Why some ru­ral hos­pi­tals may be left out of re­form

Ru­ral hos­pi­tals con­front the chal­lenges of es­tab­lish­ing ACOs and med­i­cal homes with lim­ited re­sources and thin­ner mar­gins

Modern Healthcare - - Front Page -

It might be from the ex­pe­ri­ence of nav­i­gat­ing rough ter­rain. It also could be from the abil­ity to with­stand ex­treme weather. Or per­haps it’s just from the thin­ner air. Some­thing has given of­fi­cials for a nascent ru­ral tele­health net­work in and around the moun­tains of Cal­i­for­nia the courage to con­sider tak­ing on one of the most dif­fi­cult tasks be­ing asked of providers by the health­care re­form law: cre­at­ing an ac­count­able care or­ga­ni­za­tion.

While it’s only one of many op­tions avail­able, of­fi­cials for the South­ern Sierra Tele­health Net­work are tak­ing a look at how the net­work might serve as a tem­plate for an ACO, the qual­ity and re­im­burse­ment or­ga­ni­za­tion model pro­moted by the Pa­tient Pro­tec­tion and Affordable Care Act.

“We’re look­ing at how we can do it, how we can fit into the guide­lines, if it can even work,” says Lee Bar­ron, CEO, chief fi­nan­cial of­fi­cer and ad­min­is­tra­tor of South­ern Inyo Health­care Dis- trict, Lone Pine, Calif., one of six ru­ral health­care or­ga­ni­za­tions par­tic­i­pat­ing in the South­ern Sierra net­work.

The ru­ral tele­health net­work is just get­ting off the ground by fil­ing for not-for-profit tax sta­tus, Bar­ron says, but the six hos­pi­tals that con­nect elec­tron­i­cally to four aca­demic ur­ban hos­pi­tals are al­ready look­ing at the next step.

“We’re look­ing at more grant fund­ing to de­velop the net­work fur­ther,” says Bar­ron, whose ser­vice area in­cludes the high­est point in the Lower 48, Mount Whit­ney, as well as the low­est point in North Amer­ica, in Death Val­ley. They are con­sid­er­ing such moves as cre­at­ing an ACO, a health in­for­ma­tion ex­change or a med­i­cal home. Re­gard­ing a med­i­cal home, she says “it’s some­thing we al­ready kind of do. I can see the ef­fi­cien­cies in that.”

Mem­bers of the South­ern Sierra net­work are only a few of the many ru­ral providers watch­ing what is hap­pen­ing with the im­ple­men­ta­tion of the Affordable Care Act and won­der­ing where and how they might fit into the nation’s health­care sys­tem as it changes un­der the law.

The law’s nu­mer­ous pro­vi­sions and sub­se­quent rule­mak­ing from HHS and its di­vi­sions don’t in­clude a lot of di­rect ref­er­ences to ru­ral providers, but the ma­jor pro­vi­sions have the po­ten­tial to af­fect them di­rectly or in­di­rectly. In ad­di­tion, the goals of the law par­al­lel what ru­ral hos­pi­tals are al­ready try­ing to do, ex­perts say.

“The bill is a mix­ture of try­ing to save money and try­ing to im­prove care,” says Todd Lin­den, pres­i­dent and CEO of 49-bed Grin­nell (Iowa) Re­gional Med­i­cal Cen­ter. “I think ru­ral hos­pi­tals are in a po­si­tion to ben­e­fit from that,” he says. Ru­ral providers al­ready of­fer high-qual­ity care, Lin­den adds.

Still, ru­ral providers deal in much lower vol­umes, mak­ing such things as ACO qual­i­tyrat­ing pro­cesses po­ten­tially suspect. Lin­den asks whether the qual­ity data for ru­ral hos­pi­tals will pro­duce sta­tis­ti­cally valid data.

An­other of the over­rid­ing con­cerns is the added cost of im­ple­ment­ing health­care re­form, as ru­ral providers of­ten run on thin­ner mar­gins than do ur­ban hos­pi­tals and may rely more on the lower re­im­burse­ment rates un­der Med­i­caid.

“The in­tent of health re­form is per­fect for ru­ral health­care,” says Thomas Miller, as­sis­tant pro­fes­sor in the School of Ru­ral Pub­lic Health at Texas A&M Health Science Cen­ter, Col­lege

South­ern Inyo’s par­ent or­ga­ni­za­tion is part of a net­work won­der­ing if it has what it takes to form an ACO.

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