Medicine was then prescribed by a doctor in Fairbanks and dispensed through a vending machine at the clinic in Hughes.”

Senators and Representatives speaking at the rural event brought up a number of specific issues that need to be addressed to help healthcare in rural communities. There is the need to:

  • Deal with the Opioid and Substance Abuse Disorder
  • Improve maternal health in rural areas
  • Provide more funding for community centers
  • Protect and expand Medicaid financial stability
  • Improve workforce recruitment
  • Expand work requirement waivers
  • Expand Behavior Health benefits to adequately treat people in rural communities


On February 6th, the Rural Health Policy Institute Agenda included “Advocacy Day”. Attendees were able to visit Congress to present their ideas on how bipartisan solutions could effectively address the needs of rural communities,

Rural Health Advocates suggest ending payment cuts, develop a new and sustainable rural hospital model that makes sense for patients and providers, protect the 340B program and other safety net programs, ensure Rural Health Clinics receive adequate payments, expand access to broadband and telehealth, maintain access to capital and technical assistance by building upon the 2018 Farm Bill, and support federal investment in rural health programs especially in discussion regarding funding for FY 20.

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