Good News Sweeps Across the Rural Health Landscape

There are plenty of success stories quietly and seamlessly happening in rural communities across the nation from building better margins, developing more services, and adding more collaborations and technology— all in the name of keeping high-quality services accessible near home. 

With that, the Health Resources and Services Administration (HRSA) recently recognized 10 states for the outstanding quality performance of their critical access hospitals (CAHs). The acknowledgment was, specifically, for achieving the highest levels of reporting rates and levels of improvement over the past year. 

The following are the top 10 performing states: Wisconsin, Maine, Utah, Minnesota, Illinois and Pennsylvania (tied), Michigan, Nebraska, Indiana and Massachusetts.  These states strategically built their previous successes by investing Federal Office Rural Health Policy (FORHP) funds into quality-improvement projects and developing technical resources that improve high-quality care in their respective patient communities. These top 10 states also focused on expanding and reinforcing collaborations with CAHs and other partners to share their best practices and utilizing data to drive quality improvement in their hospitals.

In 2011, the FORHP, which islocated within HRSA, created this program to promote high quality care at rural hospitals with 25 beds or fewer.  Low-volume hospitals participating in the Medicare Beneficiary Quality Improvement Project (MBQIP) voluntarily report on a set of quality measures relevant to the specific care they provide as well as participate in and implement quality-improvement initiatives and share data. 

Today, 96 percent of the 1,340 CAHs across the nation are submitting rural-relevant quality measures, which means that in their roles as safety-net providers of care, they are making a successful direct impact on the locations they serve.  This is especially exciting since rural hospitals have been suffering with programmatic and reimbursement cuts and bad policy enforcement. Clearly, rural is maximizing every resource and opportunity available to thrive.

Multi-billion Dollar Broadband Investment

Another announcement building sustainability to rural is the expansion of broadband for internet and telehealth access.  Rural relies on telehealth to fill access to gaps of care and outreach of care.  

While telehealth still has its own issues of reimbursements, availability of providers and access to specialists, the biggest barrier is dependable broadband access. This lack prompted Microsoft’s announcement to implement a $10 billion strategy to address 34-million rural and underserved Americans who still do not have high-speed internet access.  This great news is that Microsoft plans to use “free” technology as the foundation of its strategy. 

At this point the only thing not addressed is the role of the rural community in terms of employment opportunities, implementation and support services.  The billion-dollar question remains: How will Microsoft’s investment work within rural communities?

Microsoft’s focus is to use what is termed as “TV white space spectrum,” which is the unused piece of UHF television bands.  According to Microsoft, this powerful bandwith is within the 600 mHz frequency range and enables wireless signals to travel rural hills and through buildings and even trees.

Most people have never heard of this white space except those who have knowledge of its application within public library systems.  The application is that no one owns it but everyone has access to it and can share it.  This very statement applies to rural in every way. 

Basically, this unlicensed spectrum is similar to Wi-Fi. It is capable of transmitting data one to two miles away and providing access to healthcare, homes, community centers, playgrounds, parks and shelters. 

Microsoft estimates that 80 percent of the underserved rural population in its service area live in communities with a population density between two and 200 people per square mile.

Its $10 billion plan for rural broadband will support a specific technology that holds promises for serving rural America in home, business and healthcare needs.

One thing is certain: Rural communities will still need to engage the pioneering spirit of innovation with collaboration of networks, economic development, healthcare, education and larger organizations.

Now just what would it take to eliminate the disparity divide of technology completely?  The total capital and operating costs to eliminate the rural broadband is $8 to $12 billion, but this estimate is roughly 80 percent less than what it would cost for fiber cables and 50 percent less than the cost of the current model of fixed wireless technology like 4G.

Microsoft hasn’t noted any specific outreach efforts to rural America such as meeting with stakeholders or mentioning how it will meet various web-based challenges that rural communities hold as it relates to unincorporated communities, agriculture areas, various terrains, frontier designated areas or tribal nations. 

Additionally, Microsoft’s strategy will rely on business and political cooperation. Thus far these entities have not been attentive in bringing robust solutions to meet the rural technology needs.

From infrastructure to innovation this is exactly what rural communities need.  It also could help more rural healthcare entities participate in more quality and population health initiatives linking more opportunities for access to local care. 

We will see how Microsoft proceeds but this is could be the best answer yet for reducing if not eliminating the rural technology divide—if only we could solve the reimbursement, recruitment, retention and policy gaps and needs as easily.


Janelle Ali-Dinar, PhD

Janelle Ali-Dinar, PhD is a rural healthcare expert and advocate with more than 15 years of healthcare executive experience in many key areas addressing critical access hospitals (CAHs), rural health clinics (RHCs), physicians, and patients. Dr. Ali-Dinar is a sought-after speaker on Capitol Hill. A former hospital CEO and regional rural strategy executive, Janelle is also a past National Rural Health Association rural fellow, Rural Congress member, and Nebraska Rural Health Association president. She is currently the Nebraska DHHS chair of The Office of Minority Health Statewide Council, addressing needs of rural, public, minority, tribal, and refugee health, and she serves on the Regional Health Equity Region VII council as co-chair of Rural Health and Partnerships. Janelle holds a master’s degree and doctorate in communications and is a recent graduate in public health leadership. Janelle is currently the vice president of rural health for MyGenetx and is a member of the RACmonitor editorial board.

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