Current rural health care environment ‘not sustainable’

By Tammie Sloup FarmWeek

Alan Morgan

Rural communities are older, sicker and poorer.

“It’s a terrible marketing line … but a great elevator speech when trying to communicate the uniqueness of rural communities,” said Alan Morgan, chief executive officer of the National Rural Health Association.

Morgan, who has more than 31 years of experience in health policy, spoke during an Arizona Telemedicine Program webinar earlier this month about the state of rural health.

How are rural hospitals faring as they emerge from the height of the pandemic? That’s a difficult question to answer, Morgan said.

“We’re in a precarious situation where we’re seeing almost half of the nation’s rural hospitals currently operating at a negative margin,” he said. “We’re seeing tremendous Medicare and Medicaid cuts happening across the nation. And this is happening at a time where we’re seeing an amazing staffing crisis. … It’s just a tremendously difficult time for rural providers.”

Federal funding helped prop up operations during the COVID-19 public health emergency, but much of that assistance was temporary.

Since 2005, 180 rural hospitals have closed across the U.S., and a report released last month by the Center for Healthcare Quality and Payment Reform estimates more than 600 rural hospitals – nearly 30 percent of all rural hospitals in the country – are at risk of closing in the near future. The report states 13 rural hospitals are at risk of closing in Illinois but did not name them.

Looking ahead, the immediate challenge within the halls of rural hospitals is a workforce shortage, and in rural communities a lack of rural behavioral health services.

“There’s a bipartisan understanding that we have to see some movement in behavioral health and behavioral health legislation,” Morgan said. “I expect that as we move out of the public health emergency there is an understanding among both sides of the aisle that a lot of the flexibilities that the health care system has seen, most notably rural providers, has to continue.”

Telehealth services have been viewed as a solution to closing gaps in rural healthcare, but the lack of broadband access in many areas still has slowed progress.

Congress could pass a spending bill before years’ end, and rural health advocates hope legislators will incorporate provisions from the proposed Save America’s Rural Hospitals Act. The legislation would eliminate Medicare sequestration for rural hospitals, make Medicare telehealth service enhancements permanent for Federally Qualified Health Centers and Rural Health Clinics and extend increased Medicare payments for rural ground ambulance services set to expire Dec. 31.

With the nationwide health care workforce shortage, particularly in rural areas, Morgan points to rural residency training programs as a path to encouraging more students to practice in non-urban communities.

“They go to rural and they stay in rural; we need to have more of that going ahead,” he said.

Several medical school and grant programs in Illinois already incorporate that mission.

Morgan also said telehealth usage is “not flourishing” in rural communities, largely due to lack of broadband. “There is no path forward for rural health without telehealth,” he said.

The current rural health care environment is not sustainable, Morgan said, adding “we need new reimbursement models and new provider-type models.”

Earlier this month, federal officials finalized rules for the first new provider type in 20 years — a Rural Emergency Hospital designation.

These facilities must provide 24/7 emergency medical services and observation care, and have the option to provide additional outpatient medical services. However, these facilities would not provide inpatient care.

The designation goes into effect Jan. 1, with facilities likely beginning to come online within the next five years, Morgan said. He estimates between 60 and 100 communities across the U.S. will conduct feasibility studies in the coming year.

The model isn’t for every rural community.

“This is a model for a community that maybe has lost a rural hospital recently or just has such a low volume of inpatient beds and really is seeing all of their volume in outpatient and emergency room services,” he said. “This is a new tool that we have to move forward to ensure that we have that access to care.”

States also must pass laws that establish state-level requirements and regulations to license this provider type. To date, only Kansas, Nebraska and South Dakota have passed such laws.

While rural residents face health care challenges, the environment also has resulted in collaboration and new ideas amongst rural providers.

“Those challenges drive innovation,” Morgan said. “And as a result of that … hundreds of small towns all across the U.S. are really serving as innovation hubs for the redesign of our health care system. Some of the most innovative and creative approaches to delivering high quality health care services can be seen in small towns all across the U.S.”

This story was distributed through a cooperative project between Illinois Farm Bureau and the Illinois Press Association. For more food and farming news, visit